Chippenham 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

This means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this registered service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety based on openness and honesty, in which concerns about safety were listened to, safety events were investigated and reported thoroughly, and lessons were learned to continually identify and embed good practices.

The service investigated incidents and complaints and used the learning to make changes that improved the quality and safety of care. Lessons were learnt to continually identify and embed good service. For example, it was identified that some staff had been entering notes about the wrong patient on a care plan, because an incorrect name label had been applied. Immediate rectification took place, and staff ensured the right labels, were on the correct patients notes. Staff also requested the quality team reinstate documentation audits at a unit level.

Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed and learnt from clinical issues.

The service had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints, and when things went wrong, staff apologised and supported people.

Staff received feedback from the investigation of incidents, both within the service and externally. We saw evidence where changes were made in response to this feedback. For example, following a review of falls on the wards, the methodology used by staff was revised. This led to increased reporting, while the number of falls reduced by half.

The service worked with people and their partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured. They ensured the continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured all essential information about the patient was received to determine if the patient’s needs could safely be met.

The service had processes and policies to support staff in managing the discharge of patients safely. The multidisciplinary staff teams (nursing staff, therapists, and discharge coordinators) discussed plans and progress for patient discharges.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge.

Staff reported the use of additional “surge beds,” which are temporary capacity spaces used during periods of increased demand. At the time of our assessment, no additional patients were being accommodated on the wards. We saw appropriate risk assessments were consistently completed for patients who may require these beds, demonstrating patient safety was considered when managing increased capacity.

The service worked with people to understand what being safe meant to them as well as with their partners on the best way to achieve this. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and they made sure they shared concerns quickly and appropriately.

Mechanisms to ensure systems, processes and practices to protect people from abuse and neglect were effective.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff received training specific for their role on how to recognise and report abuse.

Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff we spoke with identified a named safeguarding lead and staff accessed advice and support when needed. Staff knew how to make a safeguarding referral and who to inform if they had concerns.

The service had a Safeguarding Adults policy and a Safeguarding Children and Young People policy in place, and both policies were due for review April 2027.

The service worked with people to understand and manage risks by thinking holistically so that care met their needs in a way that was safe and supportive and enabled them to do the things that mattered to them.

Staff had access to policies and procedures to support them with assessing risk of harm and deterioration of patients' conditions. Staff used treatment care plans to record and communicate personalised and realistic goals for treatment.

Staff completed risk assessments for each person on admission using nationally recognised tools. For example, The National Early Warning Score (NEWS2) was used in the service to identify people at risk of deterioration. Our review of documents showed staff completed scores correctly.

We saw a range of risk assessments, for example, falls, pressure areas, sepsis, and nutrition. When actions or plans were required to reduce the level of risk, care records showed these had been completed.

People using the service were involved in care planning and risk assessment. This was shown in care plans, participation in multidisciplinary team and reviews, access to a copy of their care plan.

Staff shared key information to keep patients safe when handing over their care to others.

Shift changes and handovers included all necessary key information to keep patients safe.

The service detected and controlled potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

Both ward layouts allowed staff to observe all parts of the ward to ensure people were safe while in their care. The service had made adaptions for people with mobility needs, for example bariatric patients. However, people living with dementia would benefit from clearer pictorial and written signage in order to be able to navigate it independently.

Secure garden and patio access provided a safe, level area for wellbeing and gentle recreation for patients, families and carers to enjoy outdoor space and seating. Beds were safe and the wards had secure window restrictors for safety. We saw the wards were free from trip hazards and were in a clean state which was fit for purpose. The service was up to date with fire safety and fire exits seen were compliant.

Staff had easy access to alarms and patients had easy access to nurse call systems. Clinic rooms were fully equipped with accessible resuscitation equipment, and emergency drugs were checked regularly. Staff carried out daily safety checks of specialist equipment.

Clinical waste was stored securely and staff disposed waste safely.

At the time of the assessment the service did not always make sure there were enough skilled people to provide safe care that met people’s needs.

Staff had completed mandatory training; however, at the time of the assessment, compliance rates for some refresher training modules were below 75%. Staff told us they had experienced difficulties accessing certain training courses. Managers advised recent service transformation and staff sickness had impacted training completion rates; however, further improvement was required.

During the inspection we saw no evidence this had adversely affected the delivery of care. The registered manager provided assurance an action plan was in place to address the shortfall and ensure staff training compliance aligns with organisational policy.

The service had enough staff to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency staff a full induction.

Managers considered requests for bank/agency staff, in line with the providers process to aid the decision making. During times of long-term sickness, they requested staff familiar with the service.

There was a suite of policies relating to safe recruitment, including Disclosure and Barring Service (DBS) checks, and all new starters received a comprehensive induction.

Nursing staff were supported by named supervisors and staff had supervisions regularly in line with organisational policy.

Staff, including temporary staff, completed training on recognising and responding to patients with mental health needs, learning disabilities, autism and dementia. The provider monitored training data through their governance meetings.

A standard operating procedure for restorative supervision had been implemented to support the newly trained Professional Nurse Advocates (PNAs).

The service assessed and managed the risk of infection, detected and controlled the risk of it spreading and shared any concerns with appropriate agencies promptly.

Patients were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. They were supported to maintain their own personal hygiene in line with their needs and preferences.

Patients were screened for infectious diseases on admission, with symptomatic patients isolated. Patient areas were safe, clean, well equipped, well furnished, well maintained and fit for purpose.

Staff adhered to the providers infection prevention and control policy and staff had completed mandatory IPC training; however, at the time of the assessment, rates for staff refresher training were below the services compliance rate of 85%. The registered manager provided assurance an action plan was in place to address the shortfall and ensure staff training compliance aligns with organisational policy.

During the inspection we saw no evidence this had adversely affected the delivery of care. Staff completed Infection Prevention and Control (IPC) cleaning audits regularly, and both wards achieved cleanliness scores above the 95% target.

Handwashing facilities and sanitising gel were readily available, and clear signage promoted effective hand hygiene. We observed staff adhering to good hygiene practices and wearing of PPE when they were supporting patients. Used PPE was disposed in the correct waste bins.

Cleaning records were up-to-date and demonstrated all areas were cleaned regularly. Staff cleaned equipment after patient contact and labelled equipment to show when it was last cleaned.

The service made sure that medicines and treatments were safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happened.

Staff followed systems and processes to prescribe and administer medicines safely.

Staff reviewed each patient’s medicines regularly and provided advice to patients and carers. A person told us their medication is discussed with staff, what the medicine is and why they need it. It is explained to them in a way they understand.

Staff accurately documented all patient medicines records accurately and kept them up to date. They stored and managed all medicines, including controlled drugs, securely and at appropriate temperatures.

Staff completed regular medicines training and competency assessments and felt confident in storing, administering and recording medicines.

Staff followed national practice to check that patients received the correct medicines when they were admitted or moved between services. They learned from safety alerts and incidents to improve practice.

The service had an audit system to ensure medicines were being prescribed, stored, recorded and disposed of in line with national guidance and local policy. Staff were following this system to dispose of and record medicine waste appropriately.