Archived: St. James Hospital Wards J30 & J31

St. James Hospital Wards J30 & J31 was run by Villa Care Limited and provided nursing care to patients over the age of 60 years who were medically optimised for discharge from hospital care or who did not require inpatient medical treatment.

The service was provided across three wards J30, J31 and J11 and was based in the Beckett Wing of St James University Hospital in Leeds. All wards were mixed gender with separate bays for males and females and a number of side rooms.

The service worked in partnership with The Leeds Teaching Hospitals NHS Trust under a service level agreement. Patients were cared for by nursing and health care staff from Villa Care Limited and medical and therapy staff input was provided by the acute trust. Patients deemed suitable were transferred to the wards from the acute NHS Trust and remained a trust patient until they were finally discharged from the service.

We carried out a responsive inspection of this service on 11 December 2018 in response to concerns we received from the local authority safeguarding team and complaints from service users and their carers and relatives about poor care and communication.

We found the following issues that the service provider needs to improve:

• We did not find a responsive culture in terms of meeting people’s needs. The service was focused on outputs in terms of timely discharge of patients but we did not find a visible person-centred culture.
• The service did not encourage patients to maintain or improve their independence whilst being cared for on the wards. Throughout the inspection most of the patients remained in hospital gowns or in their own nightwear in bed and we did not see staff encourage or assist them to get up, dressed and move around.
• We saw limited engagement with patients or activities offered to enhance their wellbeing. Most patients were either sat in a chair or in bed with very little social interaction.
• The service was not able to provide evidence of positive patient outcomes. Measures were not in place to demonstrate whether patients physical, psychological or mental well-being had been maintained, improved or deteriorated whilst they were on the wards.
• We did not see staff take the time to interact with people who use the service and those close to them. Some staff appeared to struggle to understand questions and their communication skills were limited when speaking with patients.
• Patients and those close to them did not feel involved in decisions about their care and treatment.
• We found that staff did not always ensure patients dignity was maintained. During the inspection we raised concerns with staff about three patients whose dignity was not being maintained.
• Infection control procedures were not always correctly followed and implemented by all staff and we found the completion of some patient records were poor.
• Although compliance with staff completing mandatory training was high, we found staff knowledge, understanding and application was poor in some areas for example safeguarding, infection control and the mental capacity act.
• Managers could not effectively articulate the key risks to the service and could not provide evidence of the effectiveness of the service. There was limited engagement with service users and their families to involve them in service development and improvement.

However, we found the following areas of good practice:

• The service managed medicines well. We found medicines including oxygen were correctly stored and patients received their medication, including time critical medicines on time.
• Nurse and health care staffing levels were adequate. The planned level of nurse staffing was met on the day of our visit and the staffing rota showed that planned staffing levels were mostly achieved.
• All patients we spoke with told us that staff responded to requests for pain relief and this was well managed.
• We saw good evidence of multidisciplinary working on the wards. The wards had a discharge co-ordinator who worked closely with the acute NHS trust and social workers to facilitate the safe and timely discharge of patients from the wards.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.