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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

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

How this check was done

Our judgement

The provider is not compliant with this standard.

There was not always enough qualified, skilled and experienced staff to meet people’s needs.

User experience

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”.

We saw patients wandering around the ward moving items that included electronic equipment from the nurses station. There were polite, but firm interventions from the staff asking them to put things down.

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.

Other evidence

Staff on duty on Wheal Agar ward during our inspection visit consisted of two trained nurses, two care workers and one domestic to look after the needs of 25 people. We were told that some mandatory training booked for that day had had to be cancelled in order to ensure the ward was fully staffed. We observed that the patients on Wheal Agar ward were very demanding of staff time and the staff seemed hard pressed to meet their individual needs.

The Trust told us that following the recent issues on Wheal Agar they had reviewed the staffing and support within the ward environment. They acknowledged that it had been a difficult time for all the staff and that the senior nursing team continued to maintain a regular presence on the ward on a daily basis.

They added that a number of staff remained on maternity leave, sick leave or temporary redeployment pending completion of external and internal investigations. This had challenged the service in maintaining recommended staffing levels for the ward. They told us that short and long-term bank and agency staff cover had been, and continued to be, sought for all vacant shifts. When individual shifts had not been filled, movement of staff from other wards had been employed to assist with maintaining staffing levels at recommended level. They added that the current ward leader was off sick, therefore the clinical matron and divisional nurse were working with the deputy ward sister to provide leadership and support. Additional support and supervision was also being provided via the Consultant Nurse for Older People. A senior clinical nurse was due to take temporary leadership of the ward whilst a substantive post was to be advertised.

On Phoenix ward there were three trained nurse and three care workers looking after 25 people.

We were told that a rapid review of nurse staffing levels and deployment within the whole hospital has been commenced by the Interim Nurse Executive.