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Archived: Clifton Park Hospital Good

The provider of this service changed - see new profile

Reports


Inspection carried out on 27 and 28 January 2015, and 10 February 2015

During a routine inspection

The Clifton Park Hospital is operated by Ramsay Health Care UK Operations Limited. It primarily serves the communities of York and North Yorkshire and accepts patient referrals outside of the catchment area. The hospital has two theatres and 24 beds configured into one ward which is used for day cases and inpatients. It provides elective orthopaedic surgery and care for adults including diagnostic services, outpatient facilities and physiotherapy. The hospital does not treat children or young people under the age of 18 years. Referrals were received primarily for NHS patients, treated under standard NHS contract, although there were some self-funding patients.

There were over 20 clinical staff (both nursing and physiotherapists) who were employed by the hospital and 34 consultants working at the hospital under a secondment agreement with York Teaching Hospitals Foundation Trust. There were a small number of these consultants who undertook private practice under practicing privileges. The senior leadership team comprised of a general manager, an operations manager, a matron and a finance manager. The hospital was supported by other professionals within the Ramsay Health Care UK.

We inspected the hospital on the 27 and 28 January 2015 and undertook an unannounced inspection on 10 February 2015. We inspected this hospital as part of our second wave independent hospital inspection programme. The inspection was conducted using the Care Quality Commission’s new inspection methodology.

Overall the care and treatment patients received at Clifton Park Hospital was good for the safe, effective, caring, responsive and required improvement in the well led domain.

Our key findings were as follows:

Medical and nurse staffing levels were adequate on the ward, theatres, outpatients and diagnostic services. Staffing establishments and skill mix were reviewed regularly and levels increased to meet patient needs where required.

Arrangements were in place to manage and monitor the prevention and control of infection. We found that all areas we visited were visibly clean. There were no hospital acquired infections reported from October 2013 to September 2014.

Some patients fasted pre-operatively for longer periods than necessary before their surgery. This had been identified by the hospital and an interim measure had been put in place to address this. Interim measures had improved the situation regarding prolonged fasting. Patients gave positive feedback about the choice and quality of food they received.

There was sufficient equipment to ensure staff could carry out their duties. Processes were in place for monitoring and maintaining equipment.

The majority of records we viewed across both core services were well maintained and documents were completed to a good standard including completion of patient risk assessments, however there were gaps in some records.

Staff understood their responsibilities to raise concerns and record patient safety incidents and near misses. There was evidence of a culture of learning and service improvement.

Overall the hospital responded to the Central Alert System (CAS). However we noted it had not fully implemented the National Patient Safety Agency alert “Emergency support in surgical units: Dealing with haemorrhage” Reference number 1025, dated10 September 2007. Clifton Park Hospital had not assured itself that blood products could be transported in a timely manner should an emergency arise.

Medicine management arrangements were in place. Medicines were stored securely and staff were competent to administer medicines.

There were systems for the effective management of employed staff which included an annual appraisal, however, not all staff had received an appraisal.

The monitoring system to ensure the consultants’ safety to practice within the hospital was not robust at the time of the inspection. For a significant number of the doctors information regarding: DBS checks; appraisal information from the employing organisation and; professional indemnity insurance arrangements, was out of date or had not been provided to the hospital and therefore the consultants’ safety to practice within the hospital was not assured. When this issue was raised with the hospital management team the employing trust was contacted immediately to provide this assurance. Information provided by the hospital on the 10 February 2015 indicated that the figures for appraisal and indemnity insurance had improved.

The hospital undertook a programme of clinical audits. These covered a range of areas including infection prevention and control, medicines management and nutrition and were acted upon.

There was no secure access to the theatre suite to prevent patients or other people inappropriately accessing this area

Leaders were aware of their responsibilities to promote patient and staff safety and wellbeing. Leaders were visible and there was a culture which encouraged candour, openness and honesty.

Governance arrangements enabled the effective identification and monitoring of clinical risks and action was taken to improve performance. Progress on achieving improvements was reported and measured through the relevant committees with oversight and scrutiny from the provider’s quality governance committees with ultimate responsibility resting with the Ramsay Health Care UK chief executive and board. It could be seen through the results from the audit programme that where a need for improvement had been identified this was actioned and subsequent audit demonstrated the progress made.

In addition to the above, we saw areas of good practice:

Patient information leaflets within outpatients were of a very high standard and had recently been developed and improved by members of the outpatient team. The radiology manager told us that the information tools developed were to be showcased within the Ramsay hospital group.

The radiology manager had been recognised by the Head of Diagnostics for Ramsay Health Care UK for her audit work regarding use of “C arm” equipment and had been asked to present her work to the Ramsay Radiology group.

The governance structures enabled national learning from other hospitals within Ramsay Health Care UK.

Patients were positive about their care and experiences. They felt involved in the decisions about their care and treatment and records were completed sensitively.

However, there were some limited areas of poor practice where the provider needed to make improvements:

Action the hospital MUST take to improve

  1. The provider must take action to ensure that the appropriate checks and records are in place and recorded for the doctors working at the hospital including Disclosure and Barring Service DBS checks, indemnity insurance and appraisals.
  2. The provider must take action to ensure that there is an effective system in place for the timely delivery of blood products from the local provider should an emergency arise and that emergency transport procedures are tested on a regular basis.
  3. The provider must improve the security of access to the theatre suite to prevent patients or other people inappropriately accessing this area.

Action the hospital SHOULD take to improve

  1. The provider should ensure that the timings of theatre lists were agreed in advance to avoid patients unnecessarily fasting for an excessive number of hours.
  2. The provider should ensure that all staff received an appraisal each year.
  3. The provider should ensure that all medical records are fully completed and signed.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 4 November 2013

During a routine inspection

We spoke with five people during our inspection who were receiving treatment at the hospital. They told us they been involved in the planning and delivery of their treatment and that they felt respected and listened to. People told us their stay had been made comfortable. They said they were treated well by the staff. One person told us, “I have a very confident surgeon and above all I have confidence in what they are doing.” Everyone we spoke with described the care at the hospital as being ‘fantastic’ ‘super’ and ‘very good indeed’ one person said “I would recommend it to anyone.”

We looked at three people's medical and care records and saw that they were person centred and included essential risk assessments. Records had been reviewed, to ensure on going appropriate treatment, care and support.

The hospital had infection control polices and proceedures. People we spoke with told us that their rooms were kept clean. Areas we inspected were found to be clean.

From our observations on the day of inspection, people we spoke with and records we looked at confirmed that there were sufficient staff to meet peoples care needs. People told us they were supported as and when needed.

The provider had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.

Inspection carried out on 31 January 2013

During a routine inspection

We spoke with fourteen patients in three areas of the hospital. This included people staying on the wards, people admitted for day surgery and people who were attending outpatient appointments.

People told us that they were treated with dignity and respect. They told us that their treatment options had been fully explained to them. People told us that they were able to consent to their care and treatment. One patient told us "I received a very good explanation, they were very thorough." Another patient said "I gave my consent both verbally and in writing."

People told us that they received a high standard of care and were involved in discussions regarding their care and treatment. One patient told us "The bedside manner was brilliant, nothing is too much trouble for the staff and call bells are answered quickly."

People told us they felt safe and we saw policies and systems were in place to protect people. Staff confirmed that they had received safeguarding adults and/or children training. Information on safeguarding was displayed for patients and staff.

People told us that staff were friendly and approachable and responded quickly to call bells. Staff told us that they received regular training and an annual appraisal to help them carry out their roles effectively.

There were systems in place for recording and responding to complaints. Patients were provided with information so that they could feed back their views and opinions.

Inspection carried out on 31 January 2012

During a routine inspection

We spoke with three people who use the service and they told us they were asked for written consent prior to receiving treatment. They also told us that they were allowed a choice and the treatment options were explained to them by staff.

People who use the service told us that staff explained the treatment options available to them and they were kept informed and allowed to make a choice about which treatment they required.

The people we spoke with told us they did not have any concerns about the cleanliness of equipment or the general environment. They also told us they did not have any concerns about the service they received but were aware of how to raise a complaint if they did have any issues.

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