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Royal Cornwall Hospital Requires improvement

All reports

Inspection report

Date of Inspection: 23 May 2012
Date of Publication: 11 July 2012
Inspection Report published 11 July 2012 PDF


Inspection carried out on 23 May 2012

During an inspection in response to concerns

We carried out a responsive review of the Royal Cornwall Hospital on 23 May 2012 between 4pm and 8pm. This followed safeguarding concerns about the care of vulnerable people who may not be able to speak for themselves. We visited Wheal Agar ward (from where the concerns had first been bought to our attention), Carnkie ward, Grenville ward, Phoenix ward, Roskear ward and the Medical Assessment Unit. The inspection team consisted of two compliance inspectors and a specialist nurse.

On Wheal Agar ward we observed people being assisted to stand up and move about appropriately. We saw that people were being offered a choice of meal and an explanation of what the meals were. We also saw staff chatting with people in an adult manner and at eye level with the patient.

One person on Carnkie Ward told us that they had been treated with respect and kindness throughout their 11 day stay. She added that the staff were completely flexible in responding to her needs. This view was reiterated by a patients on Roskear Ward and the Medical Admissions Unit who described the staff as �kind and caring�, �brilliant in the night� and �can�t speak highly enough� of them.

People, on all the wards we visited, told us that they did not have to wait too long to have the bell answered. This view was supported by our observations. Apart from on Wheal Agar Ward where the provider might like to note that we were told by a visitor that their relative had had to wait so long for assistance they had soiled themselves already before anybody arrived..

We saw staff on Wheal Agar ward struggling to meet the demands of the patients. Many of the patients needed two staff to help them and others were wandering around with no focus. One person was observed picking up a piece of electronic equipment from the nurse station. This warranted a staff member to quickly go to the lady to take the item off her. The equipment might have been harmful to her or become damaged by her meaning that the equipment would then not be available for other perople to use.

One person on Carnkie Ward told us that the staff had been very supportive to her through a difficult time and that she never felt rushed. Another person told us that the staff had been �excellent� and that they had �no complaints�. They added that they had been �fully involved� in their discharge plans and had had lots of information.

Patients we spoke to on the Medical Assessment Unit spoke very highly of the staff. Patients on both Medical Assessment Unit and Roskear ward told us that noise at night was an issue and this coupled with the medicine round sometimes happening at 11.30 pm often prevented them from getting proper rest.

One patient and two visitors on Phoenix ward told us that the �care couldn�t be better in a private hospital�. They added that �staff are excellent. And they keep us informed every step of the way�.

Two patients on Grenville ward told us that they had seen other patients wait for a long time to have their bells answered when they rang for assistance.

People on Carnkie Ward told us that the food was �brilliant�. Another person said that what they had chosen they had enjoyed. They were pleased that small portions were available as they did not have big appetite.

When we arrived on Wheal Agar ward it took over five minutes for anybody to answer the bell to let us in. Staff told us that staffing levels go in �peaks and troughs� as often agency staff bought in to help did not always have the relevant skills and experience to look after people with dementia. We were told that the directors of nursing have been very supportive and they were aware that recruitment specifically for Wheal Agar ward was underway.

One relative told us that there were �not enough staff� and whilst they were usually polite and helpful they were �a bit thin on the ground�.

Three staff on Carnkie ward told us that due to the high number of intravenous drugs that have to be given they often felt that there were not enough trained nurses on duty. On the day of our inspection they were managing with one less trained nurse due to sickness. Two of the staff said that the ward had recruited two trained nurses with previous relevant experience and felt that once they started the pressures would ease.

One member of staff on Roskear ward told us that she had had concerns about staffing levels in the past. As a result she had made an untoward incident report. These reports are seen by senior staff in the hospital and fed into national patient safety data.

Two patients on Grenville ward told us that the staff were very busy all of the time.

The nurse in charge on Grenville ward told us that he thought they were fully staffed at the moment. He told us that as the ward has a variety of patients, some of whom have dementia, he was the ward dementia lead. He was supported by two health care assistants. We observed him advising a relative about completion of a �This Is Me� booklet, designed to help staff understand the needs of people who may not be able to speak for themselves and describe their likes and dislikes.

Staff on Phoenix ward told us that staffing numbers go down to four overnight even though the needs of the patients are still high with many of them needing two staff to assist them.

Staff on Wheal Agar ward told us that they had recently met with senior staff regarding poor staffing levels. They told us that they are reassured that this was being actively addressed. They said that they were receiving support and regular visits from the nurse consultant and other senior nursing staff. They said this was to ensure that the skill level and numbers of staff would enable the staff to tailor the care to meet patients individual needs.

On the medical admissions unit staff told us that flexibility of staffing was required to meet the fluctuating demand. They explained that they used an electronic rostering system and had access to bank staff and funding for agency staff if required. They said that new staff had recently been recruited and would be joining the team soon.

The nurse in charge on Carnkie ward told us that the ward had recently gone through a difficult period but there were lots of improvements planned. She felt very positive about the development plan and thought it was realistic and achievable. She added that the need for annual appraisals and regular supervision (one to one) to take place had been added to the plan and were due to start taking place very soon.

We spoke to an assistant practitioner (a role developed from the health care assistant role to provide more complex support to the trained nurses). She told us that they carried out extensive training over a two year period. She added that the role has not been completely defined and so an educator had been appointed for three months to ensure the correct protocols were in place to define what an assistant practitioner can and cannot do. She felt supported by this move and enjoyed the role very much.

Staff on Phoenix ward told us that annual appraisals were taking place. They added that if you physically had to attend training there was no problem being released, but if the training was via e-learning then it was more difficult to get protected time to complete it.

The nurse in charge on Grenville ward told us that their annual appraisals take place. He added that the ward managers had an open door policy and encouraged staff to raise any concerns with them at any time.