Paulton Memorial Hospital

Updated 6 October 2022

The two main services at Paulton Hospital are urgent care (a minor injuries unit) and adult community health services (an inpatient ward).

The minor injuries unit (MIU) is an urgent care walk-in facility run by emergency nurse practitioners and emergency care practitioners (experienced and specially trained nurses and paramedics who are qualified to diagnose and treat minor injuries). The unit is open seven days a week between the hours of 8am and 8pm and offers treatment for adults, children and young people for a wide range of minor injuries. For example, cuts, bruises, sprains and simple fractures, which do not require the specialists of an Emergency Department.

Patients can walk in without an appointment or be referred by their GP or other healthcare professionals. From 9am to 5pm during the week, the service is able to refer patients to the on-site X-Ray department which is run and managed by another healthcare organisation. The unit has a registered manager and see an average of 450 patients a month. Twenty nine percent of patients are children under the age of 18 years.

The aim of the inpatient service is to enable people to regain health and wellbeing through rehabilitation and recovery. The service also plays a role in supporting adults nearing the end of their lives. It provides a bridge between care at home and care in an acute hospital setting for adults through the provision of:

• timely sub-acute treatment for individuals living at home who need a short period of intensive care and treatment for an acute illness, that can appropriately be provided in a community hospital setting
• active rehabilitation for individuals who have suffered a trauma or illness, to facilitate their ongoing independence and return to their normal place of residence as quickly as possible
• intensive and specialist rehabilitation for individuals who have suffered a stroke and are unable to return home directly from the Acute Stroke Unit
• palliative and end of life care for individuals who chose not to die at home.

This was the first inspection for this service under this provider. Paulton hospital was previously registered under a previous entity.

Updated 6 October 2022

HCRG Care Services Ltd provide services in the local community. There are two community hospitals serving the population of Bath and North East Somerset, situated at St Martin’s Hospital (29 beds) and Paulton (28 beds). Paulton Memorial Hospital offer “step-up” beds (to prevent admission to an acute hospital bed), a minor injuries unit and an out-patients department. There is a physiotherapy service and an x-ray service is provided from Monday to Friday by another healthcare organisation.

We rated this location as requires improvement because:

• The target for mandatory training in key skills for in-patient staff was not met.
• Ward staff assessed risks to patients, but assessments lacked evidence of escalation where high risks were identified.
• Care plans did not detail inpatients’ preferences on how their needs were to be met. Their care plans were not developed on all areas of need or on their discharges. Action plans did not provide guidance to staff on how assessment needs were to be met or reviewed where assessments had identified further action with monitoring potential deterioration.
• Medicine systems on the ward were not fully safe. There were gaps in the recording of medicines administered. Staff did not always record the reasons for not administering medicines.
• Whiteboards with patient’s details were in full view of patients and visitors to the ward.
• Although steps were taken to recruit and retain staff, high levels of agency staff were used on the ward to maintain basic staffing levels.
• Ward staff did not feel valued by the organisation due to the lack of resources and staff shortages.
• The x-ray department was not open during the evening or at weekends. This was provided by another hospital and not within the service’s authority to change opening hours.

However:

• The minor injuries unit (MIU) had enough staff to care for patients and keep them safe.
• All staff were committed to delivering good standards of care. The clinical lead in the MIU monitored the effectiveness of the service and made sure staff were competent.
• Staff treated patients with compassion and kindness, took account of their individual needs and helped them understand their conditions.
• Senior staff in the MIU planned care to meet the needs of local people and took account of patients’ individual needs. Patients could access the service when they needed it and did not have to wait too long for treatment.
• The leadership, governance and culture in the MIU were used to drive and improve the delivery of high-quality person-centred care.

Updated 6 October 2022

We rated it as requires improvement because:

• The target for mandatory training in key skills such as Basic Life Support, Moving and Handling and Fire awareness was not met.
• Staff assessed risks to patients, but assessments lacked evidence of escalation where high risks were identified.
• Care plans did not detail patients’ preferences on how their needs were to be met. Their care plans were not developed on all areas of need or on their discharges. Action plans did not provide guidance to staff on how assessment needs were to be met or reviewed where assessments had identified further action with monitoring potential deterioration
• Medicine systems were not fully safe. There were gaps in the recording of medicines administered. Staff did not always record the reasons for not administering medicines.
• Whiteboards with patient’s details were in full view of patients and visitors to the ward.
• Although steps were taken to recruit and retain staff high levels of agency staff were used to maintain basic staffing levels.
• Staff did not feel valued by the organisation due to the lack of resources and staff shortages.

However:

• Staff were committed to delivering good standards of care and their feedback related to the shortfalls with staff vacancies and meeting the needs of patients.
• Staff treated patients with compassion and kindness and took account of their individual needs and helped them understand their conditions.
• Patients and relatives felt confident to approach staff and managers with concerns.
• Managers investigated concerns and made recommendations on how to improve the service for patients.

Updated 6 October 2022

We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services provided by the hospital were available seven days a week, although the x-ray service (provided by another hospital) was not open at weekends.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care. The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. Patients could access the service when they needed it and did not have to wait too long for treatment.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The x-ray department was not open during the evening or at weekends. This was provided by another hospital and not within the service’s authority to change opening hours.
• There was a pain tool in use and pain levels were assessed. However, inconsistencies in documentation indicated that pain levels were not assessed or recorded in 50% of cases.