We carried out a review of the data available to us about The Kings Oak Hospital on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Kings Oak Hospital, you can give feedback on this service.
BMI The Kings Oak is operated by BMI Healthcare Limited. The hospital has 47 beds. Facilities include two operating theatres, one medical and surgical ward, one ward for services for children and young people, phlebotomy and minor operations room, outpatients and diagnostic imaging department.
The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected surgical services only during this inspection.
We previously inspected surgical services in April 2019 where we rated safe as ‘inadequate’ and well led as ‘requires improvement’. During the April 2019 inspection, we also identified a breach in regulation 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act (HSCA) 2008. We inspected this service using our focused inspection methodology to reinspect the Safe and Well Led domains and determine if improvements had been made. We looked at processes around safer surgery, infection control, safety culture and leadership within theatres. We carried out the announced focused inspection on 25 September 2019.
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.
Services we rate
Our rating of this hospital improved. We rated it as Good overall.
We found areas of good practice in surgery:
Leaders understood and managed the priorities and issues the service faced. Following the CQC inspection in April 2019, leaders worked with staff to improve practices in the theatres and build a culture to support patient safety. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
Leaders in the service worked to promote an open culture where patients, their families and staff could raise concerns without fear. Improvements were made in the service so that staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development.
Staff completed and updated risk assessments for each patient and minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
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 had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
We found areas of practice that require improvement in surgery:
Although the service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment, they did not always staff theatres in accordance with best practice. The service continued to have a high-dependency on agency staff in theatres, however most agency staff were familiar to the service and worked there regularly.
Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.
BMI The Kings Oak Hospital is operated by BMI Healthcare Limited. The hospital provided inpatient and day care services and had a total of 47 beds, including four children and young people beds. The hospital has two theatres, endoscopy, phlebotomy and minor operations room, outpatients and diagnostic imaging department.
The hospital provides surgery, medical care, services for children and young people, outpatients and diagnostic imaging. We inspected surgery, medical care, services for children and young people and outpatients.
We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 8 to 9 April 2019.
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 requires improvement overall.
Although we found good practice in all of the four services we inspected with marked improvement in medical care and key physical refurbishments in the medical care and surgical ward, we found areas of improvement in surgery and services for children and young people.
We found areas of practice that require improvement:
Medical care
Mandatory training was below the hospital target for the inpatient ward staff (79%) and lowest among the medical service.
Not all staff had received an annual appraisal. Current appraisal rates for nursing staff were 75% which was below the hospital standard of 90%.
Surgery
Although staff completed and updated risk assessments for patients on the ward, not all staff were fully engaged with best practice processes for safer surgeries. Some staff did not always follow procedures for safer surgery in theatres and other staff did not challenge poor behaviours.
The service did not always control infection risk well. Although staff mostly kept equipment and the premises clean, they did not always maintain best practice in infection prevention control. We observed that staff were not always bare below the elbow in clinical areas and that clinical waste was not always disposed of properly.
Although the service had recently refurbished some areas, other areas of the environment continued to require improvement. There continued to be challenges around space in the theatre environment.
Although the service followed best practice when prescribing, giving and recording medicines they did not always follow best practice when storing medicines. There was no clear accountability for responsibility of fluids being in date and at the right temperatures in the fluid warming cabinet.
While we found the service provided enough nursing staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment, there was a high-dependency on bank and agency staff use.
Although most managers across the service promoted a positive culture that supported and valued staff, we found there were areas requiring improvement in theatres for creating a culture of safety and supporting staff to challenge poor practice.
Although the service had systems to identify risks, plans to eliminate or reduce them, and cope with both the expected and unexpected, we found in theatres these were not always put into practice, especially in attentiveness of staff with the WHO checklist.
Although the service had systems in place to improve service quality, in practice we found that these systems were not always effective.
Services for children and young people
Mandatory training compliance was low for paediatric basic life support (PBLS) and paediatric intermediate life support (PILS) hospital wide. However, children’s nurses within the CYP service were trained in PILS and were available when children and young people accessed the hospital..
Equipment storage in the paediatric resuscitation trolleys was not in standard order. Information folders held on the trolleys was disorganised and contained varying contents in different areas of the hospital.
Where paediatric warning scores were escalated, there was no evidence of actions taken documented within patient records.
The hospital wide audit schedule included documentation and pain management audits, however these were not specific to the children and young people’s department.
There was a lack of health promotion material specific to children and young people on Acorn ward and within other areas within the hospital where children and young people were seen.
There was no designated waiting area for children in the outpatient’s department. Children, young people and their parents and carers were seated within the main area along with other adults.
Areas within the hospital where children and young people were seen lacked a child friendly environment and atmosphere.
The en-suite bathrooms were not accessible for patients who used a wheelchair as there was no specialist equipment available to use the bath or toilet.
There was a lack of child friendly or easy read information available within the hospital.
There was no formal monitoring of the objectives and priorities set out in the five-year plan for the children and young people’s service by the senior management team.
Staff spoke about making improvements within the children and young people’s service, however there were no action plans in place to demonstrate how these would be achieved.
There was no medical representative on the corporate children and young people’s committee or the resuscitation committee held within the hospital.
Departmental risks were recorded on the risk register including those identified for children and young people (CYP). At the time of our inspection we did not find any risks recorded on the register relating to CYP despite staff identifying risks at that time.
Patient satisfactory forms were available for children and young people, their parents and carers to provide feedback about their care and treatment. However, there was no audit of the feedback provided for children and young people up to the age of 16 years.
Outpatients
Some aspects of equipment and premises did not meet hygiene standards. This included the resuscitation trolley, the treatment room, the clean utility room fridge, the phlebotomy room, the minor operations treatment room and the urology waiting area.
Although the service had suitable premises and equipment there were maintenance issues on wall fixings, treatment room trolleys and some PAT testing. There were no aprons available in the phlebotomy room.
Although the service followed best practice most of the time, we found some issues with the storage of medicines. Resuscitation trolleys were not in a temperature controlled area as advised by the pharmacist due to the storage of medicines on them. Both were kept in the corridor beside a radiator.
The store cupboard contained a small amount of stock that required temperature monitoring at below 25 degrees. The room was warm and no temperature checking was taking place.
Waiting beyond appointment times continued to be a problem and was common, often for long periods of up to an hour. Patients felt they received a good service from the doctors and did not mind if the doctor was delayed or overrunning but just wanted to be informed of this. Waiting times for clinics were not displayed in waiting areas. There was a notice on display at the reception desk that advised patients to report to reception if they had been waiting more than 20 minutes. This was an action taken from a complaint regarding waiting times.
There was an access policy that required six weeks’ notice of any clinic cancellation. We were told this was difficult to implement, as clinics were cancelled at late notice.
All referrals were triaged before being accepted for a first appointment which was described as a time consuming undertaking for the senior nurses involved that meant working weekends when not on duty in order to clear backlogs.
At the last inspection we found that staff felt the changes in leadership of the hospital were unclear. At this inspection the clinical director and associate clinical director posts had both been vacant for three months. There were new starters for both on the first day of our unannounced inspection.
Recent staff survey results showed that bullying and harassment continued to be an issue. The results were not broken down by staff site or speciality, so they were unable to identify where the issue was located. The leadership team said they planned to work with staff to address the issue, and that it had improved slightly since the last survey.
Reception staff were not aware of General Data Protection Regulation 2016 (GDPR).
However we also found the following areas of good practice across all services:
The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
The service used safety monitoring results well. The service collected safety information and shared it with staff. Managers used this to improve the service.
Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
Staff provided emotional support to patients to minimise their distress.
Staff involved patients and those close to them in decisions about their care and treatment.
The service assessed nutritional states and provided food and drink to meet patient need.
Staff assessed and monitored patients to see if they were in pain. Patients were asked to complete patient questionnaires upon discharge and through this pain relief was monitored post discharge.
Staff followed policy and procedures on consent and on when a patient could not give consent.
Staff of different kinds worked together as a team to benefit patients.
The services took account of patients’ individual needs.
The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
BMI The Kings Oak Hospital is an acute independent hospital in Enfield that provides outpatient, day care and inpatient services. It has 52 registered beds. The hospital is owned and managed by BMI Healthcare Limited.
The hospital provides a range of services including surgical procedures, outpatient consultations and diagnostic imaging services. Services are provided to both insured and self-pay private patients and to NHS patients.
We inspected the hospital on 11-13 October 2016 as part of our independent hospital inspection programme. The inspection was conducted using the CQC’s comprehensive inspection methodology. It was a routine planned inspection. We inspected the following three core services at the hospital: medicine, surgery and outpatients and diagnostic imaging.
Prior to the inspection, the hospital's senior management team took the decision to restrict the treatment of children to outpatients only, with the exception of over 16s who were on an adult care pathway.
The hospital had 42 beds (registered to have a maximum of 52), split across three wards; Hadley ward with 18 beds, Ridgeway ward with 16 beds and six beds on the short stay ward which were not in use. All rooms had ensuite facilities.
There were 5,304 inpatient and day case episodes of care recorded at the hospital from July 2015 to June 2016; of these 44% were NHS funded and 56% were private or self-funded. There were 42,476 outpatient total attendances in the same reporting period; of these 37% were NHS funded and 63% were private or self-funded.
BMI The Kings Oak provided an outpatient service for various specialties. This included, but was not limited to, gynaecology, cardiology, dermatology, oncology, ophthalmology and orthopaedics. Outpatient services were provided from 12 consulting rooms, in addition to a minor procedures room, minor treatment room and phlebotomy room.
There were two operating theatres (one with laminar airflow) and an intervention radiology suite adjacent to the recovery area. There were 4,968 visits to the theatre between July 2015 and June 2016. The five most common surgical procedures performed were:
Image-guided injection(s) into joint(s) (985)
Dorsal root ganglion block (407)
Facet joint injection (263)
Hysterescopy (170)
Multiple arthroscopic op on knee (inc meniscectomy) (166)
Inpatient and day patient endoscopies were undertaken in the theatre department and beds on the wards were used pre and post procedure for recovery. Procedures undertaken included oesophago-gastro duodenoscopy (OGD), colonoscopy, and flexible sigmoidoscopy. There were 379 endoscopy procedures carried out in the twelve months before our inspection.
There were 259 doctors with practising privileges at the hospital and 104.6 whole time equivalent employed staff.
Patients were admitted and treated under the direct care of a consultant and medical care was supported 24 hours a day by an onsite resident medical officer (RMO) Patients were cared by registered nurses, health care assistants and allied health professionals such as physiotherapists and pharmacists who were employed by the hospital.
The hospital Accountable Officer for Controlled Drugs is the Executive Director.
BMI The Kings Oak was last inspected by the CQC in October 2013.
We inspected and reported on the following three core services:
• Medical care
• Surgery
• Outpatients and diagnostic imaging
We rated the hospital as requires improvement overall.
Our key findings were as follows:
We rated safe as requires improvement overall because:
However,
We rated effective as requires improvement overall because:
However
We rated caring as good overall because:
However,
We rated responsive as good overall because:
However,
We rated well led as requires improvement overall because:
However
There were areas of poor practice where the provider needs to make improvements.
The provider should:
Surgery
Ensure all clinical areas comply with the requirements of Health Building Notice HBN) 00-09: Infection control in the built environment.
Ensure all cleaning products are stored in locked cupboards as required by the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
Ensure all staff are clear and consistent on the scoring of NEWS to avoid delays in escalating deteriorating patients.
Medical care
Ensure a system for monitoring the cleaning of the endoscopy department is in place including the cleaning of trolleys.
Ensure the endoscopy room is no longer used for storage.
Ensure that signage is place to encourage hand washing and identify hand gel dispensers.
Ensure controlled drugs are disposed of in a timely way.
Should provide dispensing benches or work surfaces provided for counting or checking items.
Improve the environment in patient’s rooms and bathrooms.
Ensure staff completed their mandatory training.
Undertake audits of national early warning score (NEWS) systems to identify deteriorating patients.
Ensure that the resident medical officer RMO’s has regular clinical supervision.
Outpatients and diagnostic imaging
Ensure the hospital's target for mandatory training is met.
Improve staffing in radiology for sonographers.
Professor Sir Mike Richards
Chief Inspector of Hospitals
Patients told us they considered the service was clean and hygienic. For example, one patient said, “the hospital is spotlessly clean.” There were effective systems in place to reduce the risk of infection.
Records kept by the service were accurate and fit for purpose. There was an effective system in place for assessing and monitoring the quality of the service and the premises were maintained in a way that made them safe for patients, staff and visitors.
Staff underwent the necessary checks before starting work or being granted practising privileges (admitting rights). Staff were supported to deliver care and treatment safely and to an appropriate standard.