13 and 20 February 2014
During a routine inspection
Heatherwood Hospital is an acute location run by Heatherwood and Wexham Park Hospitals NHS Foundation Trust. The hospital provides the following services: medical rehabilitation, orthopaedic elective surgery, short stay surgery, minor injuries unit, theatres and outpatients departments. There is no Accident and Emergency at this site.
We inspected the following regulated activities for which the hospital is registered: treatment of disease, disorder or injury, diagnostics and screening, and surgical procedures.
Patient needs were assessed and care was planned and delivered to meet those needs. Patients were communicated with and felt involved in their care and in decision making. All feedback received from patients was positive; this applied across the multidisciplinary team. Patients were provided with appropriate information at all stages of their care and treatment.
Although patients received safe care and were protected from risks, incidents were not always reported appropriately and there was some evidence that the learning from incidents needed to improve (for example in relation to falls). In addition, the trusts own audits found that the World Health Organisation checklist was not being completed robustly at this site. Hospital areas visited were clean, and staffing levels were maintained for the majority of shifts.
Patient care and treatment were planned and delivered in line with legislation and best practice. Patient records were kept up to date and were updated in a timely manner. Audits were undertaken to monitor care and outcomes, and, where required, action plans were implemented to improve care. Appropriate equipment was not always available to reduce the risk of harm (for example to prevent falls). This is a breach of Regulation 10 regarding the safety and suitability of premises. There were systems in place to ensure that staff had undertaken mandatory training, but not all staff had received an annual appraisal.
All wards and departments at Heatherwood Hospital were managed as part of the three divisional structures based at Wexham Park Hospital. Governance arrangements and support from senior staff were communicated via the lead nurses for the relevant division, who ensured that reporting and feedback for Heatherwood Hospital wards and departments were fed into the relevant committees.
During our inspection, it was confirmed that the minor injuries unit and ward 8 were due to close in the near future. The plan was for the services provided by the unit and ward 8 to continue but to be provided by other providers and within the community. This situation had an impact on staff working in the affected areas, although they all continued to be committed to the delivery of high standards of care in the interim.
During our inspection, we spoke with patients and their relatives and to members of the public who shared their experience with us at a listening event the week prior to the inspection. We spoke with 10 patients and 15 members of staff.
Staffing
Some wards and departments we visited had staff vacancies. These were covered by either bank or agency staff to ensure patient safety and that the needs of patients were met. There were some occasions when the required number of staff was not available for a shift; this could have an impact on patient safety. Wards and departments at Heatherwood Hospital were supported by on-site medical staff and a range of allied health professionals. These staff members were based on the wards and worked as a cohesive team with the nursing staff. All staff we spoke with felt that joint working with the multidisciplinary team ensured positive outcomes for patients.
Cleanliness and infection control
All the areas of the hospital that we visited were clean and free from clutter. Alcohol hand disinfectant was available on entry to wards and departments, at the patients’ bedsides and in other key points, enabling good access for staff and visitors. However, this was not the case in the outpatient departments. We noted that audits of staff compliance with hand hygiene were between 89% and 100% in surgical areas. The areas we visited displayed the results of cleaning audits, which were above 90%.