People told us what it was like to be a patient in Cedar and Linden wards at Bloxwich Hospital. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector who was joined by a practising professional. These are people who have experience or working expertise of such services and who can provide the patient perspective.

Linden ward provides specialist assessment, care and treatment for people with memory problems. Cedars ward provides specialist assessment care and treatment for people who are experiencing a range of psychological difficulties affecting their well being. Both wards cared for older people so that we could focus upon this themed dignity and nutrition inspection.

To help us understand people's experiences we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

During our inspection visit we spoke with eight people, a visiting relative, two ward sisters, the matron, activities coordinator and some of the health care staff. We made some general observations, and looked at the medical and care records for five people.

People we spoke to told us they had no concerns about their care and support and we saw they had been supported to understand the reasons they were in hospital. One person told us that staff explained any medical intervention or treatment to them, another told us; “The nurses try their best to make things ok for you, let you do what you want and that, but sometimes they have to do things like being with you at bath times. It’s just part of the treatment, not what they want to do at all”.

People we spoke with told us staff respected their decisions and feelings about their treatment options. They told us they had been involved in making choices about their care, which included medications they had refused.

We saw consideration had been given in the way people were allocated a bedroom to ensure privacy and dignity was respected in shared rooms. One person said “Privacy is a bit of a problem, you can’t really be private in a room where there are four people”.

We saw the needs of people were met in a dignified way. There was minimal intrusion on their privacy especially where supervision levels were needed to ensure their safety.

People we spoke with told us that they were happy with the meals provided. Comments included; “We get plenty of choice and for hospital food it’s really good. You can always get something you like they do choices for vegetarians or diabetics and things like that as well”. We saw people had the support they needed to eat and drink enough.

We saw people moved freely from both wards. The ward was not a locked facility and therefore did not restrict people's liberty. Arrangements were in place to ensure people who had restrictions on their liberty, had the support to keep them safe.

There were sufficient numbers of trained staff to support people with their meals. This meant staff recognised the importance of supporting people to eat and drink enough.

We saw care records provided staff with up to date information about how to meet people's needs and that records were securely stored.

Cedar Ward

Core service provided: Older People

Male/female/mixed: mixed

Capacity: 20 beds

Linden Ward

Core service provided: Older People

Male/female/mixed: mixed

Capacity: 20 beds

Bloxwich Hospital is a purpose-built facility providing inpatient mental health services for older people. It has two mixed gender inpatient wards, each with 20 beds.

We found that the services provided were mostly safe and there were enough staff on the wards. Most staff knew the needs of the people who use services they were caring for, who received continuity of care.

There was evidence of good risk assessment taking place and every patient record we saw had a completed assessment. However, there was not always a plan in place to manage the identified risks.

Staff were not always trained to meet people’s specific needs, and this increases the risks of them not receiving suitable care.

Some of the care we observed being provided was based on national guidance.

People who use services were treated with dignity and respect and we saw staff and patients interacting positively with each other.

The Mental Health Act responsibilities were discharged appropriately, although actions from previous Mental Health Act monitoring visits were not fully resolved.

Staff worked with other providers to ensure that people were transferred and discharged effectively. People’s physical healthcare needs were assessed and monitored and any deterioration was acted on.

Staff were unaware of the future plans for the service at the hospital. However, staff did know about the trust-wide redesign of services.