Cleveland Clinic London Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff provided safe care and treatment, there were systems and processes in place to keep patients safe. The environment was safe, well maintained and met people’s needs. Leaders adjusted staffing levels when needed, to keep the department and people safe. Staff were trained and competent and had the right skills to meet people's needs. Staff maintained high standards of infection prevention and control and demonstrated safe medicines management.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service demonstrated effective collaboration and partnership working, ensuring continuity of care throughout patient transitions. Information sharing between the provider and other services was well established, with clear pathways for patient referrals. Patients were typically referred by their GP, specialist doctor, or emergency department. Referrals were uploaded to the electronic patient record platform ensuring seamless communication across services.

The electronic patient record was used to assess and manage risks effectively throughout the patient's care journey. Screening was completed upon admission, and the records we reviewed were consistently up to date, highlighting any identified risks. Risk assessments were carried out, including for falls using a recognised fall risk assessment tool, a method to determine falls risks, considering factors such as previous falls, medications, mobility, and mental status.

Staff could access support from other teams using an online request form such as the critical care outreach team. Policies and procedures were in place and accessible for staff to reference. This approach ensured appropriate interventions were in place and kept patients safe.

Staff demonstrated an understanding of how to coordinate care and support patients through their transitions, including discharge planning. The case manager told us they worked with different local authorities to secure funding if required and were able to provide information about private providers for home care packages, meaning patients had access to appropriate support upon discharge. Senior physiotherapists described how they assisted with arranging community physiotherapy, so the patient received continuous care.

The service adopted a holistic approach to understanding and managing risks, ensuring that care was both safe and supportive while taking into account patients' individual needs. Staff told us it was important to educate patients about their treatment plans, particularly when new medications were introduced. The nurse in charge explained how they provided information on how these medications worked, including potential side effects, so that patients were fully informed about their care. This information was recorded in the electronic patient record, where staff had access to prompts and sections to document the education or advice provided to each patient.

Staff supported patients who required additional assistance during meals by using red napkins to identify them. This meant their needs were discreetly and promptly met, aligning with a person-centred approach to care.

Risk assessments were completed in a timely manner and regularly reviewed. The electronic records clearly showed when assessments were undertaken. Staff told us they were reviewed frequently and updated following changes in the patient’s condition making sure risks were relevant to the patients ongoing needs.

We observed staff managing patients who exhibited signs of distress in a thoughtful way. Staff told us they tried to identify the cause of the distress, if delirium was suspected, medication was considered. If a situation escalated and restraint was required, a decision was made in the best interest of the patient in line with policies and procedures. We reviewed the providers policy and found it referenced national legislation and included a process flow chart for staff to follow.

The service had recruitment processes in place to make sure staff were competent to carry out their roles. Nursing staff were managed by the heads of nursing and the charge nurse for the service actively participated in interviews. Proposed medical staff were reviewed and signed off by the medical executive committee.

All staff completed the disclosure barring service (DBS) check during the recruitment process, in line with the provider’s policy. The provider used an online system to conduct the DBS check and recorded it in staff files.

The service used the safer staff model to calculate the number of staff needed to safely care for patients. The nurse in charge was not directly responsible for caring for patients, allowing them to have oversight of the ward. The AAU nursing scheduling guideline outlined the staff to patient ratio required and reasons additional staff might be considered, such as having higher acuity patients on the ward. Staff told us it was easy to arrange additional staff. On the day of our assessment, we found the unit was fully staffed with substantive staff and there were no current vacancies.

The service had a supervision and appraisal system, supporting staff development. Each member of staff was assigned a supervisor through a cascade system: charge nurses were supervised by the manager, while staff nurses were supervised by charge nurses. Annual appraisals were an opportunity to discuss training and continuous professional development (CPD). Records of all mandatory training were tracked via a staff platform that flagged upcoming deadlines.

Medical staff had annual performance reviews, and appraisals were reviewed to ensure they aligned with organisation values. Staff told us these were valuable opportunities to discuss interests and career development. A physician health committee met monthly and medical staff were encouraged to apply for research funding, reflecting the commitment to fostering a culture of learning and development.

The service demonstrated a proactive and effective approach to infection prevention and control, ensuring the safety of both patients and staff. The areas we visited were visibly clean, well maintained and cleaners were visible during our assessment.

The unit consisted of individual rooms that included a hand wash sink and hand gel dispensers. Hand gel dispensers were also placed outside the rooms, and we observed staff using hand gel when entering and leaving individual rooms, in line with the hand hygiene policy and staff were bare below the elbow.

The service had an appointed infection control champion and link nurse who was responsible for conducting audits and making sure inspection control measures were in place. Staff we spoke with were knowledgeable about infection prevention control (IPC) and demonstrated an awareness of the protocols and procedures for managing infection risks. Policies were easy to access and available to staff online.

Infection control audits were carried out monthly and the results shared and displayed publicly in the visitor’s lounge to promote transparency and accountability. The hand hygiene audit for the last quarter showed a 92% compliance rate. Staff were reminded about the importance of hand hygiene at team meetings and reflected in the meeting minutes we reviewed. Audits were carried out by internal teams and unannounced inspections by external departments were also undertaken, promoting ongoing vigilance and compliance with infection control standards.

Patients were screened for infections prior to admission, data we reviewed showed the service had not had a hospital transmitted infection for over 365 days. Staff told us barrier nursing procedures were implemented when necessary and there was a door light system in place which provided a clear visual signal to staff and visitors when additional IPC measures were in place and helped minimise the risk of infection spreading.