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Inspection Summary


Overall summary & rating

Good

Updated 17 October 2019

Our rating of services stayed the same. We rated it them as good because:

  • We rated medical care and outpatients services as good. We rated safe as requires improvement in medical care services.
  • Staff protected patients from abuse, assessed risks to patients and responded accordingly. Records were kept up to date and were available when staff needed them.
  • Staff worked well together to provide good quality care to patients. They provided evidence based care and treatment and managers used performance measures to monitor patient outcomes and improve services.
  • Services were planned to meet the needs of local people. Staff took account of people’s individual needs when planning care and treatment.
  • There was good local leadership and staff felt supported and valued by their managers.

However;

  • There were some areas for improvement which can be found within the core service reports.
  • Within medical care, there were not always enough staff to provide good quality care to patients. There were frequently fewer staff than had been planned.
  • There was limited visibility of senior leaders within the trust who were not based at Clifton Hospital.
Inspection areas

Safe

Good

Updated 17 October 2019

Effective

Good

Updated 17 October 2019

Caring

Good

Updated 17 October 2019

Responsive

Good

Updated 17 October 2019

Well-led

Good

Updated 17 October 2019

Checks on specific services

Medical care (including older people’s care)

Good

Updated 17 October 2019

Our rating of this service stayed the same. We rated it as good because:

  • The service had systems and processes in place to ensure the environment was clean, and patients were protected from infection.
  • The environment was comfortable and fit for purpose with necessary equipment in good working order, ready for patient use.
  • Staff knew how to keep patients safe and knew how to respond if a patient became unwell. Staff used risk assessments to put patients on correct pathways of care.
  • There was good access to a range of food and drinks and patients commented positively on food choices.
  • Patients’ pain levels were assessed regularly and controlled.
  • Staff had good knowledge of the Mental Capacity Act and we saw evidence that staff sought consent of patients for caring interventions.
  • There was effective and co-ordinated working between different types of staff to benefit the patient journey through the service.
  • Staff were caring, and respected patients’ privacy and dignity. We saw many examples of where staff had ‘gone the extra mile’ to make patients feel comfortable and at ease.
  • The service worked hard to meet the needs of vulnerable patients and we saw many examples of how they had done this.
  • The service worked well with local agencies to improve support for patients on discharge and to reduce the number of patients returning to hospital unnecessarily.
  • Leaders had the right skills and abilities to run the service.
  • Staff were aware of what the service was trying to achieve and felt supported by their managers.
  • Managers engaged well with patients and staff and acted on feedback.
  • Managers were aware of the top risks to the service, which echoed the views of staff.

However,

  • We found that not all shifts were covered by qualified nurses, and the skill mix of staff on duty could be improved.
  • The service did not meet its own target for compliance rates of mandatory training for nursing staff.
  • The service did not ensure medical staff completed mandatory training.
  • Best practice guidance was not always followed for medicines administration.
  • At times patients who did not meet the admission criteria were admitted to the service, which put extra demands on staff and exacerbated staffing pressures.
  • The service did not meet its own target when responding to complaints.

A different clinical division had responsibility for the medical staff.

Outpatients

Good

Updated 17 October 2019

Our rating of this service stayed the same. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. The service controlled infection risk well. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available five days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

However:

  • Staff did not always effectively record risks to patients, such as allergies. There was a risk that staff would not have the information readily available to enable them to minimise risks. Care records were not kept well, and patient records were not always available at all times to staff.
  • Leaders were not always visible and approachable in the service for patients and staff. They supported staff to develop their skills but there were limited opportunities for staff to take on more senior roles.
  • Staff did not understand or were not aware of the service’s vision and values.