4 December 2018 to 17 January 2019
During a routine inspection
Our rating of services improved. We rated it them as good because:
- There were systems and processes to keep patients safe and safeguarded from abuse. There was a proactive approach to safeguarding and prevention of harm. Staff had received up-to-date training. Staffing levels were planned and with staff with the right skills to keep patients safe. There were effective handovers so staff knew about the patients they were caring for. Medicines were used and provided safely. They were well managed. Lessons were learned when things went wrong, and staff were confident about reporting incidents.
- Patients had good outcomes, and there was a strong culture of doing what was right for patients. Care was delivered in line with national guidance and legislation. There were good assessments of patients’ needs, including pain relief, hydration and nutrition. Staff were trained and their performance regularly reviewed. They were supported to gain new and improved skills to develop their practice and experience. Staff worked together to ensure care and treatment was effective.
- Patients and relatives spoke highly of staff and the standards and quality of care. Feedback was positive, and patients we met said they had been treated with dignity and respect. Patients could make their own decisions, and the right people were involved if a patient was not able to do so. Patients’ emotional needs were recognised and supported.
- Services were planned and arranged to meet the general and specific needs of local people. The needs and preferences of different people were accounted for to give patients the best outcomes. The hospital was treating most patients on time and within national targets and standards.
- The staff leadership had the skills, knowledge, experience to oversee services. High-quality and patient-centred care was promoted. There was a clear set of values for staff which were based on the experience for the patient. Staff were well supported and there was good morale and a strong culture. Staff were willing to challenge poor practice and support each other. There was a strong culture around innovation, research, development and improvement. Staff had good systems to assure themselves they were providing a good, safe and quality service.
However:
- Some staff had yet to update their mandatory training in line with trust targets. Not all resuscitation equipment was checked as required. There were some areas where infection prevention and control were not as strong as they should be.
- Not all patients’ medical records were completed as well as they should have been. There were gaps around assessing patients’ mental health, risk assessments and responding to the needs of deteriorating patients. The paperwork documenting resuscitation discussions was not always completed in line with trust policy.
- There were issues with the environment in the children’s ward which impacted on patients. A business plan to resolve much of this had yet to be approved. Some specialist training around eating disorders for staff looking after children had yet to be provided. There was limited access to therapy for children over the weekend. The processes for safe administration of medicines through a syringe driver were not sufficient to guide staff.