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Archived: The Raphael Hospital Requires improvement

All reports

Inspection report

Date of Inspection: 19, 20 September 2013
Date of Publication: 6 November 2013
Inspection Report published 06 November 2013 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 19 September 2013 and 20 September 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and were accompanied by a specialist advisor.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

Our judgement

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Reasons for our judgement

Patients and relatives were pleased with the care delivered. The Raphael medical Centre (RMC) was able to be flexible in its approach to care. We saw one instance where a patient had been admitted to hospital. The nearest relative wanted the patient back at the RMC. When staff looked into the request in detail they found that the concern was that the patient was being looked after by staff who were unknown to him. The RMC was able to send staff to the hospital to care for the patient although only on the night shift.

Patients’ needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that patients’ needs were assessed prior to their admission. Staff from the RMC would visit the patient at the place they were being treated. We saw one occasion where the RMC had decided not to admit someone because it did not feel that it had the necessary elements in place to care for them properly. The assessment varied according to the unit to which patients were admitted. Some of the assessments we saw included daily living tasks, mobility, communications and cognitive ability. Others concerned spirituality, psychology and continence. Where appropriate we saw that there had been assessments of suicide and ligature risks.

We looked at tracheostomy (a surgical procedure where the surgeon creates an opening in the neck at the front of the windpipe) care. In patients’ rooms we saw that there was the necessary equipment for suction and changing of tubes, including a variety of catheter sizes according to the size of the tracheostomy tube. We spoke to nursing staff who described how they would change the suction catheter after each use. This is in accordance with current good practice, although the provider might like to note that the clinical guidelines to staff were out of date; saying that the suction catheter could be re-used.

When the patient was no longer to have a tracheostomy, the patient was seen by an ear nose and throat (ENT) consultant and plans were made for how they would be weaned from it. The process was regularly monitored by the ENT consultant. Staff said they would not attempt the process without close instructions from ENT specialists. We spoke with an independent therapist at the RMC who confirmed this.

Treatments were tailored to meet the needs identified. We saw notes on the use of rhythmical massage therapy which indicated the improvements a patient had experienced. We saw where art therapy had been used but when it was found to be ineffective it was stopped. There were speech and language, occupational, music and other therapies also available. Patients had individual therapy plans with goals that the therapists wrote up.

We looked at care plans in the special care unit. The provider might like to note that we saw several instances where staff talked about patients in their presence without acknowledging that they were there. Also most patients, when asked, were not able to tell us about their care plan. However in one case we saw that there was direct evidence of the patient’s involvement in his care, in that the plan had direct quotes from the patient. Generally plans did not have evidence of direct patient involvement. We discussed this with staff including the consultant psychiatrist and consultant nuero-psychologist. They said that most of the patients lacked the insight to allow them to contribute directly to care plans or to review meetings of their care. We saw that there was indirect evidence of involvement much of it based on subjective observation. For example we saw that in one case staff felt that an individual was ready to be moved from the special care unit but when they planned for this he experienced increased episodes of incontinence. Staff felt that this was evidence of his unhappiness with the changes and did not carry on with the plan. Others notes showed that some patient had signals, for example thumbs “up” or “down” to various options.