You are here

Norfolk and Norwich University Hospital Requires improvement

We are carrying out checks at Norfolk and Norwich University Hospital using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 4th, 5th and 20th April 2017

During an inspection to make sure that the improvements required had been made

The Care Quality Commission (CQC) carried out this inspection on 4th, 5th and 20th April 2017. We undertook this inspection due to a number of whistle blowing contacts from staff in relation to regular movement of staff between wards to fill gaps in rotas, insufficient staff in some areas including medical wards, maternity and children’s services and allegations of bullying. At this inspection we found that some of these concerns remained amongst some staff groups we spoke with. However, progress had been made by the trust in recruiting additional nursing staff and used other staff to mitigate risks to patients. Information also showed a poor performance in some referral to treatment times and 5 never events reported between February 2016 and January 2017.

This inspection examined the key questions of safe, responsive and well led in medicine, surgery and children’s and young people services. We looked at all key questions (including effective and caring) in maternity and gynaecology.

We carried out a comprehensive inspection at Norfolk and Norwich University Hospital NHS Trust in November 2015 when the trust was rated as requires improvement.

The hospital opened in late 2001, having been built under the private finance initiative (PFI). Cromer and District Hospital was rebuilt by the Trust in 2012.

The trust provides a full range of acute clinical services plus further private and specialist services. The Trust has 913 acute beds, 210 day case beds and provides care for a tertiary catchment area of up to 1,024,000 people from Norfolk and neighbouring counties. The hospital also has an important role in the teaching and training of a wide range of health professionals in partnership with the University of East Anglia, University Campus Suffolk and City College Norwich.

Since our last inspection the trust had recruited further substantive executives and had no interim executives on the board. Whilst we found the trust had met our previous requirement notices for some concerns we had previously raised, they had failed to meet the requirement notices or make significant progress in the management of medicines and staff mandatory training.

Our key findings were as follows:

  • There had been a change in the operational structure at the hospital since our last inspection. There were now 4 divisions, the clinical divisions being headed by a chief of division, operations director and nurse director.
  • The attitude of staff remained excellent. All staff were helpful, open and caring in their manner. We found staff to be very ‘upbeat’ locally within ward and clinical teams.
  • There were examples of excellent leadership in the areas we inspected. Some had an excellent understanding of their area and were driven and committed in leading their teams to provide excellent care.
  • Whilst we only inspected effectiveness in maternity, we saw good examples of multidisciplinary working between clinical and non clinical staff in ward areas.
  • We have seen good overall improvements in maternity services.
  • Some good examples of record keeping were seen through ward and clinical areas.
  • Staff demonstrated a good knowledge of safeguarding principles though training levels for staff were well below trust target in some areas.
  • Mandatory training compliance was variable across the trust but in most of the areas we inspected, compliance was well below trust target.
  • Staff told us that concerns or positive ideas for improvement are reported to senior managers but whilst they felt these were listened to by their immediate managers it was lost in the ether above those managers.
  • Staffing at night remained a challenge with wards having less nursing cover than planned and frequent of movement of staff between wards to manage shortfalls of shifts. Staff also raised concerns regarding skill mix particularly when staff were moved to other wards at night.
  • A number of staff told us that they felt “bullied” to take patients that they felt were not appropriate for their area. This was predominantly out of hours. Matrons were able to advocate for junior staff during the day but when not available, staff felt under increased pressure to take these patients. We had a positive discussion about this with the trust and what they were doing to address these issues. The site team felt under pressure themselves from ward staff.
  • We found that staff were not always following policies, for example we found that emergency resuscitation equipment was not always checked daily and that fridge temperatures including those in theatres were not always checked and recorded. There was ongoing poor mandatory training compliance across the areas we inspected.
  • Almost all staff we spoke with were unaware of the speak up guardians at the trust. Some had used the whistleblowing/ speak up policy but experience of it was variable. Some felt it had worked and supported them others that it had not.
  • Ward staff report the executive team as not being visible in ward or clinical areas.
  • We found that quality checks on the WHO surgical safety checklist were not being completed; this despite there being four never events within the surgery service.

We saw several areas of outstanding practice including:

  • The children and young people’s service was proactive in clinical research. There were a large number of active research studies being undertaken throughout the children and young people’s service. This meant that the service was at the forefront of clinical innovation.
  • The hospital received funding January 2017 following a successful bid to the Department of Health’s Maternity Innovation Fund and the Maternity Safety Training Fund to provide additional training for staff. The Maternity Innovation Funding was for a new piece of simulation technology called ‘CTGi’ which replicates a baby’s heart rate pattern during labour. This piece of training technology will be used within clinical areas for both the midwifery and medical teams and supplement more traditional class room tutorials and e-learning programs.
  • The trust was about to launch the ‘Baby University’ scheme. Every new or expectant mum that signs up for the scheme will receive a Baby Box made from a very thick cardboard, a firm foam mattress, waterproof mattress cover and a cotton sheet. The scheme replaces the need for a traditional Moses basket or cot, and it is thought the small size of the Baby Box helps to prevent sudden infant death syndrome.
  • Cley gynaecology ward had a bereavement baby memento bag/box for parents, which contained a form to acknowledge the existence of a foetus born before it was viable (as a birth certificate could not be issued) and tiny hand knitted garments for stillborn babies to have photographs for parents.

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

Importantly, the trust must:

  • The trust must ensure that medication is stored in line with trust policy and that staff record medication refrigeration temperatures to ensure the safe storage of refrigerated medication.
  • The trust must ensure that resuscitation equipment in wards, theatres and other areas is checked in accordance with trust policy.
  • The trust must ensure that patient records are stored securely.

  • The provider must ensure staff complete appropriate mandatory training including safeguarding training to an level appropriate to their job role.

In addition the trust should:

  • Ensure that there are adequate medical and nursing staff and an appropriate skill mix to care for patients in line with national guidance.
  • The provider should ensure they regularly undertake observational audits or measurement of the quality of the World Health Organisation (WHO) five steps to safer surgery checklists and action any lessons learnt.
  • The trust should ensure it meets the referral to treatment time for specialities that do not meet the England average such s gynaecology.
  • Ensure staff follow infection prevention and control procedures and do not leave side room doors open when they should be kept closed to minimise the spread of infection.
  • The trust should ensure that maternity electronic discharge information is sent to general practitioners within 24 hours of discharge.
  • The trust should consider how they provide community midwives with access to information technology.
  • Review access to transitional beds for young people aged 16 to 18.
  • Ensure clinical staff receive training in sepsis protocols and procedures.
  • Ensure that staff caring for children in non-paediatric areas have appropriate safeguarding and resuscitation training.
  • Ensure morbidity and mortality meeting minutes include sufficient detail of background information, discussions and those in attendance.
  • Review the children’s assessment unit to address admission times, infection control concerns, and distance to transfer acutely unwell children from the emergency department.
  • The trust should ensure that it contributes to the national Maternity Safety Thermometer.
  • Review and ensure the effective management of community midwifery staff.

Professor Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 10-13 November 2015. Unannounced inspections on 20 and 25 November 2015

During a routine inspection

The Care Quality Commission (CQC) carried out a comprehensive inspection between 10 and 13 November 2015. We also carried out unannounced inspections on 20 and 25 November 2015. We carried out this comprehensive inspection at Norfolk and Norwich University Hospital NHS Trust as part of our comprehensive inspection programme.

This organisation has two main locations:

  • Norfolk and Norwich University Hospital, a large acute hospital comprising all acute services.
  • Cromer Hospital which offers surgical and outpatients’ services.

We also inspected Henderson unit as part of the unannounced inspection on 25 November 2015.

The hospital opened in late 2001, having been built under the private finance initiative (PFI). Cromer and District Hospital was rebuilt by the Trust in 2013.

The Trust provides a full range of acute clinical services plus further private and specialist services. The Trust has 1237 acute beds and It provides care for a tertiary catchment area of up to 822,500 people from Norfolk and neighbouring counties. The hospital also has an important role in the teaching and training of a wide range of health professionals in partnership with the University of East Anglia, University Campus Suffolk and City College Norwich.

Previous unannounced responsive inspection by the CQC took place between the 4th and 6th March 2015. The inspection focused specifically on accident and emergency services, capacity and demand, medical care and cancer services, surgery, and overall leadership of the trust. As this was a responsive inspection there are no ratings attached to our findings. However, concerns were raised about governance arrangements, Mattishall ward, the Fit and Proper Persons regulations and the bullying culture.

The trust had a relatively new executive team. The Chief Executive was appointed substantively in October 2015. At the time of inspection three other members of the team were interim positions; the Chief Operating Officer, Medical Director, and Director of Finance.

The comprehensive inspections result in a trust being assigned a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. Each section of the service receives an individual rating, which, in turn, informs an overall trust rating.

The inspection found that overall; the trust had a rating of requires improvement.

Our key findings were as follows:

  • Staff were overwhelmingly caring in delivering care to patients. We witnessed some outstanding examples of care being given to patients and their relatives.
  • There were shortages of nursing staff that impacted on care provided throughout the hospital.
  • There were some areas where there were medical vacancies which impacted on care. Most notably in the palliative care team and in the critical care complex.
  • Incident investigation and root cause analysis was not always completed by those with extended training.
  • The security on the children’s ward needed to be improved to ensure their safety.
  • There was a lack of understanding by staff around patients’ ability to consent to care and treatment.
  • The consultant body was cohesive, loyal to the hospital and proud to be working at the trust.
  • The service to patients having a heart attack was extremely good.
  • The communication with parents in the neonatal unit was very good. These included well written booklets.
  • The number of one stop clinics within the out patients department was responsive to the needs of patients.

We saw several areas of outstanding practice including:

  • A specialist, midwife-led ‘Birth reflections’ clinic was provided to support women who wanted to come to terms with their birth experiences.
  • Clinical reporting and scheduling system in cardiology (Intellect) has been developed locally allowing the service to be more coordinated and efficient.
  • There was an excellent primary percutaneous coronary intervention (PPCI) service which provided prompt, effective treatment in line with national guidance and demonstrated good working with other providers and professionals.
  • On Elsing ward we observed that the bays had been colour coded to assist patients moving around the ward and used single use knitted sensory bands were available. Holt ward had refurbished a room to 1950’s décor.
  • The nursing team within the emergency department demonstrated outstanding care, leadership and treatment of patients.
  • The innovation around trialling new ways and models of care including medicines administration within the emergency department, as well as the vision for the service was outstanding.
  • The outcomes for trauma were outstanding and the best in the region.
  • The local audit programme for nurses and medical staff within the emergency department was outstanding.
  • The governance risk management, learning arrangements and staff willingness to continually strive to be better for the patients in the emergency department was outstanding.

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

Importantly, the trust must:

  • Ensure that patient acuity is properly assessed and there are adequate medical, nursing and midwifery staff to care for patients in line with national guidance.
  • Follow infection control principles when cohorting patients.
  • Ensure that all children’s inpatient wards and units have adequate security measures in place to reduce the risk of children absconding and unauthorised adults gaining entry.
  • Ensure that incidents are investigated in a timely way by trained investigators, graded, and reported in line with current national guidance.
  • Ensure that the management of outliers on Cley ward are properly assessed and provided with safe care.
  • Ensure that the management of referrals into the organisation reflects national guidance in order that the backlog of patients on an 18 week pathway are seen.
  • Ensure that patient records are legible, accurate, complete and contemporaneous for each service user, taking into account the use of both hard and electronic records.
  • Review ‘do not attempt cardio-pulmonary resuscitation’ (DNACPR) forms to ensure they are completed fully and in line with trust policy and national guidance.
  • Review its Mental Capacity Assessment and Deprivation of Liberty Safeguarding (MCADOLS) process and the way this is documented within patients’ notes – Regulation 17(2) (c).
  • Ensure that staff within the radiology department have access to appropriate support, supervision and appraisal.
  • Ensure that compliance to mandatory training is met and ensure consistent compliance across all clinical staff groups. Ensure that training is relevant to meet the needs of those in specific roles such as staff in the mortuary.
  • Ensure that medicines are stored and administered in line with national guidance.
  • Review and improve the environment of the children’s emergency department to ensure that the environment is fit for purpose and safe for children to receive care.
  • Review the staffing of the children’s emergency department to ensure that there are sufficient numbers of registered children’s nurses on duty at all times.
  • Ensure that there is an increase awareness of the complexities of end of life care, including a defined strategy and vision, increased involvement and referrals to the specialist palliative care team (SPCT) and improvement in performance indicators specifically recognition of the dying patient.

In addition the trust should:

  • Closely monitor transfers to Mattishall ward and the environment should be improved in line with the development plan for the unit.
  • The trust should reconsider the ambulatory care pathway in the acute medical unit (AMU).
  • Review the availability of adequate equipment for patients to sit out of bed if clinically able to do so.
  • Review the permanent clinical leadership in AMU.
  • Ensure a robust process for checking of emergency equipment.
  • Review its risk management and escalation policies with respect to how clinical staff raise concerns and ensure these are acted upon appropriately.
  • Reduce readmission rates for children and young people with long-term conditions.
  • Review the provision of information technology for community midwifery teams
  • Review mechanisms for supervision and appraisal for all staff so that they are supported effectively.
  • Develop an action plan to address the lack of improvement in the completion of discharge information in the specific safeguarding children paperwork for use within the maternity departments.
  • Review the provision of adequate seating in the antenatal clinic.
  • Reduce the number of cancelled gynaecology clinics.
  • Review the ratified guidelines within the Obstetric Assessment Unit and ensure that it is located in an area where it can operate effectively.
  • Put procedures in place to reduce the number of closures of the obstetric unit.
  • Review the staff understanding of the vision and strategy for their areas.
  • Review fluoroscopy changing areas and process to ensure patient privacy and dignity is maintained.
  • Ensure that doctors within the emergency department adhere to bare below the elbow policy requirements.
  • Improve the culture amongst the consultant body within the emergency department.
  • Improve the culture of the organisation towards the emergency department to reduce the feeling of blame for targets not being achieved.
  • Review the bed management process and site management processes within the organisation to increase capacity and flow.
  • Improve systems and processes for the declaration of black alert to ensure that it contains tangible changes designed to improve the service, i.e. daily consultant or nurse led discharges.
  • Review the emergency department triage process to ensure that all patients are offered pain relief where it is required.
  • Review the plans for expanding the main emergency department and make a decision swiftly on the future expansion of the service. 

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 4th-6th March 2015

During an inspection to make sure that the improvements required had been made

The Care Quality Commission (CQC) undertook an unannounced responsive inspection between 4th and 6th March 2015. The inspection rationale related to an increase throughout 2014 of negative intelligence regarding various areas within the Trust. Therefore the inspection focused specifically on accident and emergency services, capacity and demand, medical care and cancer services, surgery, and overall leadership of the trust. As this was a responsive inspection there are no ratings attached to our findings.

The hospital was opened in late 2001 having been built under the private finance initiative (PFI). The Trust provides a full range of acute clinical services plus further private and specialist services. The Trust has 1099 acute beds and It provides care for a tertiary catchment area of up to 822,500 people from Norfolk and neighbouring counties. The hospital also has an important role in the teaching and training of a wide range of health professionals in partnership with the University of East Anglia, University Campus Suffolk and City College Norwich.

Previous inspection by the CQC took place on the 2nd and 3rd December 2013 and had resulted in one compliance action in respect of Regulation 17 HSCA 2008 (Regulated Activities) Regulations

2010 Respecting and involving people who use services.

Since Qu2, 2014 the Trust has been breaching on national targets, ED waiting times, Cancer services and referral to treatment time. This has increased pressure on the leadership and staff teams to meet targets and raised concerns that patient care may be affected.

Our key findings were as follows:

  • Capacity and demand was an issue for the Trust and there were a high number of delayed transfers of care. It was evident that the lack of community provision was a contributing factor. Escalation areas had been opened in response to capacity demands however plans were not yet well established in terms of ensuring a longer term improvement strategy for capacity and demand.
  • The trust had taken action in respect of capacity management in the emergency department on a day to day basis however a cohesive strategic plan for access and flow of patients was lacking.
  • Leadership within the Trust is fragmented and the capacity and target pressures have led to the Board being too operationally focussed and reactive resulting in an inconsistent management approach to staff at a local level
  • On the Acute Medical Unit (AMU) staff were unclear regarding best interest decisions and of their responsibilities under the Mental Capacity Act 2005.
  • At the time of our inspection, there was no evidence to demonstrate that any patients had suffered an adverse clinical outcome due to breaching cancer waiting times. However, there was a significant risk of emotional impact for those people not receiving treatment within specified guidelines. An improvement in performance had been forecast but we were not assured sufficient plans were in place to ensure sustainable improvement.

There were areas of improved practice:

  • The trust had completed and implemented an action plan with regard to the compliance action and significant improvements had been made. We judged that the Trust was now meeting this requirement and therefore have removed this compliance action.
  • Following a serious incident in 2014 regarding VTE risk assessment and treatment in patients undergoing day surgery the trust had put an action plan in place to address concerns arising from this incident. We found that this action plan had been completed appropriately and that learning and improvement had taken place.

The trust needs to make the following improvements:

  • The trust should ensure that there is a clear strategy to improve patient  access and flow through the emergency department and that there is a consistent management approach in response to high demand pressures.
  • The trust should ensure that all staff receives training on the mental capacity act and that this is continuously monitored.
  • The trust should consider how it can demonstrate clinical decision making in those patients records who are admitted to Mattishall Ward.
  • The trust should consider how it can demonstrate and provide assurance that improvement to cancer services and demand for services will be sustainable.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 2, 3 December 2013

During an inspection to make sure that the improvements required had been made

This inspection had a variety of intentions. Firstly, we looked to see that the hospital had made improvements following our previous inspection undertaken in March and May 2013. During that inspection we found that the hospital was not ensuring the safe and timely discharge of people in their care. We also found that the hospital was not co-operating effectively with other providers to protect service users from potential harms. The provider was responsive to our concerns and forwarded us a report detailing the actions they were going to take in order to make improvements.

During this inspection our enquiries into these improvements demonstrated that the hospital had taken the necessary steps to safeguard people using the service. These systems were in their infancy but we were confident that the hospital would continue to make advances to better the service they provided.

In addition, following a review of information that we had received or gathered since January 2013, we identified other areas where we had concerns. We therefore undertook a detailed inspection into these areas. This included looking at how people and their representatives were kept informed about their care and treatment. We looked at how people’s dignity was maintained. We also assessed the availability of some equipment within the hospital and looked at the systems in place to demonstrate the hospital worked effectively.

We found that, in general, safe care was provided to the people using this service. Equipment (such as pressure mattresses) was usually available and where this was not staff within the hospital took necessary steps to ensure it was provided to the people who needed it as soon as possible. Quality assurance systems demonstrated that effective processes were in place to identify and deal with risks associated with the running of the service.

As part of this inspection we also looked at the quality of care provided to support patients with dementia to maintain their physical and mental health and wellbeing as part of a themed inspection programme. This programme looked at how providers worked together to provide care to people with dementia and at people’s experiences of moving between care homes and hospital. The evidence collected was used to inform the judgements we made in this inspection report. In addition we have produced a separate (annex) report summarising the evidence we collected that related to dementia care at the hospital.

Inspection carried out on 15 March and 3, 9 May 2013

During an inspection in response to concerns

We received information that people had arrived by ambulance at the A&E department of the hospital and had remained in the ambulances for long periods of time before being treated in the A&E department. A visit was carried out between 6pm and 8pm on Friday 15 March 2013 to see if delays in people remaining in the ambulance had any effect on their safety, care and welfare.

We found that the hospital was managing the risk presented due to the higher than expected demand on the A&E department and that people were cared for safely and appropriately by the ambulance crew and designated assessment nurse whilst waiting to be treated in the A&E department.

A further visit was carried out on 3 May 2013 to look at how the hospital was working with other providers and stakeholders to ensure that people were being discharged from hospital in a timely manner. At the time of this visit we found that people were not always discharged from the hospital in a timely manner. We were told that the reasons why people were being delayed were being looked at by the hospital staff, commissioners and other providers of services and that action had already started to ensure people did not remain in hospital when they did not need to be there.

People who were waiting to move out of the hospital told us, “I have been well looked after and told regularly where I am going and when.” “I know I am late in leaving but my family have been looking for the best place for me.” “I have had lots of support about my discharge from the staff on the ward.”

Inspection carried out on 3 October 2012

During a routine inspection

During this inspection visit we spoke with 14 people who were able to answer our questions on the care, treatment and support provided to them during there stay in hospital. We looked at care plans that showed us individual records of consent to treatment signed by the person and care plans that were personalised for the individuals. These records included assessed potential risks and the action required to minimise those risks.

Those people we spoke with who used the service and visitors said they were very impressed with the cleanliness and hygiene standards they had witnessed. People said staff always cleaned their hands before and after they attended to anyone.

The areas we saw had been cleaned regularly, and a cleaning schedule was available at the entrance to the ward which demonstrated to visitors the frequency and type of cleaning.

We were told staff were quick to answer call bells so that people were attended to when required. The only time there may be a delay was when an emergency arose.

People who were attending the hospital through the accident and emergency department (A&E) and were kept waiting were supported by staff who regularly attended and assessed those waiting, ensuring people with high level needs were prioritised.

During mealtimes, staff were allocated to serving and assisting with meals. This ensured that there were sufficient staff to provide people who required assistance with a relaxed and comfortable mealtime.

Inspection carried out on 21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Inspection carried out on 19 January 2012

During an inspection to make sure that the improvements required had been made

During this visit we only spoke with people admitted to the wards about their care plan records and how they were involved in completing their records.

The people we spoke with told us they had been asked about the amount of food and drink they had consumed and that staff had explained to them why it was important to keep accurate records of what they had consumed.

We did not ask direct questions about other records during this visit.

Inspection carried out on 7 October 2011

During a routine inspection

During our visit on 07 October 2011 people told us that staff were good at promoting their privacy and dignity. They told us that they had been kept well informed about their health and had been involved in any decisions made about their treatment. They told us that they had been given good information about what will happen when they leave hospital.

We were told by people on the maternity ward that they could not fault the support the hospital had given them during their stay. They told us that they knew exactly what was happening, why it was happening and what the plans were for their stay and then their discharge home. They said “I feel fully involved and not at all awkward when asking questions.”

People on one ward with whom we spoke told us that staff were very good and responded to their needs well. They said that “staff can’t do enough for you”. They also told us that staff were very busy and they had to sometimes wait for up to ten minutes for a response to a call bell. Yet another person accommodated in a side room told us “I can ring the bell at anytime and get the help I need. I never have to wait long.”

People we spoke with after the lunch meal had been served told us “The food is alright most of the time but sometimes it is not very good” and “The food is pretty fair, we get a choice from the menu and it is hot.” People told us that they got enough to eat and one person stated “When my food got cold because I was called away for a treatment my meal was replaced with a hot meal.” On the maternity ward we were told how pleasantly surprised people were by the quality and choice of the food provided which was hot and tasty.

We were told that although staff were very busy they were very caring. One person told us, from their own observations, how staff spent time with people who were very poorly and could not communicate. She said that staff would spend time sitting with people, perhaps stroking their hand or cheek to offer reassurance and try to connect with them.

New mothers on the maternity ward had nothing but praise for the staff. They gave us good examples of how staff had spent time guiding and explaining how to care for their baby. We were told, “I was anxious but am now reassured.” One mother said that she had been offered an extended stay to ensure she was confident in managing breast feeding before she was discharged.

People staying in the hospital told us that they were asked if they were satisfied with the nursing care and support they received. They also said “I have been given a questionnaire to fill in mostly about the food but also about the care I have received.”

Inspection carried out on 23 March 2011

During a themed inspection looking at Dignity and Nutrition

The people with whom we spoke told us that they were listened to and were given the opportunity to express their views about their care, support and treatment. Some people were complimentary about the medical staff, they said that staff were always kind and made comments such as ‘I am very happy with the care I am given’ and ‘I have no complaints at all’. One person told us that staff called them by their first name, which they preferred and that they had been fully informed of any care, treatment or action that was to take place.

When we asked people using the service about the food they were provided with during their stay they told us that there was a choice of food and that the meals were served hot. One person told us ‘I am so well known by the ward staff that all my meal requirements are met without question.’ and ‘The mealtimes are pleasant and there is plenty of choice’. However, we were also told by one person they required a soft diet but were given hard carrots. Two other people said that ‘too much mince is used’ and ‘not enough fish offered’.

Inspection carried out on 3 August 2010

During an inspection to make sure that the improvements required had been made

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.