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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

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

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

There were not enough qualified, skilled and experienced staff to meet people’s needs on the AAU. The Trust had not provided one to one clinical supervisions to staff and there is a low ratio of appraisals for doctors. Therefore the trust cannot evidence that that they have enough qualified, skilled and experienced doctors to meet people’s needs.

Reasons for our judgement

At our last inspection we identified concerns in relation to staffing in the maternity service. We viewed the staffing recruitment and action plan for the service. We also viewed the rotas for the service. We found that the trust had sufficient recruited staff and had appropriate numbers of people on shift. This meant that there was now enough qualified, skilled and experienced staff to meet people’s needs.

On the AAU in the green, six bedded, bay we observed that medication rounds were not protected to enable the nurse to concentrate on that important task alone, due to insufficient staffing levels on the day of our inspection. Medication protocols were for the items to be given at set times and times noted on the patients charts. Within the AAU Green bay we observed the staff being called away during a medication round to assist with care. We were told that in Green bay that they were short of staff due to sickness, the rota had been changed to ensure all bays were covered however the unit was extremely busy. We spoke with three people in the green bay who told us that staff were called away in between giving medication. This meant that medication administration was delayed due to the unavailability of staff. We spoke with the Director of Nursing about the green bay who assured us they had the staff numbers, but the responsibilities on the unit may not have been prioritised appropriately.

We were shown an induction programme for a recently appointed member of staff. This included a general orientation to the ward in order to learn more about how patients were cared for and supported. We found on the AAU that new staff shadow an experienced staff member for three weeks and undertake four night shifts. These supernumerary shadow shifts include understanding paperwork and how to undertake medication rounds. This meant that new staff on duty were able to provide care, upon commencement of active duty, with sufficient skills to meet people’s needs.

We noted in the afternoon that there were two beds in the corridor outside triage in the emergency department. We were told that these were only allowed in the corridor for a maximum of 1 hour and only if a bed was becoming available. When these beds were used the triage area had an additional nurse supplied to support people’s needs. The senior nurse on duty told us that they had enough staff in triage, medication round was protected because there was always enough staff and staff were able to take breaks.

We spoke with 40 members of staff during our inspection. We asked 22 if they had received appraisals or supervision. Most told us that they had received an appraisal, however all told us that they had not received a formal one to one supervision. They all told us that they felt like to they could go to their manger and discuss any concerns that they may have when they needed to. We asked the Chief Nurse about this who confirmed that people had appraisals but was unable to evidence that people had clinical supervisions. We viewed the appraisal data for the trust which showed a high ratio of annual appraisals completed. However we were not assured that staff skills, qualifications and experience were sufficiently monitored to ensure that safe care was provided to people who used the service.

For medical staff we found that there was a low number of doctors who had been appraised. We spoke with three doctors who told us that they had an appraisal but could not recall when. Not having an appraisal formally documented can affect the revalidation of doctor’s registration with the General Medical Council (GMC.) The Medical Director provided us with information and an action plan to demonstrate that they would get doctors appraisals completed. This meant that there is a risk to the professional practice of doctors currently. Without appraisals the trust cannot evidence that that they have enough qualified, skilled and experienced doctors to meet people’s needs.