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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

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Not met this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

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

Although there were some monitoring processes and guidance in place,

Reasons for our judgement

A survey of patients and relatives had been carried in June 2011. This showed a high degree of satisfaction with many aspects on the care and treatment. In particular there was high degree of trust and confidence in the staff. However some results highlighted concerns such as patients’ lack of knowledge of their care plan.

The Raphael Medical Centre (RMC) was part of the Kent Acquired Brain Injury Forum (KABIF). This linkage enabled health professionals to remain up to date with the latest developments in treatment. We saw that staff regularly attended specialised conferences which again helped to maintain their professional development.

There were some systems in place to protect patients from unsafe or inappropriate care or treatment. However it was apparent that they had not been kept up to date. We looked at the minutes of the clinical governance meetings. The minutes generally comprised single line entries to represent discussion on agenda items. For example the minutes of the meeting of 1 November 2012 state “(name) to be asked to make formal application for craniosacral therapy”. The minutes of the meeting of the following March state, “agreed to include craniosacral therapy”. There was no evidence of the benefits or risks of the therapy and no evidence of any discussion of the reasons for its adoption. This meant that there was a lack audit or accountability of the decision making process. When we spoke with staff who were at these meetings they told us that the entries did not represent the breadth of discussion that took place.

On other occasions matters were not followed up. For example, in the same two sets of minutes as above, a training issue was raised in the first meeting to be followed up in the second. It was not followed up. Therefore it was not possible to say whether shortcomings, that the governance process had rightly identified, had been resolved.

The frequency of the meetings was not clear. There was a meeting on 17 May 2012 during which an issue was to be followed at “… next meeting on 27 June”. However the next meeting, according to the file we were shown, was on the 1 November 2012.

The medical advisory committee and clinical governance committee met on the same day and had the same membership. It was difficult to understand the relationship between the two. There was no input from the RMC’s full time doctor into clinical governance generally.

We were told that a number of medical audits had been carried out. However the results were not available because the lead for this work was on leave. We were told that there were comprehensive health and safety policies in existence, again these were not available because the lead was on leave. In both cases the documents were locked up. This meant that they were not readily available to staff to consult.

Many of the policies and guidelines we looked at were not correctly produced as per national guidance. For example we looked at the Guideline for Procedure for Suctioning. The document was not dated and had no information on its creation, ratification, review or monitoring. There were inconsistencies between this document and both the draft Tracheostomy Guidelines for Adult Patients at Raphael Medical Centre and the Guideline for Removal and Cleaning of Inner Cannula. This guideline document also was not correctly cross referenced to other relevant guidelines such as the Tracheostomy Guidelines for Adult Patients at Raphael Medical Centre or the Guideline for Removal and Cleaning of Inner Cannula. The clinical guidelines were also contrary to the processes actually being used, as described by the nursing staff. This meant that if staff followed the Guideline for Procedure for Suctioning they would be using procedures that were out of date and not in accordance with current best practice.

We looked at the immediate life support policy for the RMC. This policy mentioned that there was a medical emergency response team but failed to indicate how it sho