St Cyril's Rehabilitation Unit is operated by St George’s Care UK Limited
We undertook this unannounced focused inspection of St Cyril’s Rehabilitation Unit in response to concerns that were raised with us about the safety and quality of the services provided to patients. This inspection focused on the safety of the services provided and how well led the service was. Where we observed practice in other areas we have included this information in the report. As this was a focused inspection we did not rate the service.
We previously inspected this service using our comprehensive inspection methodology. We carried out the previous announced inspection on 1 and 2 of March 2017.
To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
The main service provided by this hospital was Community Inpatient Services.
We found the following areas for improvement:
- Staff did not always recognise, assess and mitigate risks to patients’ safety. This included lack of compliance with the provider’s early warning scoring system. Staff were not always following the provider’s policy for recording and acting on early warning scores.
- Nurse staffing of an appropriate skill mix to provide senior nurse cover was inconsistent. Senior nurses (band 6) were in charge on most shifts but there were an excessive number of shifts, particularly night shifts, where the senior nurse was a band 5.
- The safe management of medicines continued to require improvement. Audits had identified areas for improvement but these had not been addressed and no action had been taken to improve standards.
- The medical cover arrangements were provided on a sessional basis by two consultants from local trusts which did not provide dedicated substantive medical oversight. However, the provider had advertised for a substantive full time consultant. In addition the senior clinical nurse role was vacant, this meant staff were not always able to seek senior clinical nursing advice and support. This also meant that there was a risk of insufficient clinical oversight and challenge within the hospital to recognise and act on areas of poor clinical practice.
- The hospital manager role was vacant and despite temporary cover being provided by a senior member of the corporate team this meant that there was insufficient oversight of the hospital business.
However,
- Staff treated patients with kindness and provided care to patients while maintaining their privacy, dignity and confidentiality.
- Controlled drugs were stored and managed appropriately.
- We found improvements in the way patients individual needs were catered for and considered since the last inspection.
Following the inspection, we told the provider that it must take some action to comply with the regulations and that it should make other improvements, even where a regulation had not been breached, to help the service improve.
When we formally warn a service, or propose action to add or remove a condition, we have to give it time to submit representations to us or appeal to an independent tribunal. We can only publish information about action we've taken when this period has ended.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.