The Care Quality Commission
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Archived: Chase Farm Hospital (Trust HQ)

Chase Farm Hospital, The Ridgeway, Enfield, Middlesex, EN2 8JL 0845 111 4000

Provided and run by:
Barnet and Chase Farm Hospitals NHS Trust

Important: This service is now managed by a different provider - see new profile

All Inspections

11, 13 December 2013

During a themed inspection looking at Dementia Services

As part of this inspection we were looking at the care provided to people with dementia that had been admitted to hospital for a variety of medical reasons. We spent two days looking at records and speaking with patients, their relatives and staff about the care and treatment provided at this hospital. We visited and collected evidence from five separate wards, three were general medical wards, one was a dedicated discharge ward and we visited the newly introduced Older People's Assessment Unit.

People were positive about the service and the staff who supported them. Comments from patients with dementia included 'I'm treated very well" and 'it's run quite well. No complaints at all.' Relatives of patients with dementia commented 'they told me I could come and visit anytime I wanted' and 'they keep me updated.'

The care and treatment plan for patients with dementia was based on an initial assessment of their needs and involved a number of healthcare professionals including doctors, nurses, occupational therapists and physiotherapists. We saw that the assessment and planning of care and treatment had been discussed with either the patient with dementia, their family or, if they lived in a care home, with staff that knew them well.

Staff told us that the dementia awareness training they had undertaken had improved their understanding of how to support patients with dementia. Staff talked about the importance of having empathy with their patients and said they felt much more 'relaxed' about supporting patients.

Although the service had a number of initiatives to better support patients with dementia these were not yet fully implemented. The management were aware of where improvements were needed because they were monitoring service provision on a regular basis.

10, 11, 12, 13 December 2013

During an inspection looking at part of the service

We carried out this inspection to check whether the hospital had made improvements since our last inspection in June 2013. At our last inspection we had found that patients on Canterbury ward were not always being treated with dignity and respect and some patients did not receive adequate explanations of their care and treatment. Assessments of patients' needs had not always taken place in a way that supported the planning and delivery of appropriate care and treatment. We also found there were not always sufficient staff available to meet patients' needs in a timely manner. Systems in place to assess and monitor the quality of services had identified shortfalls but had not been effective in bringing about prompt improvements in care and treatment.

In addition, during this inspection we looked at other outcomes we had not inspected for some time including procedures for obtaining the consent of patients, support and training for staff and infection control and cleanliness.

We carried out inspections of the hospital over a four day period and involved seven inspectors, three nurse advisors, and an operating theatre specialist advisor. We visited the urgent care centre, out-patient clinics, older people's assessment unit, three wards and the operating theatre suite. We inspected an additional three wards in respect of their cleanliness and infection prevention and control measures. We spoke separately with individual doctors and met with senior managers and a non-executive director of the Trust Board.

We spoke with more than 50 patients and relatives using hospital services about their experiences of care and treatment. We found that improvements had been made in all the areas in which we had previously made compliance actions. There had been a significant improvement in patients' experiences on Canterbury ward since our last inspection. Patients told us their privacy and dignity had been respected by staff and they had received clear explanations of their care and treatment. A patient on Canterbury ward described nursing staff as 'very good and very attentive.' Another patient said that care on the ward was 'marvellous.' A patient on Bramley ward said they would rate their experience as '95 out of 100%.' Another patient on the ward told us that care was 'very good indeed.'

Staff assessed patients' needs and planned and delivered care compassionately and safely. We saw many positive, caring and compassionate interactions between staff and patients on the wards during periods of structured observation. Staff were proactive in approaching patients to check whether they needed anything and responded promptly to requests for assistance. Staff gave time and were comfortable providing care to patients with dementia. Patients told us they were asked for their consent before staff provided care or carried out a procedure. For example, a patient told us, 'all the staff are polite and ask before they do things.'

There were sufficient numbers of staff available to provide care to patients and minimise risks to their safety. Staff received appropriate training and support to enable them to provide the care and treatment that patients needed. The trust was well-led and responsive to people's needs. Systems were in place to assess and monitor the quality of service that patients received and ensure care was provided safely and effectively.

However, although we found that all wards were clean, with good standards of infection prevention and control, we identified concerns in respect of standards of cleanliness in the theatre suite. We found a mop bucket stored inappropriately, dust accumulating on equipment and some items of equipment that were torn, making them difficult to clean effectively. As a result patients were not being appropriately protected against the risks of infection by means of the maintenance of appropriate standards of cleanliness in theatres.

20 June 2013

During an inspection in response to concerns

The inspection focused on the care and treatment provided to patients on Canterbury ward, a 32 bed female acute surgical ward. This was because we had received information of concern about care and treatment being provided on the ward. Patients had mixed views about the quality of care provided to them. For example, a patient told us she had been very well looked after and said, 'the nurses are very kind.' However, others were less positive. One patient described care on the ward as 'not brilliant'. Staff were described as very busy and there were delays in some patients receiving the care they needed. As one patient said, 'staff are terribly busy, you get left on the bedpan sometimes for up to 10 or 15 minutes.'

Patients were supported by staff to obtain appropriate health and social care support after discharge and accurate records of care and treatment were being maintained.

However, we found that patients were not always treated with dignity and respect and some patients did not receive adequate explanations of their care and treatment. Assessments of patients' needs did not always take place in a way that supported the planning and delivery of appropriate care and treatment. There were not always sufficient staff available to meet patients' needs in a timely manner. Systems in place to assess and monitor the quality of services had identified shortfalls but had not been effective in bringing about prompt improvements in care and treatment.

13 February 2013

During an inspection looking at part of the service

We carried out this inspection to check whether improvements had been made in staffing levels and record-keeping following concerns identified at our inspection of the hospital in August 2012.

During the current inspection we spoke with 32 patients on three different wards. Most patients were very positive about the quality of care and treatment they had received. For example, one patient said, 'the staff are very helpful and always attentive.' This was confirmed by another patient who said, 'staff work hard and do everything. You don't need to ask, they do it.' Patients told us that call bells were usually answered promptly, and confirmed that there were enough staff on the ward to meet their needs.

Patients' records were accurate and contained appropriate information in relation to patient care and treatment. There had been an improvement in the completion of records since the last inspection.

28 December 2012

During an inspection in response to concerns

We carried out this inspection following receipt of information of concern from the Trust about practices that had been identified in the Accident and Emergency (A&E) department at Chase Farm Hospital. We were aware that the Trust had commissioned an external review of the functioning of the department which had confirmed some concerns such as the inappropriate placement of patients in the fracture clinic, out-of-hours. The detailed findings of the investigation were subsequently made available to us by the Trust following the inspection. An action plan had been put in place to address the findings and recommendations of the investigation report.

We observed care in the major injuries, urgent care and paediatric areas of the A&E. We spoke with patients and relatives in A&E and in the Clinical Decisions Unit (CDU) where some patients were admitted after leaving A&E. Most patients were positive about the care and treatment they had received. One patient described the service as 'very efficient' and another said, 'it's absolutely superb, I can't fault it.' Everyone told us their privacy and dignity was respected by staff. Information about patient's care and treatment in A&E was shared with their GP. The Trust had a plan in place to improve the quality of information shared with GPs.

20 August 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to be a patient in Chase Farm Hospital. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

The inspection team visited a 32 bedded ward for female patients most of whom had medical problems. On the day of our visit 27 beds on the ward were occupied by patients over the age of 65. We spoke with five patients about their experiences on the ward.

We used the Short Observational Framework for Inspection (SOFI) during our visit. SOFI is a specific way of observing care to help us understand the experience of patients who could not talk to us.

Patients we spoke with told us that staff respected their privacy and dignity when providing care. Most patients were satisfied with the care and treatment they received. They understood why they were in hospital but had not seen any written information about the ward itself. There were mixed views about the quality of food provided. Three patients described the food as 'ok' or 'quite nice', whereas another patient expressed their dislike of the food. Patients were given a choice of meals, including those designed to meet people's cultural and religious needs.

We observed the care and support provided to patients and saw many examples of staff interacting sensitively and in a caring manner with patients. However, we also noted that there were not always enough staff available to meet patient's needs effectively, particularly during the lunchtime meal. Records kept about people were sometimes inaccurate. As a result patients were not protected against the risks of unsafe or inappropriate care.

20 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

4 October 2011

During a routine inspection

We spoke to women and their partners about their experiences on Victoria Ward, the labour ward, and Hertford Ward, the antenatal and postnatal ward. Women were generally very happy with the care and treatment provided to them at the antenatal clinic and during the delivery process. Midwives were described as 'amazing' and 'very good and caring'. However, women expressed concerns about staffing levels on Hertford Ward on the evening prior to our visit. They had experienced a long wait for their needs to be attended to. Staff had been redeployed to the labour ward to assist with an unexpected increase in the number of women going in to labour, which had left Hertford Ward understaffed for several hours.

23 February 2011

During a routine inspection

We spoke to a number of patients on both in-patient wards and out-patient areas including Accident & Emergency. The majority of people we spoke to told us they were happy with the services provided at the hospital. Most people confirmed they had been treated with dignity and privacy by staff, treatment had been fully explained and most understood their plan of care. An out-patient told us, for example, 'the doctor took his time and listened to my questions and answered them, I am very happy with how I was treated here'. There were mixed views on the quality of food provided but patients described a wide choice of meals and said they generally received a meal that met their needs. Almost all said that the hospital was 'very clean' and one person told us it was 'marvellous'. Although a few patients described the behaviour of one or two staff as rude, the overall standard of care was considered 'very good'.