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Inspection Summary


Overall summary & rating

Updated 26 October 2016

Following a focussed inspection carried out in March and April 2016 where a warning notice was issued, we found that:

  • The hospital had made improvements and progress occurred against the requirements of the warning notice on how the observations had been carried out. All four wards had an observation policy that had been reviewed in June 2016 and the general observations across the hospital were now carried out every 30 minutes.

  • The hospital monitored and had a system in place to ensure that staff had read the policy and signed it. Staff followed the policy and demonstrated a good understanding of the policy. The hospital carried out audits to monitor that staff were carrying out observations in line with the trust’s policy. The manager regularly reviewed closed circuit television (CCTV) to ensure that staff followed good practice.

  • The hospital provided us with information that showed that they were monitoring staffing levels. The information demonstrated that the hospital was above their budgeted staffing levels. Patients and staff told us that they felt safe. The hospital reviewed staffing levels daily and used bank staff when necessary.

  • The hospital offered patients 25 hours a week of planned meaningful activities. The hospital monitored the uptake of all patients. Those that achieved less than 25 hours of activities were monitored closely with a view to increasing uptake of activities.

However:

  • Staff on Jade ward used additional codes that were not on the policy forms to specify certain locations or activity. Staff on Alford ward omitted to use the location codes on a number of occasions particularly at night. Three clocks on Emerald ward showed different times.

  • Two staff from women’s services reported that they did not get breaks from observations when on night shifts.

  • Eight patients and seven staff across all four wards told us that low staffing levels occasionally led to activities being cancelled and staff moved around wards. The management deployed therapeutic involvement workers from the resource centre on the wards to cover for staff shortages.

Inspection areas

Safe

Updated 26 October 2016

We found that:

  • Staff followed the policy and demonstrated a good understanding of the policy. The trust provided training on the observations policy to staff. The hospital monitored and had a system in place to ensure that staff had read the policy and signed it.

  • Patients told us that staff always carried out their observations and were not left unobserved when on enhanced observations. The doctors reviewed patients on one to one observations on a daily basis.

  • The hospital regularly monitored that staff carried out observations in line with the trust’s policy.

  • The hospital monitored and reviewed staffing levels on a daily basis and recruited staff above their budgeted staffing levels. Patients and staff told us that they felt safe. The hospital used bank staff when necessary to ensure that staffing levels were maintained at safe levels.

However:

  • Staff on Jade ward used additional codes that were not on the policy forms to specify certain locations or activity. Three clocks on Emerald ward showed different times.

  • Two staff from women’s services reported that they did not get breaks from continuous observations when on night shifts.

  • Eight patients out of 17 and seven out of 19 staff across all four wards told us that activities were occasionally cancelled due to staff shortages and staff were moved around wards.

Effective

Updated 26 October 2016

Caring

Updated 26 October 2016

Responsive

Updated 26 October 2016

We found that:

  • The hospital offered patients 25 hours a week of planned meaningful activities. The hospital monitored the uptake of all patients. Those that achieved less than 25 hours of activities were monitored closely with a view to increasing uptake of activities.

  • The hospital monitored patient engagement to their planned therapeutic, leisure, social and educational activities. The hospital was to introduce a new electronic reporting system to monitor closely individual reasons for not attending activities.

However:

  • Patients and staff told us that activities were reduced in summer time and that the resource centre was closed.

Well-led

Updated 26 October 2016

Other CQC inspections of services

Community & mental health inspection reports for Rampton Hospital can be found at Nottinghamshire Healthcare NHS Foundation Trust.