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Watford General Hospital Requires improvement

All reports

Inspection report

Date of Inspection: 17 December 2013
Date of Publication: 21 January 2014
Inspection Report published 21 January 2014 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)

Meeting 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

We looked at the personal care or treatment records of people who use the service, carried out a visit on 17 December 2013, observed how people were being cared for and talked with people who use the service. We talked with staff, reviewed information given to us by the provider, reviewed information sent to us by other regulators or the Department of Health and talked with other regulators or the Department of Health. We were accompanied by a specialist advisor.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Our judgement

In most cases we observed that people’s privacy, dignity and independence were respected. People who use the service were given appropriate information and support regarding their care or treatment.

Reasons for our judgement

In general people were very satisfied with the care and treatment they had received and in most cases were very complimentary about the attention and attitude of staff towards them. Comments included, “The staff are wonderful,” “Staff are brilliant, I couldn’t fault them.” “It’s constantly busy but nothing is too much trouble for them.”

We observed that although the wards were busy staff remained calm and spoke with people in a courteous manner. We saw that men and women were accommodated in separate bays and curtains were drawn to maintain people’s privacy and dignity so far as possible. We observed a doctors ward round. The provider may find it useful to note that although curtains were drawn around the bed when the doctors were talking to the person, we could hear conversations that were of a confidential nature taking place. This meant that people’s privacy could be compromised.

There were instances brought to our attention where maintaining people’s dignity may have been compromised. For example we observed a staff member walk over to a patient in a bay. They proceeded to provide a treatment to them without drawing the curtains and we also observed that they did not speak to them or explain the treatment being provided. The provider may find it useful to note that we raised our concerns around this patient being treated with dignity and respect to the Director of Nursing who assured us that the matter would be addressed.

We examined a ‘Do Not Attempt Resuscitation’ (DNAR) order that had been written for one patient. There was evidence in the person’s records that a discussion had taken place with the person and their relative. These discussions surrounded what treatment would be given should their health deteriorate and what was in the person’s best interests. This meant that the person and their relative were involved in important decisions surrounding treatment and care.

We spoke with one person who told us, “They have been really good. I was very frightened when I came in. They have explained everything in a way I can understand.” Another person told us, “They provided me with lots of information, and I have seen the doctor a few times.” We viewed the boards at the entrance of each ward and department which provided information about the ward, the service and where to ask questions should the patient wish to talk to a staff member. This meant that people who used the service were given appropriate information and support regarding their care or treatment.

We used the Short Observational Framework for Inspection (SOFI) to observed care on Croxley, Sarratt, Ridge Ward and the AAU. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Overall we observed that most people were treated kindly, with dignity and with respect. For the majority of the observation periods we observed positive interactions between people and the staff. In one example we observed a nurse patiently explain to a person where they were as they comforted them because they were upset. We saw several members of staff kneel or squat so that they were level with the person in their bed or chair before they spoke with them.

We saw a form used to record observations of people who were confused and were recorded as likely to forget where they were. The form was entitled, ‘Wanderer Watch.’ One member of staff explained that they provided one to one support to a person with dementia. They told us, that the person was a, “Wanderer and is at risk of falling so has to have someone here all the time.” The provider may find it useful to note that although awareness was raised with regard to people who required extra observation, the use of the phrase ‘Wanderer’ is a practice that may lead to people being ‘Objectified’ and risks the loss of their individuality and identity.

The ‘White Suite’ is a 16 bedded ward that provided care for people with dementia. It opened at the beginning of December 201