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Chesterfield Royal Hospital Requires improvement

We are carrying out a review of quality at Chesterfield Royal Hospital. We will publish a report when our review is complete. Find out more about our inspection reports.
All reports

Inspection report

Date of Inspection: 11 August 2012
Date of Publication: 5 October 2012
Inspection report published 5 October 2012 PDF

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run (outcome 1)

Not met this standard

We checked that people who use this service

  • Understand the care, treatment and support choices available to them.
  • Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support.
  • Have their privacy, dignity and independence respected.
  • Have their views and experiences taken into account in the way the service is provided and delivered.

How this check was done

Our judgement

The provider was not meeting this standard.

People's individual needs, preferences and decisions were not always at the centre of assessment, planning and delivery of care. This meant that people's privacy, dignity and independence were not always respected.

We judged that this had a minor impact on people using the service and action was needed for this essential standard.

User experience

Most of the patients and visiting relatives we spoke with felt that staff respected their privacy and dignity. Patients said that staff asked them what they liked to be called when they arrived on the ward, and staff then referred to them by their preferred name.

Patients mostly felt that staff spoke to them appropriately and took their views into account. However, one patient said that some staff shouted over patients across the ward to other staff, which they felt was not respectful. Another patient said that that some staff were, "Impatient, don't have the right attitude".

Patients who were able to express their views said they felt involved in decisions about their care and treatment. One patient told us that staff had explained the options, and they had been given sufficient information to help them to make decisions. One patient who was due to be discharged home told us they were involved in planning their discharge, and they were happy with the arrangements in place.

We saw positive and respectful interactions between staff and patients on both wards. For example, we saw staff providing kind and sensitive assistance to a patient who was confused. We saw that staff always used curtains around the bed when assisting with personal care.

However, we also observed examples where patients' privacy, dignity and independence were not respected. For example, the first patient we spoke with on one ward did not have a nurse call button within easy reach. When we asked the patient how they would call for assistance, a member of staff came over, gave the patient the nurse call button and explained how to use it. We saw that seven out of 31 patients on the same ward did not have a nurse call bell within easy reach. This meant that patients may experience delays in receiving assistance.

Visiting relatives whose family member was receiving end of life care told us that staff had involved them in decisions about the patient's care and treatment. The relatives expressed concern that the patient was being cared for in a six bedded bay, which was very noisy at times. They felt that the environment did not provide sufficient privacy. Staff had not discussed the option of moving the patient to a single room.

We saw that all patients were accommodated in single sex bays or single rooms; not all rooms had en-suite facilities. We saw that some communal toilets and bathing facilities had a sign to show that these were for male or female patients, but some of the facilities did not have a sign. The provider may find it useful to note that although staff knew which facilities to direct patients to, patients may not be aware without a sign in place.

The bedside lockers were adequate for storing patients' belongings. However, the lockers did not have a lockable drawer to enable patients to secure any valuables or personal items.

Other evidence

Were people's privacy and dignity respected?

Staff told us that issues relating to patient privacy and dignity and promoting independence were discussed at staff meetings and handovers. The wards we visited did not have a 'lead' member of staff responsible for promoting dignity and privacy matters. This role could help to ensure a focus on promoting privacy and dignity, and provide a source of information for patients, visitors and staff.

We looked at the nursing care records for eight patients. Four records included the patient's preferred name, four did not. Patients who were able to give their views told us that staff did refer to them by their preferred name. The patient's preferred name should be recorded to ensure all staff are aware. This is particularly important for patients whose communication abilities may be limited. For example, a person with dementia who has always used a nickname may only respond to this. The person may not be able to tell staff about this, but staff could seek this information from the person's relatives.

We saw from the nursing records that staff made regular checks of each patient throughout the day to ensure their comfort, including a 'modesty check'. This meant that staff checked patients were appropriately dressed and covered to ensure their dignity.

The nursing care plans we looked at did not include details of how each patient wanted their privacy and dignity to be respected. For example, the care plans lacked detail of patients' normal routines regarding their personal hygiene. It is particularly important for these details to be obtained and recorded for patients who may be unable to express their needs and preferences.

Were people involved in making decisions about their care and treatment?

We saw that the information guides about the wards and services provided were available to patients and visitors.

Staff told us that they discussed a patient's care and treatment needs with their family or carers where they were unable to discuss this with the patient. We saw evidence of this in three of the records we looked at. However, we found that a 'Do not attempt cardiopulmonary resuscitation' form had not been fully completed for one patient and did not note if the decision had been discussed with the patient or their representatives.