Oldbury Birmingham

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

• The service strived to support people to have the maximum possible choice, control, and independence, be independent and they had control over their own lives.
• Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.
• People were supported by staff to pursue their interests.
• Staff supported people to achieve their aspirations and goals.
• The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.
• Staff did everything they could to avoid restraining people. The service recorded when staff restrained people. However, we did not see evidence in staff meetings about learning from incidents.
• People had a choice about their living environment and were able to personalise their rooms.
• People benefitted from the interactive and stimulating environment
• The service made reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go.
• Staff supported people to play an active role in maintaining their own health and wellbeing.
• Staff supported people to take part in activities and pursue their interests in their local area.
• Staff enabled people to access specialist health and social care support in the community.
• Staff supported people to make decisions following best practice in decision making but this was limited due to the longstanding speech and language therapy vacancy which reduced peoples confidence and ability to speak up for themselves.
• Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

• Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.
• Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.
• Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Although staff had training available on how to recognise and report abuse there were low completion rates.
• People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.
• People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

Right Culture:The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

• People received good quality care, support, and treatment because trained staff and specialists could meet their needs and wishes.
• People were supported by staff who understood best practice in relation to the wide range of strengths, impairments, or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.
• Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.
• Staff placed people’s wishes, needs, and rights at the heart of everything they did.
• People and those important to them, including advocates, were involved in planning their care.
• Staff evaluated the quality of support provided to people, involving the person, their families, and other professionals as appropriate.
• The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.
• People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.
• Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity.
• However, the poor quality of the ward environment meant care provided was not always dignified. For example, when people had to use old or dirty furniture.

SUMMARY

Our rating of this service went down. We rated it as requires improvement because:

• People were protected from abuse and poor care. The service had enough, appropriately skilled staff to meet people’s needs and keep them safe.
• People were supported to be independent and had control over their own lives. Their human rights were upheld.
• People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.
• People’s risks were assessed regularly and managed safely. People were involved in managing their own risks whenever possible.
• If restrictive practices were used, there was a reporting system in place and there were comprehensive reviews to try and reduce the use of these practices.
• People made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
• People’s care, treatment, and support plans reflected their sensory, cognitive, and functioning needs.
• People received care, support and treatment that met their needs and aspirations. Care focused on people’s quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
• The service provided care, support and treatment from trained staff and specialists able to meet people’s needs. Managers ensured that staff had relevant training, regular supervision, and appraisal.
• People and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983, and the Mental Capacity Act 2005.
• People were in hospital to receive active, goal oriented treatment. People had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support they went home.
• Staff supported people through recognised models of care and treatment for people with a learning disability or autistic people. Leadership was good, and governance processes helped the service to keep people safe, protect their human rights and provide good care, support, and treatment.

However,

• People were cared for in an environment that was not always clean and in which some of the furnishings were damaged. We found that a fridge and cupboards where food was stored were dirty and the covering on some chairs was ripped.
• Although the provider had a decorator on site decorating the environment, and they organised more furniture to be delivered during this inspection. However, some of this replacement furniture was dirty.
• There were blind spots on the ward that were not mitigated with mirrors or CCTV. We saw that one of the mirrors staff had put up to try to mitigate a blind spot was not fully fixed to the wall and could be easily removed.
• Some training completion rates were low. Training rates basic life support was 60% and the highest training completion rate for the providers restraint training modules which was 61%.
• Some staff told us they did not always feel valued or supported by managers and that this contributed to them feeling stressed at work.
• The service did not operate regular team meetings. Some staff told us they rarely had team meetings and minutes of meetings provided to us showed these had happened every 4 months.