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Inspection Summary


Overall summary & rating

Good

Updated 14 December 2018

Our rating of services stayed the same. We rated it them as good because:

  • Urgent and emergency care has not been rated before. Safe, effective, caring, responsive and well led have all been rated good.
  • Medicine has stayed the same since our last inspection and was rated as good. Safe was found to be worse and went down one rating to requires improvement. Effective remained the same and was rated as good. Caring went down one rating from outstanding and was rated as good. Responsive and well led remained the same as our last inspection and were rated as good.
  • Surgery remained as good overall. Safe stayed the same since our last inspection and was rated requires improvement. Effective, stayed the same and was rated as good. Caring stayed the same since our last inspection and was rated good. Responsive and well-led both also both stayed the same since our last inspection and were rated good.
  • Outpatients was rated as good overall. Safe, caring, responsive and well led were all rated as good. Effective was not rated.
Inspection areas

Safe

Requires improvement

Updated 14 December 2018

Effective

Good

Updated 14 December 2018

Caring

Good

Updated 14 December 2018

Responsive

Good

Updated 14 December 2018

Well-led

Good

Updated 14 December 2018

Checks on specific services

Medical care (including older people’s care)

Good

Updated 14 December 2018

Our rating of this service stayed the same. We rated it as good because:

  • Effective, caring, responsive and well-led were rated good. Safe was rated as requires improvement.

Minor injuries unit

Good

Updated 27 March 2014

The urgent care centre was a type 3 service. This means that it is a doctor led service, and this is combined with an urgent care service provision with GP cover. Patients received safe and effective care. There were sufficient numbers of staff, with appropriate qualifications, skills and experience to ensure that patient needs were met. The vast majority of patients were seen within four hours and additional resources were brought in to manage the higher demand for the service in the summer months. The centre was well-led; staff were well supported and were confident in raising issues with senior managers

Surgery

Requires improvement

Updated 14 December 2018

Our rating of this service went down. We rated it as requires improvement because:

  • The process for managing patients whose condition deteriorated post-operatively was inconsistent and staff reported continued delays and added pressure on nursing staff because of this.
  • Staff told us not all consultants visited patients following completion of theatre lists and while staff told us that some consultants could be contacted once they had left the hospital, this was not consistent.
  • Medicines were not consistently used safely. We observed the use of unlabelled syringes in the ophthalmology theatre presenting a risk of the wrong medicine being injected.
  • Sterile equipment returned from the sterilising department was not always packaged appropriately to protect from damage.
  • The appraisal rates for nursing and support staff at West Cornwall Hospital were below the trust target.
  • There was limited capacity for single sex care in the treatment centre recovery area.
  • There were a high number of patients who had been waiting for 52 weeks or longer for their urology surgery.
  • The timeliness of responding to complaints needed improvement.
  • The management and oversight of the risk register and performance were not clear. Ward staff reported that they did not have access to performance data.
  • Leadership capacity and capability to deliver high-quality and sustainable care was unclear. The theatre and ward manager posts continued to be covered on an interim basis and staff reported that trust leaders were not visible.

However:

  • Skill mix and overall staffing numbers were based on service needs. Bank and agency were used minimally.
  • Nursing staff we spoke with understood and followed the process to report safeguarding concerns and there was evidence of learning and sharing of good practice. Nursing staff were compliant with completion of all safeguarding training modules.
  • Staff kept detailed records of patients’ care and treatment. Records were completed comprehensively and included up-to-date information that was readily available to all staff providing care.
  • The effectiveness of care and treatment was reviewed through local and national audit. Outcomes were collected and monitored and were within expected range when benchmarked nationally. West Cornwall Hospital had a lower than expected risk of readmission for elective admissions when compared to the England average.
  • The multidisciplinary team were involved and worked together to deliver the most effective care and treatment to patients.
  • People were treated with kindness, dignity, respect and compassion. Patients spoken with were positive about the care and treatment they received.
  • People received personal care that was responsive to their needs. Staff were aware of the importance of learning about individual needs to provide personalised care.
  • The services were delivered, made accessible and coordinated to take account of the needs of different people.
  • Staff reported they felt supported by local leaders and managers.
  • There was a positive culture and team approach within the service.

Outpatients

Good

Updated 14 December 2018

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with previous ratings.

We rated this service as good because:

  • The hospital provided a safe service to patients and made sure they were protected for avoidable harm and abuse. There were safe levels of staffing to cover clinics who had completed mandatory training to enable them to provide safe care, records were well maintained, and infection prevention and control practices adhered to.
  • Staff were competent to carry out their role and we saw examples of good multidisciplinary working between staff in the department.
  • Patients were treated with dignity and respect and there was a strong patient centred culture. Staff recognised when they need to provide emotional support and how to involve patients and those close to them in their care.
  • Services met the needs of the population and the individuals attending clinics. Reasonable adjustments were made for patients with physical disabilities where possible. There was information available for patients to make a complaint.
  • Risk was understood and managed, and the governance framework made sure aspects of quality and safety were regularly reviewed. Staff felt valued and respected and said there was a positive, open working culture. The governance framework supported the delivery of good quality care and risk was understood and managed.

However:

  • Electrical testing was not up to date and there was a risk a deteriorating patient may go unnoticed in one area of the one small area of the waiting room not covered by the cameras.
  • The storage of patient records did not always ensure patient confidentiality.
  • Accessibility was a challenge to some patient groups due to the ageing building, layout and facilities
  • Patient outcome data was not always effectively utilised to identify areas for service improvement.
  • Staff were not familiar with the trusts vision or values and they did not feel part of the wider organisation.

Urgent and emergency services

Good

Updated 14 December 2018

  • Safe, effective, caring, responsive and well-led were all rated good.