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Inspection report

Date of Inspection: 4, 5 February 2014
Date of Publication: 17 June 2014
Inspection Report published 17 June 2014 PDF | 114.9 KB

Overview

Inspection carried out on 4, 5 February 2014

During a themed inspection looking at Dementia Services

In addition to the dementia themed inspection this visit considered staffing levels, particularly outside of standard working hours. This was due to concerns that had been raised to us by Monitor and the local Clinical Commissioning Group (CCG). These concerns had been raised due to data that showed a possible increase of risks to patients’ care and welfare at night and at weekends.

We visited the Accident and Emergency department (A&E), and three wards: Ward 7 (gastro-intestinal), Ward 15 – (orthopaedic), and Ward 14, (older people’s care).

We spoke with staff in each of the clinical areas including consultants, nursing, health care, and administration staff. In addition we met with a group of five junior doctors and three matrons / link nurses.

We left comments cards and collection boxes in each of the areas we visited for a week following our visit. We received 56 returned comments cards that had been completed by relatives of patients and staff working at the hospital. 24 comments were positive, 23 contained mixed comments, 6 contained negative comments and 3 comment cards contained comments that did not relate to the theme of the inspection. Staff responses indicated that at times the quality of care provided to patients with dementia was compromised due to staffing levels.

We case tracked 10 patients identified as living with dementia across the areas we visited. We found that incomplete assessments and care records potentially impacted on the quality of the care and treatment patients received. We saw that on 2 occasions people had to wait for extended periods of time, for example 10 minutes and 20 minutes respectively, to receive support. Incomplete care records meant that in some cases it was not always possible to check that patients had their needs met.

Staff at the hospital worked with others to promote continuity of care for patients living with dementia who were admitted and discharged from the hospital. Where there was a lack of appropriate information regarding a patient living with dementia staff were proactive in gathering information about their physical and medical care needs.

We spoke with 5 junior doctors, 1 clinical nurse specialist, 1 discharge co-ordinator, 2 RGN's, 2 ward managers, 1 health care assistant and 1 student nurse. Staff told us they did not feel they had appropriate training to understand the needs of patients living with dementia. A discharge co-ordinator told us they had received no dementia training.

Although there were some quality assurance and monitoring systems in place at Leighton Hospital it was not clear how the quality of dementia care was monitored. Senior ward staff were not always familiar with the latest guidance regarding the care of patients living with dementia. This meant that available guidance was not always impacting on the quality of care patients received at ward level. Although the Trust had plans to improve the quality of support provided to patients with dementia these were still in their infancy, with some initiatives at planning stage.

Following the inspection the Trust told us that they were clear that the quality of the care provided to all patients was monitored. They submitted to us a patient feedback report and carer survey results to evidence this after they received the draft inspection report.