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Inspection carried out on 19,20,25 July

During a routine inspection

Renacres hospital is an independent hospital, based in a rural location near Southport and is part of Ramsay Health Care UK. Renacres hospital is registered to provide the following regulated activities:

  • Diagnostic and screening procedures.

  • Surgical procedures

  • Family planning services

  • Treatment of disease, disorder or injury.

Our key findings were as follows:

  • Safety Thermometer information between June 2015 and June 2016 showed there were no pressure ulcers, falls with harm or catheter urinary tract infections reported by the hospital relating to surgical services.

  • Systems were in place to protect people from healthcare associated infections. There had been no cases of MRSA or clostridium difficile at the hospital. There was a lead nurse for infection control that was given protected time in her job role. There were monthly infection prevention audits and hand washing audits

  • Staffing levels were good at the hospital and sickness levels were low. Use of agency staff was low as there was a bank of existing staff that were happy to work additional hours. There was a corporate workforce policy, though senior managers felt that it needed to be strengthened to retain and recruit nursing staff. The Ramsay group was looking at international recruitment for nurses. However, skill mix was not always appropriately used at the hospital. In theatre some of the health care assistants had been trained as first scrub assistants but elsewhere in the hospital there were fewer opportunities. On the ward, trained nurses were cleaning equipment and in the OPD blood was taken by trained nurses. These tasks could be delegated to lower banded staff following appropriate training and competency assessment.

  • Mandatory training levels were good; the hospital informed us that all eligible staff had completed their training. We were shown a completed training matrix for staff and signing in sheets for the face to face sessions.

  • The (resident medical officer) RMO was available 24 hours a day seven days a week and had full access to the consultant surgeon and anaesthetists details. Nursing staff said that they worked well with the RMO but if they had concerns they would contact the consultants directly.

  • There were robust systems in place to ensure that information was communicated with the patients GP.

  • There was a clear patient exclusion criteria to identify patients who were not suitable for surgery at Renacres hospital.

  • The hospital had a ‘management of patient complaints’ policy in place. The rate of complaints received was lower than other independent hospitals. No complaints progressed to the Ombudsman or to ISCAS (Independent Healthcare Sector Complaints Adjudication Service), or were received by CQC in this period.

  • There was a corporate risk register. The current register recorded 10 risks; six of which related to financial risks. The remainder included a number of risks that were not relevant or of very low risk to Renacres hospital. The risk registers were an agenda item on the health and safety committee, which was not attended by the MAC chair; this meant that there was no clinical ownership of risk. Risks were reviewed annually. There were risk registers for clinical areas, some of these had review dates and actions and others did not. Risks were reviewed at the health and safety meetings and did not feed into the corporate risk register.

  • There was a policy in place for the granting of admitting rights and/or practising privileges to health care professionals. Compliance with the policy was mandatory for all consultants, staff and accredited healthcare professionals and approval needed to be granted at a local and national level. Consultants could only practice at the hospital what they practiced in the NHS and the MAC chair would look at the number of procedures that had been carried out in the NHS and the training logs of the consultants, he would also look at local data available on the consultants e.g. complication rates and infection rates

  • Consultants had to provide evidence of revalidation and indemnity insurance. If they did not, payments were withheld The MAC chair was about to start the appraisal training so that he could undertake consultant appraisals.

  • Some of the consultants did not work in the NHS, including the MAC chair; he discussed the robust processes for revalidation and appraisals. Although the hospital were keen to recruit new consultants, the MAC chair said that he would be comfortable refusing a potential new consultant practising privileges if necessary.

  • The MAC chair audited consultants practice and could benchmark this against other consultants in the Ramsay group and identify individual consultants who were outliers. He was proud of his service and the level of governance at the hospital.

  • The hospital had a responding to concerns about a doctor’s practice policy in place. It set out the actions to be taken when concerns were raised about any GMC registered doctor in the hospital. The policy did not set out any details about informing other local healthcare providers about the concerns but the MAC chair said that he would always write to the medical director of the employing trust outlining his concerns if there were any issues about a doctor and he gave us a specific example where this had happened.

  • Staff could be nominated for customer service excellence awards, these were for staff who had gone the extra mile in their work, we saw three nominations for staff working at Renacres.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 5 November 2013

During a routine inspection

People we spoke with during this inspection were all very complimentary about the service and the treatment they had received. People felt their needs were being met by a knowledgeable and caring staff team. One person simply remarked; �It is brilliant!� Another said; �The staff are marvellous...They attend to my needs exceedingly well." Another patient said; �Everything has been explained to me very well.�

We found people were protected from the risk of inadequate nutrition and hydration. Methods of monitoring were in place for individuals and people were given advice and information about nutrition. The food was of good quality and there was plenty of choice. One person said; "There is so much choice on the menu...Then if we don�t like what is on the menu we can request something else and they will do their best to provide it for us...Everything we get is delicious.�

During our inspection we looked at standards relating to consent and care and welfare. We also assessed the safety and suitability of the hospital premises and how the quality of the service was monitored. We did not identify any concerns in any of the areas we reviewed.

Inspection carried out on 29 January 2013

During a routine inspection

During our visit to this location we spoke with four patients (inpatients and outpatients). We received consistently positive comments about the services and facilities provided. We also spoke with several members of staff of varying skills and qualifications.

We observed staff talking with people in a respectful manner and on one occasion heard a member of staff providing a patient with clear explanations about their treatment.

People�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A comprehensive pre operative assessment was completed for all patients.

Patients we spoke with had no concerns about their safety one person told us, �I was so nervous about coming to hospital, but the staff really put me at ease. They are so reassuring. I have been told to rest after my operation this afternoon and I will take their advice, because I trust the staff here.��

Staff we spoke with told us about their induction programme, this training would make sure they were confident, safe and competent. Staff spoken with talked us through their induction programme or that of any newcomers, which seemed to be a thorough process. All staff completed the Ramsey Induction programme before they started work.

People we spoke with said they would know how to make a complaint if they had to and one person showed us the leaflet �We value your opinion� supplied to new patients, telling people how to make a complaint.

Inspection carried out on 21 February 2012

During a routine inspection

People told us they were very satisfied with the service, one person said, �I have been given loads of information about my operation and I have been treated very well throughout my time here�, another person commented, �I have no complaints whatsoever, I have been pleased with everything and well looked after�. During our visit we observed positive and respectful interactions between the staff and people using the service.

We tracked a person from ward to theatre and back to the ward and noted all safety procedures were followed and the person was treated with respect throughout the process. The person told us they were satisfied with all aspects of their care.

None of the people spoken with had any concerns or complaints about the service.

Staff were provided with ongoing opportunities for training and development and were given an annual appraisal of their work performance. Staff spoken with were positive about their organisation and said they enjoyed their work. People made complimentary comments about the staff team and felt they could talk to the staff if they had a problem or query.

There were established systems in place to monitor the quality and operation of the service. People were regularly consulted about their opinion of the service and their comments were used to shape future plans.

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