We rated St Andrew's Healthcare - Birmingham as good because:

There were a range of measures in place throughout the hospital to ensure patient safety.  There were policies in place to make sure patients and staff were safe.  The hospital were committed to learning lessons from identified areas of risk and they had procedures in place to capture risk issues and made changes when needed. 

Staff in all wards, at all levels, were caring and compassionate. We saw that there were a really good skills mix in all the wards to support the patients and staff.  We saw that staff worked positively with patients and supported them well. 

Staff said that they were supported by managers and senior managers, which helped them to feel valued. The hospital had a clear vision and this was understood by staff.  The hospital also invested in their staff to ensure they were skilled to provide the best possible care to patients.  

During our inspection, we spoke with fourteen patients and spent some time on four of the wards, Moor Green, Edgbaston, Speedwell and Northfield.

Patients we spoke with told us ‘everything is fine’ and ‘feel safe’. They were satisfied with the care and support they received from staff. Patients were being supported by skilled staff that had undertaken a range of relevant training.

Patients were able to access other health care professionals when needed, for example, doctors, dentists, psychiatrists, social workers and occupational therapists.

We found that patients were involved in making decisions about their care and their daily lives on an ongoing basis. There was a range of activities available for patients to choose from.

Patients were encouraged to be involved in the every day tasks on the wards while they were using the hospital service. They spoke with us about keeping their rooms clean and tidy, doing their own laundry and cooking for themselves. Patients told us they been made fully aware of any restrictions in their movements around the hospital or in the community and why these were in place.

Patients that we spoke with had mixed views about the range and quality of food available to them from the menus on the wards.

The hospital was making sure that patients had opportunities to give their views about the service. This happened in one to one conversations with staff and hospital wide meetings and ward meetings.

We rated St Andrew’s Healthcare Birmingham as good because:

• Staff treated patients well, taking the time to listen to their concerns and were sensitive to patient issues. Patients said they felt staff understood their individual needs. Patients told us they were actively involved in care planning and risk assessment and this was evident in care plans.
• Staff ensured that the admission process informed and orientated patients to the ward and the service. Staff displayed posters in communal areas alerting patients to the daily activities and meetings for the ward.
• Staff completed comprehensive care plans which demonstrated good practice. We saw evidence that staff followed National Institute for Health and Care Excellence guidance when providing therapy and prescribing medication.
• A dedicated physical healthcare team provided effective and timely physical healthcare to patients. The team provider tailored services to meet the needs of individual people and services were delivered in a way to ensure flexibility, choice and continuity of care.
• Managers ensured that staff received mandatory training. Staff were appraised annually and supervised monthly.
• Managers ensured shifts were covered by enough staff of the right grades and experience, and that staff maximised shift-time on direct care activities.
• The provider demonstrated a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met these needs and promoted equality. The provider used interpreters to ensure that patients could communicate if they did not speak or understand English. The provider also worked with catering so that the food provided met patients’ cultural needs with respect to diet. The provider had a RACE (Race, Culture and Ethnicity) group which looked at ways that patients from different ethnic backgrounds could be supported. The chaplaincy department ran an awareness session on Ramadan and worked with catering on what foods to serve post fasting.
• Staff provided information in other languages and there were some examples of wards buying in newspapers, CDs and books in different languages to enable patients to keep connected to their cultural identity. The chaplaincy department carried out an exercise to establish patient feedback on how the provider met their spiritual needs.
• Managers planned the services to integrate with other organisations and the local community and ensured that services meet people’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.

However:

• The provider had not mitigated all risks posed to the quality of stored medication by broken air conditioning. On Hurst ward, and in the separate physical healthcare clinic room, the ambient room temperature was 29.8 degrees centigrade. In the months of May and June 2018, the provider had recorded temperatures above the maximum 25 degrees centigrade on each day between 5 May 2018 and the day of the inspection, yet had continued to dispense medication from these rooms. There was a risk that medication may become less effective if stored at the incorrect temperature.
• The seclusion room on Speedwell ward had been damaged on 8 June 2018 and therefore was not in use. Hurst seclusion room was not in use due to the air conditioning not working. This meant that, if staff decided that a patient should be secluded, they would have to use the facility on another ward.
• Managers had not ensured a safe environment on Speedwell. The lock to the staff office door had been damaged on 1 June 2018. This meant that staff had to use a key to lock the door rather than it locking automatically on closing. There was a risk that staff may forget to lock the door as they entered or left the office. This could allow patients to access confidential information. Also, it would take staff longer to respond to incidents because staff had to lock themselves in the office and so would have to unlock the door to get out to attend an incident.

• On Lifford and Edgbaston wards there was a delay in referrals to urology for two patients who had markers indicating they could have prostate cancer. This meant that there was a risk of a delay in diagnosing a potentially treatable cancer.

• Staff had not completed appropriate care plans for one patient on Speedwell ward, with complex needs and behavioural issues. We found there was no positive behavioural support plan for staff to follow and an inconsistent approach to assessment and care planning for this patient. Staff demonstrated a lack of understanding of the patient’s needs.