BLACK Country Healthcare NHS Foundation Trust has been told it must make improvements following an inspection of its acute wards for adults and psychiatric intensive care units.

An unannounced inspection of the service was carried out by the Care Quality Commission (CQC) in February following reports of safeguarding incidents which were being investigated by the local authority and police at the time.

The overall rating for the service has now been downgraded from good to requires improvement. The areas that were effective, well-led and responsive have also been rated down from good to requires improvement. The categories looking at whether the service was caring remains good and the category on whether the service is safe remains as requires improvement.

Andy Brand, CQC’s deputy director of operations in the Midlands, said: “When we inspected this service, whilst we saw a strong and supported workforce that felt proud to work for the trust, some improvements were needed to ensure people were receiving appropriate care.

“It was concerning that people sometimes had their escorted leave or activities cancelled and some wards didn’t have enough occupational therapists or activity staff. This meant people didn’t receive the treatment they needed to support their discharge from hospital, or have their wellbeing needs met.

“In addition, people’s care plans weren’t always updated or reviewed effectively which impacted the care they received. We saw examples where people’s health needs or medication had changed but nothing had been noted in their plan meaning staff wouldn’t be delivering the correct care.

“However, we did also see some positive areas of care. For example, people told us staff were very caring and always treated them with respect. Relatives said staff were helpful and kept them updated regularly on their family member.

“We also noted that staff assessed and managed risk well and minimised the use of restrictive practices on people. Staff also knew about any potential ligature anchor points that people could use to self-harm and mitigated these risks to keep people safe.

“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people can receive safe and appropriate care.”

Inspectors found the service didn’t always have a bed available for someone who would benefit from admission and patients were not always discharged promptly.

They also found some people didn’t have one-to-one time with their named nurse; ward teams didn’t always have access to the full range of specialists required to meet people’s needs; ward staff didn’t always work well together as a multidisciplinary team and with community teams and external providers; and the trust had not trained all staff in immediate life support.

However, people said staff were kind, caring, interested in them and treated them with respect; staff followed good practice with respect to safeguarding; the trust had reduced staff turnover rates across the wards; staff engaged in clinical audits to evaluate the quality of care provided; and staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

The trust said although its adult mental health inpatient services and psychiatric intensive care has been rated as requires improvement – the overall rating for the trust remains good.

Marsha Foster, chief executive at Black Country Healthcare NHS Foundation Trust said of the report: "We welcome the feedback received and take the required actions very seriously.

“We are committed to improving our services and are taking necessary steps to address the issues raised. We have developed a comprehensive plan to increase training compliance and we continue to work closely with staff to improve the quality of care we provide.

“We acknowledge there are areas where we need to improve and have already begun working diligently to address these issues. Our adult inpatient services, in particular, have experienced a number of challenges over the past six months, and we continue to work closely with the CQC and partners to implement the improvements that have been identified.

“We are also really pleased that inspectors observed examples of good care and received positive feedback from staff and patients.

“I would like to thank staff for their continued hard work and commitment. They do an incredible job, and I am confident that together we will continue to build on our strengths and achievements and make the improvements required."

The full report can be seen on the CQC website.