You are here

Inspection Summary


Overall summary & rating

Good

Updated 24 October 2019

Circle Reading has 30 inpatient beds with 20-day case pods plus eight ambulatory day case chairs. The hospital has five operating theatres, three of which have laminar flow. There is an endoscopy suite within the theatre complex, as well as a suite of consulting and treatment rooms, and an imaging department offering x-ray, ultrasound and scans. The hospital also has a pharmacy on site.

Circle Reading provides a range of medical, surgical and diagnostic services to patients who pay for themselves, are insured, or are NHS funded patients. Services offered by the hospital include orthopaedics, spinal, general surgery, gynaecology, ENT, ophthalmology, endoscopy, physiotherapy and diagnostic imaging.

We inspected this service using our comprehensive inspection methodology and undertook an unannounced inspection of the service on 25 June 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.

Inspection areas

Safe

Good

Updated 24 October 2019

We rated the safe domain as good.

There was generally good practice in all areas of the hospital.

There sufficient numbers of staff with the right qualifications, skills and experience to provide safe care and treatment to patients.

Staff knew how to protect vulnerable people from abuse and completed training in adult and child safeguarding.

Staff recognised and responded to deteriorations in the condition of patients. Comprehensive risk assessments for individual patients were completed and used to inform the care and treatment that was provided. There were suitable arrangements to ensure an appropriate response to emergency situations.

Patients were protected from the risks associated with hospital acquired infections. The majority of staff adhered to the provider's infection prevention and control policies.

The premises and equipment were fit for their intended purpose and well maintained. The premises were clean and in good repair. The environment was light, airy and spacious with comfortable furnishings.

There was sufficient equipment available for staff to carry out their roles efficiently and safely.

Medicines were generally well managed across the hospital. Controlled drugs were managed in accordance with the legislative framework.

Incidents were usually managed in line with the provider policy. There was a good reporting culture and staff felt confident to raise concerns. There was evidence of the provider making changes in response to feedback from staff and patients.

However,

Individual contemporaneous written healthcare records were not always sufficiently comprehensive or legible. In the outpatient department, some records made by medical staff were very difficult to read.

Effective

Good

Updated 24 October 2019

We rated the effective domain as good. People had assessments of their needs, which include consideration of clinical needs, mental health, physical health and wellbeing, and nutrition and hydration needs.

Information about people’s care and treatment, and their outcomes, was routinely collected and monitored. Outcomes for people who used services was positive, consistent and met expectations.

Staff were qualified and had the skills they needed to carry out their roles effectively and in line with best practice. The learning needs of staff were identified, and training was available to meet these learning needs.

Staff understood the need to obtain informed consent and were clear about what action they would take where a patient lacked capacity to make a decision.

Caring

Good

Updated 24 October 2019

We rated the caring domain as good.

Feedback from people who used the service and those close to them was positive about the way staff treat people. People were treated with dignity, respect and kindness during all interactions with staff and relationships with staff were positive. People felt supported and said staff care about them.

Staff spent time talking to people. They were communicated with and received information in a way that they could understand.

Staff responded compassionately when people needed help and supported them to meet their basic personal needs as and when required. Staff helped people and those close to them to cope emotionally with their care and treatment. People were supported to maintain their relationships with those close to them. They were enabled to manage their own health and care when they can, and to maintain independence

Responsive

Good

Updated 24 October 2019

We rated the responsive domain as good.

Services were planned and delivered in a way that met the needs of the local population. Reasonable adjustments were made and action was taken to remove barriers when people find it hard to use or access services.

Facilities and premises were appropriate for the services being delivered. The premises were fully accessible to those with limited mobility and adapted seating as available throughout.

The appointments system was easy to use and supported people to make appointments. People were kept informed of any disruption to their care or treatment.

It was easy for people to complain or raise a concern and they were treated compassionately when they did so. Complaints and concerns were always taken seriously, responded to in a timely way and listened to. Improvements were made to the quality of care as a result of complaints and concerns.

Well-led

Good

Updated 24 October 2019

We rated the well-led domain as good.

Leaders had a shared purpose and motivated staff to succeed. Comprehensive and successful leadership strategies were in place to ensure delivery and to develop the desired culture.

There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture. There were consistently high levels of constructive engagement with staff, including all equality groups. Staff at all levels were actively encouraged to raise concerns.

There were governance systems to ensure that risks were identified and acted upon. The provider and leaders at the hospital knew their service well and could provide a comprehensive narrative to support the data.

Checks on specific services

Surgery

Good

Updated 24 October 2019

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.


The service controlled infection risk well. The service used systems to identify and prevent surgical site infections. Staff usually used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean.


Staff completed and updated risk assessments for each patient and removed or minimised risks.


The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.


Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. The service made sure staff were competent for their roles.


The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patient’s subject to the Mental Health Act 1983.


Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way.


Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.


Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.


The service was selective to ensure that they were able to meet the needs of individual patients. For the patients’ that met the acceptance criteria their individual needs and preferences were considered.


The service had a system for reporting and managing patient safety incidents. Staff felt able to report incidents and sufficiently confident to speak out when things went wrong.


Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients.


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. The service had an open culture where patients, their families and staff could raise concerns without fear.


Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

Diagnostic imaging

Good

Updated 24 October 2019

People could access the service when they needed it and receive the right care promptly.


The service had enough allied health professionals and medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.


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.


Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.


The service provided care and treatment based on national guidance and evidence-based practice. To support the service, there was a Radiation Protector Advisor, a radiation protection supervisor and a medical physics expert for the department.


Radiographers, radiologists, the radiography assistant, administration staff and other health professionals at the hospital worked together as a team to benefit patients.


Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.


Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.


The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.


The service was inclusive and took account of patient individual needs and preferences.


It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons with all staff. The service included patients in the investigation of their complaint.


Leaders had the integrity, skills and abilities to run the service. They understood and managed priorities and issues the service faced. 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.


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. The service had an open culture where patients, their families and staff could raise concerns without fear.


The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure.

Outpatients

Good

Updated 24 October 2019

The service provided mandatory training in key skills to all staff and made sure everyone completed it.


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 controlled infection risk well. Staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean.


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


The service used systems and processes to safely prescribe, administer, record and store medicines.


The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately.Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.


Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.


Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.


It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.


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. 


However,


Staff did not keep detailed written records of patients’ care and treatment. Some patient records were very difficult to read.


The WHO Surgical Safety Checklist was not always completed for outpatient procedures. Subsequent to the inspection, the provider ensured that the checklist was used in the outpatient department.