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Inspection Summary


Overall summary & rating

Good

Updated 30 April 2019

We rated them as good because:

Urgent and emergency care was rated as good. We found risks to patients were being assessed, monitored and managed to maintain the safety of patients. Staff demonstrated they were knowledgeable about the risks to vulnerable adults. The premises were suitable for their purpose and maintained to ensure patient safety. Medicines were managed in a way that kept patients safe, stored safely and recorded correctly. Systems were used to report, investigate and learn from incidents. Patients’ consent to care and treatment was sought in line with legislation and guidance. We observed that staff treated patients with kindness, dignity, and respect. Services reflected the needs of the local population and was responsive to patient’s needs. Patients can access care and treatment in a timely way and that there was a structured and effective information governance management framework to monitor and develop the minor injury service.

However:

Security systems were under consideration to ensure safety of staff and patients. Out of hours and at weekends, when reception staff were not employed, there was a risk that patients’ initial assessment may be delayed, because nursing staff were seeing other patients. and delays to patients being transferred in emergencies, by ambulance to the acute hospital, were not raised as incidents or monitored.

Inspection areas

Safe

Good

Updated 30 April 2019

Effective

Good

Updated 30 April 2019

Caring

Good

Updated 30 April 2019

Responsive

Good

Updated 30 April 2019

Well-led

Good

Updated 30 April 2019

Checks on specific services

Urgent and emergency services

Good

Updated 30 April 2019

  • Risks to patients were assessed, monitored and managed to maintain their safety and meet their health needs. The trust aimed for all patients to be seen and triaged within 15 minutes. The trust monitored performance against this 15-minute standard and it was consistently met.
  • Staffing levels were consistently maintained at planned levels by staff with appropriate skills. Staff told us they considered staffing levels to be safe.
  • Staff demonstrated they were knowledgeable about the risks to vulnerable adults. Safeguarding training had been undertaken and there were prompts on the assessment form to encourage professional curiosity during assessment.
  • Staff had the right qualifications, skills and knowledge to do their jobs effectively. Staff appraisal was in place to support staff development.
  • The premises were suitable for their purpose and maintained to ensure patient safety. Cleanliness, infection control and hygiene was well managed with systems and processes to reduce and control the risk of cross infection.
  • All records were fully completed, legible, signed and dated. Systems were in place to ensure patients’ information was kept safe. Records audits were used to monitor the content and quality of patient’s records.
  • Medicines were managed in a way that kept patients safe, stored safely and recorded correctly. Patient group directions (PGDs) were completed and up to date.
  • The trust had limited participation in national audit for minor injury units but reviewed the service they provided for effectiveness.
  • Systems were used to report, investigate and learn from incidents. Staff understood their responsibility to report incidents and said they received feedback from incidents and saw changes in practice as a result.
  • The trust’s policies and services were developed to reflect best practice and evidence-based guidelines. We observed best practice guidance being followed.
  • Pain management was well organised and established as part of triage and treatment.
  • Patients’ consent to care and treatment was sought in line with legislation and guidance. Staff had a clear understanding of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and patient consent.
  • We observed that staff treated patients with kindness, dignity, and respect. Staff interacted with patients in a positive, professional, and informative manner. Staff members displayed understanding and a non-judgemental attitude when talking about patients who have mental health needs.
  • Staff understood the importance of relatives and carers in the treatment of some patients. Staff considered any communication difficulties and had access to support services and aids to ensure patients and carers understood the care and treatment provided.
  • Services reflected the needs of the local population and was responsive to patient’s needs. The Minor Injury Unit was open seven days a week between 8 am and 10pm. Patients could attend during open times without an appointment or any prior booking. The MIU staff worked across organisations to deliver effective care and treatment.
  • The minor injury unit took account of patients’ specific individual needs. Staff supported patients with complex physical needs and mental health needs to understand the care and treatment being provided.
  • Patients can access care and treatment in a timely way. The service delivered was flexible and creative to ensure the flow of patients through the department was maintained. We observed patients being treated promptly and there was evident team work between staff to ensure patients were booked in, triaged, treated and discharged quickly and safely.
  • Complaints were handled in accordance with trust policy and within the provided timescale. Changes to practice and learning opportunities were made because of issues raised.
  • Staff felt local leadership represented and enabled them, and hospital and divisional lead staff were accessible.
  • Staff were aware of the vision and strategy for the minor injury unit as well as the wider trust strategy. As part of the trust the MIU worked towards the ongoing support of patients with mental health needs.
  • There was a strong ethos of teamwork and staff felt very well supported. Staff told us they enjoyed their jobs and there was a culture of openness and honesty where they felt listened to and supported.
  • There was a structured and effective information governance management framework to monitor and develop the minor injury service. Governance arrangements demonstrated the processes through which unit to board reporting and continuous learning was achieved.
  • A local risk register was not in place in a standard template form risks were included as part of the emergency department and divisional risk registers and were overseen as part ofmedical services divisionalgovernance. This meant any risks of concern could be flagged to the divisional and trust board and learning shared across the hospital.

However:

  • Although a programme of mandatory training was provided for all staff to keep patients safe, mandatory training compliance did not meet the trust’s target of 75% completion.
  • Security systems were under consideration to ensure safety of staff and patients. The estates department and trust health and safety representatives were aware that alarm systems used during working hours, which had been previously suitable, were no longer appropriate.
  • Out of hours and at weekends, when reception staff were not employed, there was a risk that patients’ initial assessment may be delayed, because nursing staff were seeing other patients. However, Patients in the minor injury units were kept safe during normal daily opening hours because they received prompt assessment and treatment.
  • Delays to patients being transferred in emergencies, by ambulance to the acute hospital, were not raised as incidents or monitored. This was currently being considered to identify any trends for action. However, patients who required transfer were monitored in the MIU until the transfer was possible.
Other CQC inspections of services

Community & mental health inspection reports for Honiton Hospital can be found at Royal Devon and Exeter NHS Foundation Trust.