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Ellesmere Port Hospital Good

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 29 June 2016

Ellesmere Port Hospital is part of Countess of Chester NHS Foundation Trust and provides medical care services, outpatient services, rehabilitation and intermediate care to patients over 65 years age. Patients admitted to this hospital no longer require acute medical support.

It has approximately 56 beds over three ward areas, of which one has shared care arrangements with other community providers.

There is a small outpatient facility which is shared with other community services that includes an ultrasound room and a plaster room. The x-ray department is close by with two rooms available.

We visited Ellesmere Port Hospital as part of our announced inspection of Countess of Chester NHS Foundation trust on 16th to 19th February 2016. During this inspection, the team inspected the following core services at Ellesmere Port Hospital :

  • Medical care (including older people's care)
  • Outpatients. We inspected but did not rate this service at Ellesmere Port Hospital.

Over- all we rated Ellesmere Port Hospital as ‘good’. We rated it good for being safe, effective, caring, responsive and well- led.

Our key findings were as follows:

Cleanliness and infection control

  • The trust had infection prevention and control policies and procedures in place which were accessible to staff at this hospital.

  • Staff followed good practice guidance in relation to the control and prevention of infection in line with trust policies and procedures.

  • We observed staff following hand hygiene practice, bare below the elbow and using personal protective equipment (PPE) appropriately.

  • There had been no cases of MRSA bacteraemia reported at Ellesmere Port hospital and one reported case of Clostridium difficile from April 2015 to November 2015.

  • Side rooms were used as isolation rooms to support patients and increased risk of cross infection. There was clear signage outside the rooms so staff and visitors were aware of the increased precautions they must take when entering and leaving the room.

  • Some areas were dusty is outpatient clinic rooms.

Nurse staffing

  • The hospital undertook biannual nurse staffing establishment reviews as part of mandatory requirements and set key objectives though this work to support safer staffing.Data provided as part of this review in January 2016 identified that over-all the hospital had maintained over 95% of staffing levels planned against actual levels for nine months.

  • Nursing staff in the departments worked effectively across both sites to meet the demands of the service. The outpatient’s department’s staff included registered nurses and dental nurses, advanced practitioners and health care assistants.

Medical staffing

  • Medical treatment was delivered by skilled and committed medical staff.

  • The information we reviewed showed that medical staffing was generally sufficient at the time of the inspection.

  • A middle grade and senior house officer (SHO) provided a presence Monday to Friday with SHO cover Saturday & Sunday morning.  Three care of the elderly consultants  provided a ward round weekly.

  • There were no consultant vacancies in elderly care across medical services trust wide however there were 7 trainee grade Dr vacancies.

Mortality rates

  • Mortality and morbidity reviews were held in accordance with trust policies and were underpinned by policies and procedures. All cases were reviewed and appropriate changes made to help to promote the safety of patients. Key learning Information was cascaded to staff appropriately.

  • The Summary Trust-level Mortality Indicator (SHMI) is a set of data indicators, which is used to measure mortality outcomes at trust level across the NHS in England using a standard and transparent methodology. The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die based on average England figures, given the characteristics of the patients treated at the hospital. Between August 2014 and July 2015 the trust score was 103, which was slightly higher than the national average.

  • Notably the hospital had achieved a “B” rating for the Senital Stroke National Audit Programme (SSNAP) in 2014, which was a significant improvement from an “E” rating in 2013. The stroke service had been recognised regionally for using innovation to improve outcomes for patients

Nutrition and hydration

  • There were systems in place to ensure that patients nutritional and hydration needs were met.

  • Nutritional risk assessments (MUST) were completed on all of the patient’s records we reviewed although some were not weekly as per trust policy.

  • Patients requiring monitoring of their fluid balance had red lids on their water jugs to act as a visible reminder to staff.

  • Dieticians visited Ruby and Diamond wards daily and would review patients the same day if the referral was urgent.

  • Patients had access to dementia friendly crockery to assist with eating and drinking and promote independence.

We saw several areas of outstanding practice including:

  • The Stroke service were recently awarded Innovative Team of the Year 2015 by North West Coast Research and Innovation Awards for the work the team had undertaken to develop a robust auditing tool.

  • The trust was working collaboratively with other agencies in delivering the ‘discharge to assess’ (D2A) project which included introduction of frailty ward at the Countess of Chester hospital and the GP led ward at Ellesmere port hospital.

  • The trust were rolling out care and comfort worker roles to work across the wards to assist patients with nutrition andhydration feeding, and any other basic assistance including getting newspapers.

However, there were also areas of poor practice where the trust needs to make improvements.

The trust should:

  • Ensure changes are made to improve the layout of ward areas to allow patients to be cared for in a safe environment.

  • Ensure that all staff receive mandatory training including mental capacity act training.

  • Ensure all staff are aware of escalation pathways and standard operating procedures.

  • Ensure the electronic paper records system is robust and staff are sufficiently trained.

  • The trust should ensure that all resuscitation equipment is checked and positioned appropriately in order that it is available in an emergency situation.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 29 June 2016

Effective

Good

Updated 29 June 2016

Caring

Good

Updated 29 June 2016

Responsive

Good

Updated 29 June 2016

Well-led

Good

Updated 29 June 2016

Checks on specific services

Medical care (including older people’s care)

Good

Updated 29 June 2016

We rated services as good because:

  • The ward areas were visibly clean and spacious.

  • Staff followed good hygiene practices and there were good systems for handling and disposing of medicines.

  • There was good evidence of multidisciplinary team working with regular meetings held to review patient’s on going development and needs.

  • Incidents were reported through effective systems and lessons learnt or improvements made following investigations were shared.

  • Staff were aware of their role and responsibilities around the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. A very small number of staff across the wards were identified by the trust as requiring Mental Capacity Act training.

  • Staff had access to information they required, for example diagnostic tests and risk assessments.

  • Best practice guidance in relation to care and treatment was followed and medical services across the trust participated in national and local audits and action plans formulated following the results of audits.

  • Care provided was patient centred with patients were involved in their care and planning individual goals.

  • Patients were observed receiving compassionate care and their privacy and dignity were maintained.

  • Staff were passionate about their work and felt supported and part of the team.

However,

  • Planned staffing levels on the wards during the day were not always sufficient, however bank and agency staff were used on a regular basis to support safe staffing levels.

  • Compliance with mandatory training was not all above target

  • The geographical lay out of the wards along with complexity of some patients was not ideal as many patients could not be observed from the nurses station. Staff on the wards managed the situation by placing those patients at a higher risk in zoned areas.

  • There were issues with access and flow across the trust with high bed occupancy rates and there were 4 escalation beds in use at the hospital.

  • At the time of our inspection nearly a third of all patients at the hospital were unable to be discharged due to waiting for services to become available in the community.

Outpatients and diagnostic imaging

Insufficient evidence to rate

Updated 29 June 2016

  • The outpatient department was a space that is shared with other local community services during out of hour’s periods.

  • There is some clinic and radiology activity, however; the main outpatient and radiology activity, took place at the Countess of Chester Hospital. As a result, we have reported our findings for the safe and well-led sections, however; not rated the service.

  • Systems were in place for the maintenance of equipment.

  • We observed that some aspects of outpatient rooms and medical equipment at Ellesmere Port hospital were shared with other organisations.

  • The checking of resuscitation equipment at Ellesmere Port hospital and processes for managing the outpatients and x-ray departments were not robust.

  • Patients’ records were maintained on paper ad via electronic systems, although; plans for changes in electronic systems were in place.

  • There was a clear vision and strategy for the future.

  • The management teams were stable and committed to patient well-being in both outpatients and diagnostics despite challenges.

  • There were governance processes embedded with action plans in progress to improve services.

  • There were regular meetings, at all levels. Staff felt supported by their line managers and there was good team working in the departments.

  • There were several innovations taking place with plans to increase services.

  • There was a sharing of facilities that contributed to a lack of ownership for the department.

  • The outpatient department was a space that is shared with other local community services during out of hour’s periods.

  • There is some clinic and radiology activity, however; the main outpatient and radiology activity, took place at the Countess of Chester Hospital. As a result, we have reported our findings for the safe and well-led sections, however; not rated the service.

  • Systems were in place for the maintenance of equipment.

  • We observed that some aspects of outpatient rooms and medical equipment at Ellesmere Port hospital were shared with other organisations.

  • The checking of resuscitation equipment at Ellesmere Port hospital and processes for managing the outpatients and x-ray departments were not robust.

  • Patients’ records were maintained on paper ad via electronic systems, although; plans for changes in electronic systems were in place.

  • There was a clear vision and strategy for the future.

  • The management teams were stable and committed to patient well-being in both outpatients and diagnostics despite challenges.

  • There were governance processes embedded with action plans in progress to improve services.

  • There were regular meetings, at all levels. Staff felt supported by their line managers and there was good team working in the departments.

  • There were several innovations taking place with plans to increase services.

  • There was a sharing of facilities that contributed to a lack of ownership for the department.