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Inspection Summary


Overall summary & rating

Good

Updated 2 May 2017

BMI Coombe Wing is operated by BMI Healthcare Limited. BMI Coombe Wing operates one ward, located within Kingston Hospital and provides beds for patients with medical conditions, following surgery or for mothers after delivery of their baby. The ward has 22 beds and four outpatient consulting rooms.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 4 and 5 October 2016. We did not carry out an unannounced visit because we had obtained all the evidence required to make judgements, during the announced visit.

We did not inspect any of the services that are provided under Service Level Agreements by Kingston Hospital as these are services from another provider. Kingston Hospital NHS Foundation Trust was inspected and rated separately, and the report was published in July 2016.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

  • Is it safe?
  • Is it effective?
  • Is it caring?
  • Is it responsive to people’s needs?
  • Is it well led?

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 medicine. Where our findings on medicine – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the medicine core service section.

Services we rate

We rated this service as good overall. This deviated from the aggregation principles that we apply when rating services, however we were satisfied that prompt action had been taken by the provider to rectify the issues that were raised for the safe domain so this was considered when rating the service overall.

We rated the services for medicine and outpatients and diagnostic imaging and used these ratings to rate the service overall.

We found good practice in relation to medicine and outpatients and diagnostic imaging:

  • The quality handover was an effective method of communicating information to staff and learning about incidents, complaints and changes of policy and practice.
  • The service managed staffing well with a flexible approach that meant there were always enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
  • The service had a robust admission policy which meant that there were limited occasions when a patient was inappropriately admitted.
  • All incidents were investigated and lessons shared with staff.
  • We observed effective multidisciplinary team (MDT) working to provide holistic care for patients which was confirmed by feedback from different staff groups.
  • Patients were positive about the way staff treated them
  • There were good systems in place to manage patient flow. Admission and discharges were multidisciplinary focused to ensure all the needs of patients were met.
  • Staff spoke positively of the leadership and this was reflected in the culture across the service. Clinical leads were visible, approachable and supportive.

However, we found the following issues that the service provider needs to improve:

  • There were no clinical handwashing basins within any of the patient rooms or along the patient corridor and hand sanitiser gel was not always positioned ideally within a room. This meant that there was potential for hand hygiene not to be undertaken in a best practice manner. However the service did have a risk assessment with mitigation actions and had a plan for four new sinks and 11 additional hand sanitiser dispensers to be installed within a month of our inspection. Evidence was provided following the inspection to show that this was completed in October 2016.
  • The corridor floor of the ward was lined with carpets. This was an infection control and prevention risk. However, permission had been obtained to have the carpets changed to vinyl and this was evidenced as completed by the provider in December 2016.
  • There was a low compliance level in the monthly audits reported of venous thromboembolism assessment and treatment.
  • Some visiting consultants working in the outpatients department did not comply with bare below the elbow guidance.

Services we do not rate

The surgical activities conducted by the provider consisted mainly of diagnostic scoping. Only 36% of the activities logged were in fact surgical cases (93 procedures in total).

Due to the small size of the maternity service and the nature of the surgical services conducted at BMI Coombe Wing, we did not have sufficient evidence to rate these services. However, we have highlighted good practice and issues that the provider needs to improve.

We found the following areas of good practice:

  • All patients were followed up within 24 to 48 hours from discharge with a phonecall from a ward nurse.
  • There was clear evidence of learning from incidents, including the review and update of a policy when required.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 2 May 2017

We rated safe as good because:

  • The service managed staffing well with a flexible approach that meant there were always enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
  • All incidents were investigated and lessons shared with staff, as well as actions taken where required.
  • The service had an annual mortality and morbidity meeting where all patient deaths were reviewed, including those which were expected. This was so that care could be reviewed and improved if necessary.
  • Patient-led assessments of the care environment (PLACE) audits for 2016 showed the ward had achieved 100% for cleanliness. This was above the national average of 98%.
  • Six resuscitation scenarios were run each year on the ward so staff were well trained for care of patients in an emergency.

However;

  • There were no clinical handwashing basins within any of the patient rooms or along the patient corridor and hand sanitiser gel was not always positioned ideally within a room. However, four new sinks and 11 additional hand sanitiser dispensers were installed in October 2016.
  • The carpeted floor in the corridor was an infection control risk, however new vinyl flooring was installed in December 2016.
  • There was a low compliance level in the monthly audits reported of venous thromboembolism assessment and treatment.

Effective

Requires improvement

Updated 2 May 2017

We rated effective as requires improvement because:

  • There was no national benchmarking carried out for patient outcomes.
  • Supervision of nurses was not documented despite there being a corporate template to do this.

However

  • There was a good relationship with Kingston Hospital, in which the ward was based. This meant there was effective use of learning and resources where appropriate.
  • The ward had met 13 out of 15 recommendations of a national self-assessment checklist for sepsis.
  • Results from patient feedback and surveys showed that over 90% of respondents felt their pain was well managed.

Caring

Good

Updated 2 May 2017

We rated caring as good because:

  • Patients reported that the quality of their care was very good.
  • Relatives were welcomed to stay with patients on the ward.
  • Patients consistently told us that they were provided with information about their condition. Information leaflets were provided for patients for most procedures to read at home.

Responsive

Good

Updated 2 May 2017

We rated responsive as good because:

  • Changes had been made to the environment to make it more accessible for patients living with dementia.
  • There was a clear admission policy and process for admissions.
  • There had been changes made within the ward as a response from feedback and complaints, such as new dressing gowns.

Visiting hours were flexible to accommodate patient’s needs. 

Well-led

Good

Updated 2 May 2017

We rated well led as good because:

  • Staff spoke positively of the leadership and this was reflected in the culture across the service. Clinical leads were visible, approachable and supportive.
  • There was a clear vision that all staff understood and were able to explain.
  • There was a clear governance process that worked with both Kingston Hospital where the ward was based, and the corporate provider.
  • There was a clear line of communication from the staff through to the senior managers. Information was cascaded down from senior meetings so that all staff were aware of relevant points.
Checks on specific services

Maternity

Not sufficient evidence to rate

Updated 2 May 2017

The maternity services accounted for a small proportion of the service business and were managed and run jointly with the medicine and surgery services. Where arrangements were the same we have reported the detail in medicine.

As there were very few women cared for annually in this service, we did not have enough evidence to rate it, but highlighted good practice and issues that provider needs to improve.

Medical care (including older people’s care)

Requires improvement

Updated 2 May 2017

Medical services were the main service of the hospital. Where our findings on medicine also apply to other service, we do not repeat the information but cross-refer to the medicine section.

Most staffing, incident reporting and mandatory training were managed jointly with surgery, outpatient and maternity.

We rated this service as requires improvement because the areas of safe, and effective were rated as required improvement although the areas for caring, responsive and well led were rated as good.

Surgery

Not sufficient evidence to rate

Updated 2 May 2017

Although surgery patients made up the majority of patients only pre-assessment and post-operative ward care was provided on the ward, as surgical procedures and all theatre services were all carried out under a service level agreement (SLA) with Kingston Hospital.

The majority of surgical activities conducted by the provider were diagnostic scoping. Only 36% of the activities logged were in fact surgical cases (93 procedures in total).

Where arrangements were the same, we have reported the detail within medicine. Due to the nature of this service, we did not have sufficient evidence to rate it, but have highlighted good practice and issues that the provider needs to improve.

Outpatients

Good

Updated 2 May 2017

The outpatients department was directly next to the ward. Leadership and some staffing was managed jointly with medicine. Where arrangements were the same, we have reported the detail within medicine. Diagnostic imaging was not provided by the ward but through an SLA with Kingston hospital.

We rated this service as good because it was safe, effective, caring, responsive and well led.