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Nuffield Health Guildford Hospital Good

Reports


Inspection carried out on 10 to 11 April 2019

During a routine inspection

Guildford Hospital is operated by Nuffield Health. The hospital has 49 beds and is an independent hospital. Facilities include four operating theatres, oncology unit, outpatient and diagnostic facilities.

The hospital is located in Guildford and is sited close to the local NHS trust Hospital. The hospital provides surgery, medical care including oncology, services for children and young people, outpatients and diagnostic imaging.

We inspected the service using our comprehensive inspection methodology. We carried out an unannounced visit to the hospital on the 10 and 11th April 2019. We inspected surgery, medical care, services for children and young people and outpatients.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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

Services we rate

Our rating of this hospital stayed the same. We rated it as Good overall.

We found good practice in relation to:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service controlled infection risk well and had suitable premises and equipment and looked after the general environment well.

  • Staff completed and updated risk assessments for each patient and kept detailed records of patients’ care.
  • In all areas caring for adults the service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • The service provided best practice when prescribing, dispensing, recording and storing medicines.
  • The service managed patient safety incidents well by completing investigations and learning from outcomes. The service used safety monitoring results well and used them to initiate change of practice.
  • Staff gave patients enough food and drink to meet their needs and improve their health, the service made adjustments for patient’s religious, cultural and other preferences.
  • The staff assessed and monitored the patients regularly to see if they were in pain and audited outcomes to improve care.
  • The service provided care and treatment based on national guidance and a local audit plan was established to check effectiveness.
  • All staff had an appraisal and the service made sure staff were competent for their role and supported their professional development.
  • Staff of different kinds worked together as a team to benefit patients.
  • Staff understood how and when to assess whether a patient had the capacity to make their decisions about their care and followed procedure when a patient could not give consent.
  • Staff cared for the patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness and provided emotional support.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The service planned and provided services in a way that met the needs of patients. The service took account of patient’s individual needs.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results and shared these with staff.
  • Managers at all levels had the skills and ability to run a service and shared a corporate strategy, vision and values with the staff of what it wanted to achieve.
  • Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for clinical care to flourish.
  • The service engaged well with patients, staff and local organisations and collaborated with partner organisations effectively.

We found areas of outstanding practice in the oncology service, surgery and children’s and young people’s service.

  • Oncology patients could be referred to a personal trainer as part of the hospital’s ‘Recovery Plus’ initiative. This was a personalised training programme which was part of the patient’s care planning.
  • The implementation of monthly scenario training for all staff developed learning and auditing of clinical practice. Staff had put their scenario training into practice in a critical situation and the learning was shared nationally across the Nuffield hospitals.
  • Information for children and young persons was clearly displayed on the ward in books, information leaflets, on boards and addressed general wellbeing as well as specific hospital admission information. The information was current and in line with best practice.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached.

Nigel Acheson

Deputy Chief Inspector of Hospitals (South)

Inspection carried out on 17 to 18 November 2016

During a routine inspection

Nuffield Health Guildford Hospital is operated by Nuffield Health. It is an independent hospital and has 49 beds. The hospital has 4 operating theatres, diagnostic imaging and outpatient services

The hospital provides surgery, services for children and young people, and outpatients and diagnostic imaging. We inspected surgery (including endoscopy), services for children and young people and outpatients and diagnostic imaging. We did not inspect oncology services, but will inspect this service within six months, as the service had recently moved to a refurbished ward.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 to18 November 2016 and an unannounced visit on 1 December 2016.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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

We rated this hospital as good overall because:

  • Staff confidently escalated any risks that could affect patient safety and we saw effective systems for reporting, investigating and learning from incidents.

  • There were sufficient staff with the right skills to care for patients and staff had been provided with induction, mandatory and additional training for their roles. Completion rates for mandatory training including key topics such as safeguarding was better than the target set by the Nuffield Group.

  • The hospital was visibly clean and there were appropriate systems to prevent and control healthcare associated infections. We saw that rooms were equipped with sufficient equipment and consumable items for their intended purpose. The waiting areas were spacious and well-appointed with amenities for refreshments and comfortable seating, including a variety of seat heights available to assist those recovering from surgery.

  • Medicines were managed safely in accordance with legal requirements and checks on emergency resuscitation equipment were performed routinely.

  • Staff responded compassionately when people needed help and support to meet their basic personal needs. Staff also respected people’s privacy and confidentiality at all times. Patients’ feedback through interviews and comment cards was positive.

  • People were always made aware of waiting times and meals were offered to those delayed or in clinic over meal times. Any concerns or complaints were listened and responded to and feedback was used to improve the quality of care.

  • We saw strong leadership at the location with an open and transparent culture. The hospital director used the Heads of Departments forum as a governance and performance management tool to maintain and improve the quality of the service. There was a clear vision and focused strategy to deliver good quality care.

  • The governance framework ensured staff responsibilities were clear and that quality, performance and risks were all understood and managed. Services continuously sought to improve and develop novel approaches to enhancing care, such as exercise courses offered to the public.

  • Staff were overwhelmingly positive about their experience of working at the hospital and showed commitment to achieving the provider's strategic aims and demonstrating their stated values. Staff told us they were supported by the hospital director and the new matron, both of whom were visible and approachable.

  • We found evidence of multidisciplinary team (MDT) working across all of the areas we visited and we saw good collaborative working and communication amongst all staff in and outside the department. Staff frequently reported they worked well as a team and liked the “family” feel of the organisation.

  • There were no delays in accessing surgical intervention once the patient was identified and had accessed the hospital’s booking systems. The hospital offered rapid access to diagnostic imaging and physiotherapy services, usually within a week. The hospital was above the 90% national referral to treatment (RTT) waiting time target for the majority of the year.

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

  • The provider must improve the way it manages records in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided’.

  • Staff should ensure all entries in the theatres CD register are legible and in line with Nursing and midwifery council (NMC) Standards for medicine management.

  • The provider should ensure that they are assured at all times that staff are complying with the bare beneath the elbows policy.

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, to help the service improve. Details are at the end of the report.

Name of signatory

Professor Edward Baker

Deputy Chief Inspector of Hospitals (London and the South)

Inspection carried out on 25 February 2014

During a routine inspection

During our inspection of Guildford Nuffield Hospital we spoke with seven staff, including doctors, nurses, reception staff and housekeeping staff. We also spoke with patients who had undergone or were about to undergo surgical procedures.

The discussions we had with patients indicated a high level of satisfaction with the service they received at the hospital. Patients commented that they were treated with dignity and respect and that they felt involved in their treatment and that the care they received at the hospital was good. One patient commented �I am always given information and choices regarding my care� A second patient commented �Always satisfied with the service and treatment.� A third patient commented �The advice and guidance and care I have always received has been excellent.�

The hospital had policies and procedures regarding safeguarding children and adults. We found that staff were aware of these procedures. Patients commented they always felt safe with the staff at the hospital. One person commented �No, I have never at any time felt unsafe or had any concerns.�

We found that the hospital had good processes in place to manage infection control. Patients commented that the hospital was clean. One patient commented �It is a comfortable clean environment.� Another person commented �Excellent the hospital is always clean and tidy.�

Patients were protected by the arrangements in place for managing medicines. There were procedures in place regarding complaints management and patients felt their complaints were dealt with appropriately and in a timely manner. One patient commented �If I had to complain I am sure it would be responded to very quickly.� Another patient commented �No, I have been in the hospital for some time now and never had to complain an excellent service.�

During a check to make sure that the improvements required had been made

We found from the documentary evidence provided to us by the registered manager that the revised forms used to record checks of the resuscitation trolley were fit for purpose and enabled staff to accurately record the checks carried out. The revision also allowed staff to ensure that equipment upon the trolley was free of defect and, where appropriate, had not expired.

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Inspection carried out on 5 November 2012

During a routine inspection

During the inspection we spoke with more than twelve patients on the wards and three people in the outpatients department.

The majority of patients we spoke with said they were extremely well looked after and treated with care. They said that staff were polite and courteous but one patient told us that one staff member had not spoken to them politely. This was raised with the registered manager during the inspection.

One patient told us they could find no fault with the nursing care although they missed having the little extras for example pencils, paper and envelopes which used to be provided.

Two people visiting the hospital told us they felt strongly that there should be single sex toilets available throughout the hospital. They said that there was no signage on the toilet doors of a man and a woman side by side on shared/unisex toilets.

The provider had informed CQC that a previous manager had left but they had not deregistered with CQC. Therefore their name still remains on this report. The CQC has received the required information to deregister the previous manager. This application is currently being processed and following completion the previous manager�s name will not appear on any subsequent reports.

Inspection carried out on 25 January 2012

During a routine inspection

Patients who spoke with us indicated that they were very satisfied with the services provided at the hospital. They felt that they had been fully informed about their treatment and care needs, had been involved at all stages of their care, and made aware of their progress.

Staff were said to be very professional in their duties and respected the dignity and rights of each person. Preferences and choices had been taken into account when planning individual care.

Reports under our old system of regulation (including those from before CQC was created)