We carried out a review of the data available to us about The Royal Buckinghamshire 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 Royal Buckinghamshire Hospital, you can give feedback on this service.
Our rating of this location improved. We rated it as good because:
• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives and supported them to make decisions about their care. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
However:
• Processes did not provide assurance of the completion of tasks or evidence learning from complaints and incidents.
• The safeguarding policy was not reflective of current practice for safeguarding children and therapy staff completion of safeguarding training did not meet the hospitals target.
• Not all non-clinical staff received an annual appraisal.
The Royal Buckinghamshire Hospital is operated by The Royal Buckinghamshire Hospital Limited. It has 22 beds and offers inpatient and outpatient rehabilitation for patients who have a spinal cord injury, acquired brain injury, stroke and other neurological conditions.
We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on the 29 August 2018 along with an announced visit to the service on the 5 September 2018.
To get to the heart of patient’s experience 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.
Our rating of this hospital/service went down. We rated it as requires improvement overall.
Our key findings from this inspection were as follows;
However we found areas of good practice;
We also found areas of outstanding practice:
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, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.
Amanda Standford
Deputy Chief Inspector of Hospitals (South and London)
The Royal Buckinghamshire Hospital is a care home with nursing which provides care and treatment for up to fourteen people. At the time of our inspection nine people were living there.
The aim of the service is to rehabilitate people who have suffered a spinal or brain injury. They employ a team of nursing and care staff, physiotherapists, occupational therapists and have a resident medical officer (RMO) on site.
The Royal Buckinghamshire hospital has been renovated and provides accommodation on the first and second floor. The therapy department and administration offices are situated on the ground floor.
In this report the name, of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. At the time of this inspection a new manager was in post and had applied to be registered with the Care Quality Commission.
We previously inspected the service on 5, 6 and 12 November 2014. The service was not meeting the requirements of the regulations at that time. Requirements were made to address our concerns. At this inspection we reviewed the progress made with the requirements from the last inspection. We saw the requirements had been met or were being addressed.
People were assessed prior to admission. A recommendation has been made to improve the way out of hours admissions are managed.
Risk assessments and risk management plans were in place. Accident/ incidents to people were appropriately managed. People’s medicines were handled safely and systems were in place to pick up discrepancies in medicine administration.
People told us they felt safe. Relatives were confident people were safe. Staff were trained in safeguarding and policies and procedures were in place to support safe practice to safeguard people.
People had access to a range of healthcare professionals to promote their rehabilitation. They were actively involved and consulted with on their therapy programme and regular reviews and goal planning meetings took place to monitor their progress. People and their relatives described the therapy provided as “Outstanding, wonderful, second to none and the equipment and facilities as “State of the art”.
A new care plan format had been introduced. These provided guidance for staff on how people were to be supported. People were not actively involved in their care plans and were not encouraged to contribute to them. One person told us the care provided varied and commented “The onus is on me to instruct staff on how I like to be supported”. The provider recognised they still had work to do to provide more person centred care plans.
People felt cared for. Relatives were happy with the care provided. People and their relatives described the care as “Unbelievable and real quality care”. Staff were observed to be kind, caring, enabling and had a good relationship with the people they supported.
Safe staffing levels were maintained and were dependant on people’s needs and dependency levels. Key roles such as ward sisters had recently been introduced to provide clinical leads on shifts. Safe recruitment practices were promoted to ensure staff had the right skills and attributes for the role. Staff were inducted and had received training the provider considered mandatory to their roles. Specialist training was being accessed and provided for staff to increase their knowledge and skills in supporting people with brain and spinal injury.
Staff felt supported although formal supervisions were not taking place regularly and annual appraisals had not yet commenced. The provider was already aware of this and had an action plan in place to address it.
The service was clean, maintained and kept in a safe condition. Plans were in place to refurbish and update the service further. Equipment was cleaned and regularly serviced.
Systems were in place to audit and monitor the service provided. The manager and nominated individual were new to post. They had identified areas for improvement and had implemented a number of positive improvements to provide a better service to people. They were keen to involve people and their relatives in the service. As a result they had introduced a patient and relative forum group and had drafted a patient handbook to provide people with key information on their admission, treatment and procedures relevant to them. This would address some of the issues raised with us by people in relation to their admission, rehabilitation programme and access to guidance on making a complaint.
The inspection took place on the 5, 6 and 12 November 2014. The inspection was unannounced. This is the first inspection of the service since being registered with the Care Quality Commission (CQC).
The Royal Buckinghamshire Hospital is registered as a care home with nursing to provide care for up to 14 people. The aim of the service is to rehabilitate people and promote their independence. As a result the provider employs a team of nursing and care staff, physiotherapists, occupational therapists and a resident medical officer (RMO)
At the time of our inspection there were seven people living in the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Although people told us they felt safe we found The Royal Buckinghamshire Hospital was not providing safe care and people’s safety was compromised in a number of areas. Risk assessments were in place but did not provide clear guidance for staff to minimise risks to people. As a result we saw risks in relation to moving and handling and pressure sores were not properly addressed and managed.
We found aspects of safety of the building was compromised. This was because risk assessments were not in place in relation to fire safety practices and security of the building. Doors that should be locked were left open, fire doors were propped open, smoke detectors were covered, a radiator was loose and another radiator was uncovered. Contingency plans were not in place either to provide guidance on the actions to take in the event of an emergency.
The records in relation to safe recruitment practices were not up to date. This was because staff files did not include evidence that the required recruitment checks had taken place.
We found safe systems were not in place in relation to infection control. This was because appropriate measures were not taken to manage and reduce the potential risks of cross infection. Staff did not know who had responsibility for infection control in the home. Cleaning schedules were not detailed either to ensure staff were clear of their responsibilities in relation to cleaning and infection control prevention.
In the records viewed we saw medicines was given as prescribed however a medication administration policy was not in place to provide guidance for staff on all aspects of medicines administration to ensure medicines was safely administered.
Staff were not inducted into their roles and some staff were unclear of their roles. They did not have the required training and no assessment procedures were in place to ensure they had the appropriate skills and competencies to carry out specific tasks. Senior staff were facilitating training but they had not been trained to deliver the training. Staff felt supported and nurses and carers received one to one supervisions however, senior staff were not formally supervised.
People’s care plans did not provide clear guidance for staff on how people’s care needs were to be met. As a result some people were at risk of receiving inconsistent and unsafe care.
Quality monitoring systems were in place and the provider had identified some of the issues we found but had not yet acted on them. We found however some audits had not picked up the shortfalls we identified and therefore the monitoring and auditing processes were ineffective. We have made a recommendation in regards to the management of the service.
Accurate records were not always maintained in respect of each person who used the service and records in respect of staff were not accessible and available either.
People told us they thought the service was well managed. Staff told us the senior member of the team was available, approachable and supportive to them but the registered manager was less accessible and did not have a presence in the home to monitor and ensure it was well led.
People told us they were happy with their care and commented “the care is fantastic and the rehabilitation therapy is exceptional”. We found staff were caring and supportive of people.
People’s health needs were identified. People had access to a range of health professionals on site as well as being able to access other health specialist if required. We found people’s religious and cultural needs were met and a translator was available on site to ensure they could communicate with people who’s first language was not English.
People were not sure of the formal process for making a compliant but they said they would feel able to talk to staff. The service has a complaints procedure in place and complaints were logged.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which from the 1 April 2015 is the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.