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Inspection carried out on 16th February 2016

During an inspection to make sure that the improvements required had been made

Basildon and Thurrock University Hospitals NHS Foundation Trust serves a population of around 415,000 in south west Essex covering Basildon and Thurrock, together with parts of Brentwood and Castle Point. The trust also provides services across south Essex. The trust provides an extensive range of acute medical services at Basildon University Hospital, which includes The Essex Cardiothoracic Centre and Orsett Hospital as well as x-ray and blood testing facilities at the St Andrew's Centre in Billericay. The trust employs more than 4,000 staff and has more than 10,000 public members. The trust became one of the first 10 NHS foundation trusts in April 2004.

The trust was placed into special measures following reviews by Sir Bruce Keogh June 2013 following concerns around quality of care and high mortality. The Care Quality Commission undertook a comprehensive inspection of the trust in March 2014 and rated the trust as Good. Following this inspection the Commission recommended to Monitor that the trust could come out of special measures.

We undertook a responsive inspection to the critical care unit in March 2015 in response to concerns relating to safety with staffing shortages within the critical care outreach team, areas for improvement within the effectiveness of the service, responsiveness on patient pathways and the pace at which change had been implemented. Subsequently the rating for this service overall changed from ‘Good’ to ‘Requires Improvement’.

We returned to inspect on 16th February 2016 and inspected all the key questions in the critical care service with a view to providing a new rating. We did not undertake a full comprehensive inspection of the trust, this inspection focused solely on the general critical care unit. We found that the service had made significant improvement in the delivery of the service which we have detailed through this report, and we have changed the rating of the service to ‘Good’.

The change to the ratings of the critical care service has also changed the overall trust rating for the key question of ‘is the service safe?’ to Good overall.

Our key findings were as follows:

  • There were significant improvements made to how safe, effective, responsive and well led the service was since our last inspection in March 2015.

  • Staffing levels for nursing, medical and therapies staff had improved and were at a safe level.

  • The mortality ratio for the unit has reduced significantly since our last inspection where it was 1.8 and is now 1.0 on the ICNARC SMR and 0.83 on the APACHE model.

  • The critical care unit acquired infection in the blood rates per 100 admissions was consistently in line with or better than the England average of four.

  • The critical care unit does not currently meet the core standard of 50% of registered nurses having a recognised critical care course with 27% of nursing staff who had completed their certificate in critical care, however a number of staff were currently on the course and the rates by the end of the year were expected to reach over 50%.

  • We observed good use of mental capacity assessments and deprivation of liberty safeguards during the inspection.

  • The completion of DNACPR forms has significantly improved since the previous inspection with a greater awareness of what is required of the medical staff with regards to DNACPR.

  • There had been notable improvements in the leadership of the critical care and outreach service.

  • Morale and culture within the critical care and outreach service had improved significantly since our previous inspection.

Following our inspection the trust should:

  • Improve the mandatory training rates for the critical care outreach team.

  • Ensure all staff receive updated equipment competency training.

  • Reduce the delayed discharges over four hours from the critical care unit to the main wards.

  • Reduce the number of transfers out of hours between 10pm and 7am.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 17 and 18 March 2015

During an inspection to make sure that the improvements required had been made

Basildon and Thurrock University Hospitals NHS Foundation Trust serves a population of around 405,000 in south west Essex covering Basildon and Thurrock, together with parts of Brentwood and Castle Point. The trust also provides services across south Essex. The trust provides an extensive range of acute medical services at Basildon University Hospital, which includes The Essex Cardiothoracic Centre and Orsett Hospital as well as x-ray and blood testing facilities at the St Andrew's Centre in Billericay. The trust employs more than 4,000 staff and has more than 10,000 public members. The trust became one of the first 10 NHS foundation trusts in April 2004.

The trust was placed into special measures following reviews by Sir Bruce Keogh June 2013 following concerns around quality of care and high mortality. The Care Quality Commission undertook a comprehensive inspection of the trust in March 2014 and rated the trust as Good. Following this inspection the Commission recommended to Monitor that the trust could come out of special measures.

We returned to inspect on 17th and 18th March 2015 and inspected those key questions where the service had been rated as requiring improvement which are reported in a separate report. We did not undertake a full comprehensive inspection. We undertook an inspection of the critical care service during this inspection due to concerns received about the leadership and responsiveness of the service.

In 2014 we inspected the critical care unit at Basildon University Hospitals NHS Foundation Trust and found significant improvements to the care delivered to the population. At this time we rated the unit as Good.  When we returned in 2015 we found this service had concerns relating safety with staffing shortages within the critical care outreach team, areas for improvement within the effectiveness of the service, responsiveness on patient pathways and the pace at which change had been implemented. The rating for this service overall has changed from ‘Good’ to ‘Requires Improvement’.

Our key findings were as follows:

  • The critical care outreach team had been depleted through maternity leave and resignation and the trust had commissioned a review prior to our inspection.

  • There were also significant delays on occasions in discharging patients from critical care unit which impacted on the responsiveness of the service. The trust had commissioned a report into delayed transfers of care within the hospital.

  • The pace of change within the critical care, although improving, required further work to ensure that patients received a timely service.
  • Patient outcomes as recorded by the Intensive Care National Audit and Research Centre were poor in four out of the seven areas reviewed.
  • The strategy for the critical care unit was discussed by the senior management group during our inspection.

We identified the following areas of poor practice where the trust needs to make improvements:

The trust should:

  • Continue to work and improve on the skill mix and staffing levels throughout the hospital particularly in the critical care service.
  • Review staffing and management structures for the critical care outreach service to ensure that an appropriate number of outreach staff are on duty for each shift.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 17 and 18 March 2015

During an inspection to make sure that the improvements required had been made

Basildon and Thurrock University Hospitals NHS Foundation Trust serves a population of around 405,000 in south west Essex covering Basildon and Thurrock, together with parts of Brentwood and Castle Point. The trust also provides services across south Essex. The trust provides an extensive range of acute medical services at Basildon University Hospital, which includes The Essex Cardiothoracic Centre and Orsett Hospital as well as x-ray and blood testing facilities at the St Andrew's Centre in Billericay. The trust employs more than 4,000 staff and has more than 10,000 public members. The trust was awarded the status of Associate Teaching Hospital by the Royal Free University College London Medical School in 1997 and in 2002, the Secretary of State for Health conferred University Hospital status. The trust became one of the first 10 NHS foundation trusts in April 2004.

The trust was placed into special measures following reviews by Sir Bruce Keogh June 2013 following concerns around quality of care and high mortality. The Care Quality Commission undertook a comprehensive inspection of the trust in March 2014 and rated the trust as Good. Following this inspection the Commission recommended to Monitor that the trust could come out of special measures.

We returned to inspect on 17th and 18th March 2015 and inspected those key questions where the service had been rated as requiring improvement. We did not undertake a full comprehensive inspection. We did undertake an inspection of the critical care service during this inspection due to concerns received about the leadership and responsiveness of the service. The report for this service is reported separately due to it being inspected against the new methodology used by the Care Quality Commission.

In 2014 we inspected Basildon University Hospital and found significant improvements to the care delivered to the population. We found very good care in most of the services we inspected. We saw some very good examples of care and treatment in maternity and children’s services. Patients who needed end of life care were supported by staff that were compassionate and caring.

The service in A&E was improving and patients were mostly seen within the four-hour target. However, we also found areas where the hospital needs to continue to improve. We have said that the hospital needs to improve the way it manages medication on some wards. We have also said the hospital must improve how it treated some people with respect and dignity.

When we returned in 2015, we saw that significant changes had been implemented across the medical care and surgery services and several areas of improvements, particularly on the management of medicines; overall we rated these services as good. A&E services the last inspection required improvement on safety and whilst we saw significant improvements in the waiting area, streaming and triage process which was now robustly embedded some minor concerns were found with the level of staffing in the clinical decisions unit. The rating for the safety in A&E for this reason remains ‘Requires Improvement’.

Overall the rating for Basildon University Hospital remains as ‘Good’ and the compliance action issued on the last inspection has been removed following improvements in the management of medicines.

Our key findings were as follows:

  • Within the A&E service improvements were noted in the waiting area with patients being routinely observed and monitored for signs of changing or deteriorating conditions. However we identified that the protocol for patients to be admitted to the CDU was not being adhered to at the time of the inspection as the hospital was on black alert at the time of our inspection and nurse staffing levels were not appropriate.
  • The streaming process within A&E was now embedded and working effectively as a pathway for patients through the department.
  • Medicines management in all areas inspected had improved significantly and was safer for patients, though improvements in the recording of medicines administration was still required on Osler Ward.
  • We noted significant improvements in the care provided to patients in surgery. Patients’ privacy and dignity was respected and patients spoken to all felt well cared for.

We identified the following areas of outstanding practice:

  • We found the innovation around development of medical staff in the A&E service with career progression to consultant level to be a very innovative response to a national shortage of emergency department medical staff.
  • The preparedness of staff for major or emergency incidents in the medical care areas was outstanding. Staff were very aware of their responsibilities and were engaged with the trust’s processes.

However we identified the following areas of poor practice where the trust needs to make improvements:

The trust should:

  • Improve the management of medicines across the medical care directorate. There is a particular need to improve the recording of medicines administration and storage and prescription of oxygen.
  • Improve the governance from the top at executive level to the local wards and departments and ensure that risk assessments and service plans are available to staff providing direct patient care in escalation areas.
  • Continue to work and improve on the skill mix and staffing levels throughout the hospital.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 17/03/2014

During a routine inspection

Basildon and Thurrock University Hospitals NHS Foundation Trust serves a population of around 405,000 in south west Essex covering Basildon and Thurrock, together with parts of Brentwood and Castle Point. The trust also provides services across south Essex. The trust employs more than 4,000 staff and has more than 10,000 public members. The trust was awarded the status of Associate Teaching Hospital by the Royal Free University College London Medical School in 1997 and in 2002, the Secretary of State for Health conferred University Hospital status. The trust became one of the first 10 NHS foundation trusts in April 2004. The trust was placed into special measures following reviews by Sir Bruce Keogh June 2013.

The trust provides an extensive range of acute medical services at Basildon University Hospital, which includes The Essex Cardiothoracic Centre and Orsett Hospital as well as x-ray and blood testing facilities at the St Andrew's Centre in Billericay.

We inspected Basildon University Hospital and found significant improvements to the care delivered to the population. We found very good care in most of the services we inspected. We saw some very good examples of care and treatment in maternity and children’s services. Patients who needed end of life care were supported by staff that were compassionate and caring. The service in A&E was improving and patients were mostly seen within the four-hour target. However, we also found areas where the hospital needs to continue to improve. We have said that the hospital needs to improve the way it manages medication on some wards. We have also said the hospital must improve how it treated some people with respect and dignity.

Staffing

The trust has difficulties in recruiting and retaining sufficient staff, particularly nursing staff, mostly because of its proximity to London. The trust has an ongoing recruitment campaign and has recently recruited over 200 new staff. It employed agency and bank staff to make up the shortfalls, and the permanent staff spoke positively about the skills of their temporary colleagues. We found wards were staffed appropriately; staff were able to say when they needed extra staff to cover shortfalls and staff would be supplied. Recruitment of senior medical staff was in progress to boost the numbers of staff who provided care and treatment both in and out of hours.

Cleanliness and infection control.

In February 2013, CQC issued a compliance action in respect of cleanliness as staff were not always following national guidance. At this inspection we found that most staff were now following guidance. The hospital was clean and we observed good infection control practices among staff. Staff were wearing appropriate personal protective equipment when delivering care and they cleaned their hands between patients. There were suitable hand washing facilities in the hospitals and a good provision of hand gels. We saw staff using the gels and asking patients to do the same. We did see two occasions when staff disposed of water they had used to wash patients in the hand washing sink rather than the sluice; this is not in line with the national guidance. Staff observed the hospital’s policy on being bare below the elbow. The number of methicillin resistant Staphylococcus Aureus (MRSA) bacteraemia infections and Clostridium difficile (C-diff) infections were within an acceptable range for a trust of this size. Each reported case had been reviewed in detail. The trust takes action to access its own performance with its policies and practices, both for cleaning and infection control.

Inspection carried out on 16, 17 September 2013

During an inspection to make sure that the improvements required had been made

This was a follow up inspection to check that a warning notice and two compliance actions raised in January 2013 had been addressed. We found that the trust had addressed the warning notice regarding incident management and were following infection control guidance. Children’s assessment services had improved, cardiac services were good but we found that palliative care and coding practices required improvement.

We spoke with a number of people. Most were happy with the care provided and with the nursing staff in particular. However, there was a theme that people felt that the wards were at times understaffed and waits for call bells to be answered took too long. People in outpatients had noticed good changes over the last few months. One person said it felt like a ‘different place’. On an inpatient ward, one lady told us how they had been allowed to visit their husband outside of normal visiting hours. This had created a good impression. People felt that wards were clean, with staff washing their hands between seeing patients. One patient had complained about the care they received from a nurse and was pleased that their concerns were listened to and acted upon.

However, some people were dissatisfied. One person had been in hospital eight days and was still awaiting a scan, which they felt was too long to wait. Another person said they had had problems in getting pain relief and had to keep asking for this. People said they were not usually asked for feedback.

During a check to make sure that the improvements required had been made

This compliance review was carried out on 23 April 2013 to specifically look at the prevention and control of Legionella at Basildon University Hospital.

When we inspected Basildon University hospital (BHUT) in August 2012, we imposed a compliance action as there were ongoing moderate concerns about the prevention and control of legionella at the hospital. At this review we looked at the work the trust had done to address the compliance action.

We found that adequate actions had been taken. The information submitted by the trust and follow up feedback from the independent expert and other stakeholders at the multi agency meeting held in February 2013 has indicated that the Trust has implemented most of the recommended actions and has a programme of work to implement the remainder. The meeting also confirmed that the governance and risk management arrangements to manage Legionella at the Trust were appropriate.

All NHS internal and external stakeholders in the process have now concluded that the trust is operating a water system that is under control and compliant and that the trust has a robust system of legionella control and assurance that will monitor and mitigate any legionella risk to patients, staff and visitors going forward.

It should be noted that there have been no further cases of hospital acquired legionella at the trust since November 2011

Inspection carried out on 21, 22, 23 January 2013

During an inspection to make sure that the improvements required had been made

We conducted an inspection to see the actions Basildon Hospital had taken to become compliant with two warning notices and four compliance actions. We spoke with 76 patients, carers or family members. We also interviewed over 70 staff.

We saw marked improvements in the medical and nursing leadership practices within the paediatric department. Medical assessments were actioned in a timely manner and the paediatric department was being safely managed. Safeguarding practices, medicines management and complaints handling were satisfactory.

More work is required in infection control, assessment and risk management practices. There were not effective systems in place to identify, monitor and protect against identified risks at this time. Legionella practices were not inspected, as final reports were not due from key partner agencies until March 2013. This will be reviewed in the near future.

People who use the service we spoke with were positive about the quality of services. External partners such as Monitor, the foundation trust regulator and the Primary Care Trust / Clinical Commission Group supported the view given to CQC inspectors by the majority of staff of a changing culture focussed on patient safety driven by the new Chief Executive, Director of Nursing and the chairman of the board of directors.

Due to high mortality rates at Basildon Hospital, the Government made the decision on 6 February 2013 to investigate the trust in the near future.

Inspection carried out on 3 November 2012

During an inspection in response to concerns

Following review of two serious incidents which occurred in October 2012 and the information we gained at this unannounced inspection, we had significant concerns regarding the current medical and nursing leadership within the children’s department to support junior staff, and protect children who may be at risk of inappropriate or unsafe care and treatment. We also had concerns around the quality of medicines management within the trust.

Whilst families we spoke to were complimentary regarding the service given by the trust, we found systematic failings in monitoring practices, risk management practices and learning lessons to ensure safe practice and continuous improvement in children’s services. Whilst the Care Quality Commission (CQC) acknowledges the immediate actions taken to minimise risks to children being cared for by the provider, the provider has instigated ongoing investigations regarding the two serious incidents. If necessary, CQC will not hesitate to take further enforcement actions to ensure the safety of children.

Inspection carried out on 4 September 2012

During an inspection in response to concerns

We did not speak to people regarding this standard as this was a review of a warning notice around incident reporting, quality monitoring and assessment practices.

Inspection carried out on 1 August 2012

During an inspection in response to concerns

People we spoke with told us that they were happy with the care and treatment they received. We spoke with the parents of four children who were attending the Accident and Emergency department. They told us that they were happy with the care and treatment their children received. One person told us: “We were seen almost immediately. I cannot fault the nurses or doctors here.” Another person said: ”It can be very busy here at times but we are always seen as soon as possible.”

Inspection carried out on 10 July 2012

During an inspection in response to concerns

We spoke with ten people in different areas of the hospital, who told us that they had been thoroughly involved in decision making about their care and treatment. They told us that the nursing and care staff in particular were very good at explaining their care and treatment options to them. People also told us that staff treated them with respect and dignity and they found staff to be kind and caring.

People we spoke with were knowledgeable about different elements of their care, such as the medication they were taking, physiotherapy and occupational therapy interventions. They told us that staff responded to their care needs in a timely manner. Comments included “The staff have been excellent” and “they cared for me well.”

Not all patients were made aware of the complaints system. We asked six patients who were using services in the department of geriatric medicine what they would do if they had a complaint or concern about the services they were receiving. None of them knew about the hospital’s complaints procedure and only one knew about the patient advice and liaison service (PALS) where they could get assistance.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 11 January 2012

During an inspection in response to concerns

The overall feedback from people in the Accident & Emergency (A&E) department was positive. Whilst some had been waiting a couple of hours to be seen, they recognised the need of staff to prioritise the more urgent cases. They told us that staff were professional and caring, although information about what was happening and how long they may have to wait was not always good.

Other comments people made to us included that the department was clean, the waiting area could be larger, vending machines should be made available, information provision could be better and the seating could be more comfortable.

Inspection carried out on 2 November 2011

During an inspection to make sure that the improvements required had been made

Overall, people with whom we spoke were satisfied with the care provided across the trust. People, told us that they were well informed regarding their care and treatment. They said they felt involved in the decision making and were made aware of any risks associated with their treatment.

Carers we spoke with were satisfied with the information provided and felt well informed of the care being provided to their relatives. They said that staff were helpful and willing to answer questions. A number of people on the wards we visited told us that there were not always enough staff available to assist them at times.

People said that the staff were knowledgeable, and that they felt safe in their hands. One person told us ‘’I feel safe here. Staff are caring and gentle I have no concerns at all.’’

Inspection carried out on 10 May 2011

During an inspection to make sure that the improvements required had been made

People told us that since their admission to hospital they had been treated with respect and dignity. Written information is not always freely available and some people said that the doctors and triage staff do not always provide them with adequate information.

People were positive about the care and welfare provision and the staff across the trust. They described the staff as caring and helpful and that there were sufficient numbers of staff on duty and in general they responded to requests for help.

People with whom we spoke were complimentary about the quality and choice of meals provided and told us they had no real complaints. They also said that the cleaning standards within the hospital were good. They said there were cleaners around a lot of the time who were working hard to keep the areas clean.

People said that the staff knew what they were doing and were helpful. People told us they would complain if they were not satisfied with the service. Two relatives confirmed that they were unaware of how to raise concerns or make a complaint but had heard of Patient Advice and Liaison Service (PALS).

Overall, the people with whom we spoke told us they found their experience at Basildon Hospital to be positive and were happy with the care, treatment and support provided.

Inspection carried out on 6, 8 December 2010

During a routine inspection

More than 60 patients, carers and relatives were spoken with or interviewed over the three days of inspection and most of them (across six clinical areas) did not identify any privacy and dignity issues. They noted that information provision, especially around complaints, needs improvement in some areas although the information on medical conditions, such as stroke, was noted as good and freely available. Two patients recovering from a stroke were positive about the care and treatment available on the stroke rehabilitation ward, but both felt they would progress more quickly if there was physiotherapy available at weekends.

Overall patients felt well informed by medical staff when being asked for their consent; they stated that they had been given a full explanation of what was happening and their treatment. Maternity patients were very positive about the care and treatment that they had received, including breast feeding support, free visiting for fathers, cleanliness, hand hygiene and security of their belongings but were less positive about sleeping facilities for fathers and storage facilities. There were no complaints regarding levels of staff in the departments.

Patient feedback about their care and treatment across Basildon Hospital was generally positive and that the response to call bells is usually prompt, although there was some criticism of occasional slow response to call bells during handover.

Patients in the Elective Admissions Unit expressed positive feedback about the unit and the staff. However, a patient interviewed in the elective admissions unit reported that during a recent admission to Elsdon Ward they had experienced some difficulties due to their physical disability. They stated that their care and wellbeing had been compromised due to the lack of a fully accessible shower and other adaptations to maintain their welfare in getting in and out of bed and their sense of security whilst in bed. Another patient felt their needs had not been fully understood by staff on Kingswood ward, as they had been admitted to a surgical ward although they had a medical condition.

We spoke with eight patients about the quality of meals provided. In general terms all were complimentary about the quality of meals provided and advised they had no complaints. The only negative comment was in relation to one male patient who found the quantity of meals provided to be inadequate and not satisfying enough. Patients said that overall the food had improved since the new catering system had been introduced. They said that there was more choice, food was hot, its presentation was good and that if they had a meal late it was still edible. They also said that drinks were available and they could ask for a hot drink at any time.

Patients were positive about cleanliness and hand hygiene across all areas visited. They felt the wards were clean and that the staff worked hard on this, especially in busy areas such as the Acute Medical Unit [AMU]. Patients also observed and commented that staff washed their hands a lot and wore gloves and aprons when required.

We discussed medication practices with six people. One patient reported that one intravenous dose of antibiotics had been administered four and half hours late and only after repeated prompting from the patient. Five of the patients said that they had received enough information about their medicines and that they would ask the nurses if they needed further medicines information.

Patients consistently expressed positive feedback about the hospital environment. On the stroke rehabilitation ward patients spoke very positively about having easy access to facilities to help them with their rehabilitation programmes. Patients on maternity noted there is 24-hour visiting for partners and a partner said they were impressed by security, as staff always checked who they were before allowing them in.

Issues were raised by some patients where they said that they had been on the AMU for several days, up to five, as there was not a bed available on a ward. They said the unit was very busy and described a day when there was a 'sea of people' in the corridors. They also said that the unit was very busy at night and that staff were noisy at the nurses’ station. They were also unhappy because there was no proper call bell system available and just a light went on, which they reported staff could turn off at the desk and that this did happen at night when you wanted something. One patient told us that staff are fast and efficient but found that, “paperwork comes first and the patient second; there is an impersonal feel and staff have little time to talk to you."

Numerous people made comments that staff were knowledgeable, and included them in discussion about their care and treatment and that they treated patients with respect. Patients reported that staff were doing a very good job. One patient said that their painkillers always arrived on time and that after being in and out of hospital for most of her life she felt that staff on Mary Seacole Ward were the best she had ever experienced.

We spoke to a member of the patients’ panel, who spoke positively about the Trust and the role of the panel. They felt that everywhere was not perfect, there remains a lot to be done but that the Trust is being proactive about it. They felt that they were given the information that they needed, they were listened to and, although the panel is in its early stages, having had only three meetings, the Trust has already taken suggestions on board and actioned them. The panel member was able to show us examples of work completed, such as the admission and discharge letters on the ward. The panel member felt it was an open forum and that, if required, they could raise any issues and dissatisfactions comfortably. One concern raised by the forum was about the lack of improvement in dementia care and care of the elderly, which was borne out by the inspectors’ observations during the visit. The trust did report its plans, including a proposed project which brings the national dementia strategy together with the ‘Who Cares’ for Carers?’ project, which remains in pilot form on the Trust’s older people’s wards. However, it was apparent from talking to staff and observing care in the clinical areas that awareness training needs to be actioned quickly to support staff in this challenging environment, particularly to manage and improve outcomes for patients with dementia.

Patients interviewed said they would feel comfortable in making a complaint if they wished to. However, three patients interviewed on Florence Nightingale ward, which had been admitted as emergency cases, had not been provided with 'Help us get it right' leaflets or information about the Patient Advisory Liaison Service [PALS]. One patient was in the process of making a complaint as they had not received their evening meal until 23.00 hrs the night before. They said they had not been provided with any information about making a complaint or about the PALS. No patients reported concerns about confidentiality or data protection.

Where people were unable to provide a verbal response, for example as a result of limited verbal communication or poor cognitive ability, we noted their non-verbal cues. These indicated that people were relaxed and comfortable and found their experience at the hospital to be positive. Two relatives with whom we spoke confirmed they were happy with their relative's treatment and care at the hospital.

Inspection carried out on 28 September 2010

During an inspection to make sure that the improvements required had been made

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

Inspection carried out on 22 July 2010

During an inspection to make sure that the improvements required had been made

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

Inspection carried out on 7 May 2010

During an inspection to make sure that the improvements required had been made

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.