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Royal Preston Hospital Requires improvement

Reports


Inspection carried out on 27 to 30 September 2016

During a routine inspection

Royal Preston Hospital provides a full range of district general hospital services including Emergency Department, critical care, general medicine including elderly care, general surgery, oral and maxillo-facial surgery, ear nose and throat surgery, anaesthetics, children’s services, women’s health and maternity, and several specialist regional services including cancer, neurosurgery and neurology, renal, plastics and burns, rehabilitation, and the major trauma centre for Lancashire and South Cumbria.

The hospital has around 700 beds, operating theatre complex, outpatient suites, and education facilities.

We inspected the hospital as a follow up to the inspection in July 2014 where the hospital was found to require improvement in the safe, responsive and well led domains and good in the effective and caring domains. We visited Royal Preston Hospital between 27 and 30 September 2016.

Following this inspection we have rated the hospital as requires improvement overall and the trust needs to make improvements. Staff were noted to be caring and patient focused and the caring domain was rated as good in all service areas. 

We saw several areas of outstanding practice including:

In Outpatients and diagnostic imaging the introduction in dermatology of a computerised diary colour codes patients by procedure enabling the service to plan a block of 12 week care in one go to suit the requirements of each patient. It also flags and calculates potential breeches giving better patient flow, facilitating comprehensive audit of care provision and outcome of treatment.

In Critical Care the trust had launched the Sleep Improvement in Adult Critical Care Programme. Disturbed sleep in critical care patients is associated with delirium, in which patients become confused, restless and experience hallucinations. This can delay their recovery from critical illness. The trust recognised this and identified the potential disturbances to sleep. To minimise disruption to patients during the night, they offered eye masks and earplugs, dimmed lights, anticipated empty infusion alarms, turned down the volume on medical equipment and phones and encouraged staff to talk away from the bedside. Staff were also reminded to check regularly for signs of delirium. The project and associated resources were shared with neighbouring critical care networks and at national meetings. An initial research study showed that making small changes caused a 50% reduction in patient delirium and significantly improved the quality of sleep experienced by patients. The study had won an initiative award at the National Nursing Times Awards.

However there were areas for improvement. 

Importantly, the hospital must:

In Urgent and Emergency Care services

;

  • Ensure access to the main entrance paediatric waiting area is limited to reduce the risk of children exiting the area through the automatic doorway.
  • Ensure intravenous fluids are stored securely and daily checks are completed with actions to address issues identified, completed.
  • Ensure mandatory training, including safeguarding, compliance reaches and consistently achieves the trust target.
  • Ensure clinical staff are aware of and adhering to the requirement for senior review of specific patient groups prior to discharge from the ED
  • Ensure appropriate signage is displayed in areas where close circuit television cameras are used.
  • Ensure action plans following CEM audits target areas of poor performance and improve practice.
  • Improve performance, particularly in relation to the department of health four hour target; wait times following a decision to admit, ambulance handovers.
  • Ensure version control for policies, procedures and guidance is robust and that these are kept up to date and reviewed regularly.
  • Ensure the department has a dedicated risk register with start dates, timelines, mitigating action and responsible person with review dates included.

In Medicine;

  • Ensure that all staff receive appraisals and complete mandatory training to enable them to carry out the duties they are employed to perform.
  • Ensure that records are kept secure at all times, so that they are only accessed by authorised people.
  • Ensure procedures in place around medicine management are robust and that policies are followed.
  • Ensure the risk registers are consistent and demonstrate mitigating actions and review dates

In Surgery;

  • Take appropriate actions to improve staff training compliance in areas such as safeguarding training and life support training.
  • Take appropriate actions to ensure that patients requiring escalation, as part of the national early warning score system (NEWS), are appropriately escalated by staff.
  • Take appropriate actions to improve compliance against 18 week referral to treatment standards.
  • Take appropriate actions to reduce the number of cancelled operations and the number of patients whose operations were cancelled and were not treated within the 28 days.

In Maternity and Gynaecology;

  • Ensure midwifery and support staffing levels and skill mix are sufficient in order for staff to carry out all the tasks required for them to work within their code of practice and meet the needs of the patient.
  • Ensure  there is a safe system for protecting babies from abduction.
  • Ensure all necessary staff completes mandatory training, including Level 3 safeguarding training and annual appraisals.
  • Ensure that the assessment and mitigation of risk and the delivery of safe patient care is in the most appropriate place.
  • Complete risk assessments for midwives carrying medical gases in their cars and develop a Standing Operating Procedure (SOP) or protocol for carrying medical gases by car.
  • Ensure that all staff receive medical devices training to ensure all equipment is used in a safe way.

In Critical Care;

  • Ensure that escalation procedures are followed appropriately across the hospital where patients’ National Early Warning Scores (NEWS) are greater than five and the patient may need to be assessed for admittance to the critical care unit.
  • Ensure that any patients admitted to Ward 2A, who are assessed as Level 2 high dependency patients, receive nursing care at a ratio of 1:2 in accordance with national standards.
  • Address action points on a gap analysis that showed that there was no availability for endoscopy for urgent gastro intestinal bleeds 24 hours a day.

In Children and Young People’s services;

  • Ensure that staffing levels in neonatal and children’s services are maintained in accordance with national guidelines.
  • Ensure that all relevant staff having regular contact with children, as defined by intercollegiate guidance, complete level three safeguarding training.
  • Ensure that indicators for managing the changing condition of ill children are consistently used and responded to appropriately on the children’s ward.
  • Ensure that the isolation room used on the children’s ward is free from access to ligature points
  • Ensure that patient records are kept securely in the children’s out patients department.
  • Ensure that checks on emergency resuscitation equipment, are completed and accurately recorded on the neonatal unit.
  • Ensure that secure access to the neonatal unit and children’s ward is maintained at all times by staff, parents and visitors.

In Outpatients and Diagnostic Imaging;

  • Ensure that clear processes and structures are in place for the management and reviewing of governance, quality and risks.
  • Review the processes for managing access and flow for outpatient services to ensure patients are not put at risk.
  • Ensure staff complete mandatory training as per the trust policy.

In addition the trust should:

Urgent and Emergency Services

  • The service should work to embed the forthcoming escalation process to support staff when capacity issues arise.
  • The service should have access to information in languages other than English
  • The service should improve attendance at monthly ED safeguarding meetings

Medical Care (including older peoples care)

  • The service should ensure that patients are discharged as soon as they are fit to do so.

  • The service should ensure that patients are not moved ward more than is necessary during their admission and are cared for on a ward suited to meet their needs.
  • The service should consider improving the environment of the discharge lounge to maintain patient’s privacy and dignity.
  • The service should ensure that patients have access to pressure relieving equipment at all times.
  • Consider implementing formal procedures for the supervision of staff to enable them to carry out the duties they are employed to perform.

Surgery

  • The service should take appropriate actions to maintain safe nurse staffing levels across the surgical wards.
  • The service should take appropriate actions to improve the general environment in the theatre areas.
  • The service should take appropriate actions to improve staff appraisal completion rates.
  • The service should take appropriate actions to improve infection rates following knee replacement surgery.

Critical Care

  • The trust should ensure intravenous fluids are stored appropriately and are not accessible to patients or visitors on the critical care unit.
  • The trust should make every effort to secure funding to expand the critical care unit in order to bring bed spaces within the recommended guidelines, make the flooring safe and to reduce the level of bed occupancy.
  • The Critical Care Governance Team should follow up the request for a review of the risk rating of the lack of a specialist critical care trained pharmacist on a weekend.
  • The trust should ensure that all staff in critical care receive mandatory training so that trust mandatory training targets are met.
  • The trust should ensure that all staff in critical care (especially nursing staff) receive an annual appraisal, in line with trust targets.
  • The service should ensure that action plans arising from audits are kept up to date until complete or actions should be removed.
  • The service should ensure that GPICS guidelines for 50% of nursing staff to have undertaken a post qualification course in critical care nursing is achieved as soon as possible.
  • The trust should for any mitigating actions that could reduce the number of delayed discharges from critical care.
  • The trust should look for ways that Speech and Language therapy (SALT) assessments can be carried out in a more timely manner.

Maternity and Gynaecology

  • The service should improve the recording of the review dates and version control of all policies and procedures.
  • The service should strengthen the risk registers to support the management of risk.
  • The service should improve attendance at governance meetings.
  • The service should consider the safe storage of patient’s notes on the gynaecology wards.
  • The service should consider the safe storage of expressed breast milk on the postnatal ward.
  • The service should consider the dignity and privacy of patients within the clinical areas, especially where curtains are used between bed areas and waiting areas that are positioned near procedure rooms.
  • The service should continue to monitor consultant labour ward presence with an aim of extending weekday and weekend cover.
  • The service should ensure that the capacity within the obstetrics and gynaecology theatres prevent delays in patient procedures.
  • The service should continue to ensure that processes for the storage, recording and traceability of fetal pregnancy remains on the gynaecology wards are robust.
  • The service should improve staff annual appraisal rates.
  • The service should increase staff training uptake for Female Genital Mutilation (FGM) training.
  • The service should work to better understand the variation in unplanned home birth rates to ensure safety of patients and babies.

Services for Children and Young People

  • The service should use an evidence-based dependency tool to manage appropriate staffing ratios for nursing care on the children’s ward.
  • The service should appropriately meet the continuing needs of patients who are admitted for child and adolescent mental health services, with adequate support and training for nursing staff where this is required.
  • The service should accurately record the completed temperature checks for breastmilk fridges and stores on the neonatal unit.
  • The service should maintain appropriate environmental temperatures on the children’s ward.
  • The service should maintain neonatal guidelines in an up to date and accessible format for staff to use on the neonatal unit.
  • The service should that complete and maintain appropriate records for staff supervision and appraisals on children’s and neonatal wards
  • The service should collect patient feedback responses on the children’s ward using the NHS Friends and Family Test

End of Life services

  • The service should improve compliance for mandatory training particularly safeguarding, life support and care of the dying education.
  • SPC staff appraisal rate should meet the trust target of 85%.
  • The service should address the low numbers of registered nurses who were trained in delivery of end of life care, particularly surgical staff.
  • The service should create a system for monitoring numbers of staff trained in syringe driver use to assure competency.
  • The service should consider they take steps to meet the needs of patients by providing a seven day specialist palliative care service.
  • The service should review staffing levels to ensure they are adequate to maintain the excellent results of the donor retrieval team.

Outpatient and diagnostic imaging services

  • The service should continue to monitor and review the procedures for caring for vulnerable patients attending for cancer therapy.
  • The service should consider improving the environment in the Outpatients department to ensure privacy and dignity is maintained.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 9, 10, 11 July 2014

During a routine inspection

Royal Preston Hospital provides a full range of district general hospital services including Emergency Department, critical care, general medicine including elderly care, general surgery, oral and maxillo-facial surgery, ear nose and throat surgery, anaesthetics, children’s services, women’s health and maternity, and several specialist regional services including cancer, neurosurgery and neurology, renal, plastics and burns, rehabilitation, and the major trauma centre for Lancashire and South Cumbria.

The hospital has around 700 beds, operating theatre complex, outpatient suites, and education facilities.

We inspected the hospital as a follow up to the inspection in July 2014 where the hospital was found to require improvement in the safe, responsive and well led domains and good in the effective and caring domains. We visited Royal Preston Hospital between 27 and 30 September 2016.

Following this inspection we have rated the hospital as requires improvement overall and the trust needs to make improvements. Staff were noted to be caring and patient focused and the caring domain was rated as good in all service areas. 

We saw several areas of outstanding practice including:

In Outpatients and diagnostic imaging the introduction in dermatology of a computerised diary colour codes patients by procedure enabling the service to plan a block of 12 week care in one go to suit the requirements of each patient. It also flags and calculates potential breeches giving better patient flow, facilitating comprehensive audit of care provision and outcome of treatment.

In Critical Care the trust had launched the Sleep Improvement in Adult Critical Care Programme. Disturbed sleep in critical care patients is associated with delirium, in which patients become confused, restless and experience hallucinations. This can delay their recovery from critical illness. The trust recognised this and identified the potential disturbances to sleep. To minimise disruption to patients during the night, they offered eye masks and earplugs, dimmed lights, anticipated empty infusion alarms, turned down the volume on medical equipment and phones and encouraged staff to talk away from the bedside. Staff were also reminded to check regularly for signs of delirium. The project and associated resources were shared with neighbouring critical care networks and at national meetings. An initial research study showed that making small changes caused a 50% reduction in patient delirium and significantly improved the quality of sleep experienced by patients. The study had won an initiative award at the National Nursing Times Awards.

However there were areas for improvement. 

Importantly, the hospital must:

In Urgent and Emergency Care services

;

  • Ensure access to the main entrance paediatric waiting area is limited to reduce the risk of children exiting the area through the automatic doorway.
  • Ensure intravenous fluids are stored securely and daily checks are completed with actions to address issues identified, completed.
  • Ensure mandatory training, including safeguarding, compliance reaches and consistently achieves the trust target.
  • Ensure clinical staff are aware of and adhering to the requirement for senior review of specific patient groups prior to discharge from the ED
  • Ensure appropriate signage is displayed in areas where close circuit television cameras are used.
  • Ensure action plans following CEM audits target areas of poor performance and improve practice.
  • Improve performance, particularly in relation to the department of health four hour target; wait times following a decision to admit, ambulance handovers.
  • Ensure version control for policies, procedures and guidance is robust and that these are kept up to date and reviewed regularly.
  • Ensure the department has a dedicated risk register with start dates, timelines, mitigating action and responsible person with review dates included.

In Medicine;

  • Ensure that all staff receive appraisals and complete mandatory training to enable them to carry out the duties they are employed to perform.
  • Ensure that records are kept secure at all times, so that they are only accessed by authorised people.
  • Ensure procedures in place around medicine management are robust and that policies are followed.
  • Ensure the risk registers are consistent and demonstrate mitigating actions and review dates

In Surgery;

  • Take appropriate actions to improve staff training compliance in areas such as safeguarding training and life support training.
  • Take appropriate actions to ensure that patients requiring escalation, as part of the national early warning score system (NEWS), are appropriately escalated by staff.
  • Take appropriate actions to improve compliance against 18 week referral to treatment standards.
  • Take appropriate actions to reduce the number of cancelled operations and the number of patients whose operations were cancelled and were not treated within the 28 days.

In Maternity and Gynaecology;

  • Ensure midwifery and support staffing levels and skill mix are sufficient in order for staff to carry out all the tasks required for them to work within their code of practice and meet the needs of the patient.
  • Ensure  there is a safe system for protecting babies from abduction.
  • Ensure all necessary staff completes mandatory training, including Level 3 safeguarding training and annual appraisals.
  • Ensure that the assessment and mitigation of risk and the delivery of safe patient care is in the most appropriate place.
  • Complete risk assessments for midwives carrying medical gases in their cars and develop a Standing Operating Procedure (SOP) or protocol for carrying medical gases by car.
  • Ensure that all staff receive medical devices training to ensure all equipment is used in a safe way.

In Critical Care;

  • Ensure that escalation procedures are followed appropriately across the hospital where patients’ National Early Warning Scores (NEWS) are greater than five and the patient may need to be assessed for admittance to the critical care unit.
  • Ensure that any patients admitted to Ward 2A, who are assessed as Level 2 high dependency patients, receive nursing care at a ratio of 1:2 in accordance with national standards.
  • Address action points on a gap analysis that showed that there was no availability for endoscopy for urgent gastro intestinal bleeds 24 hours a day.

In Children and Young People’s services;

  • Ensure that staffing levels in neonatal and children’s services are maintained in accordance with national guidelines.
  • Ensure that all relevant staff having regular contact with children, as defined by intercollegiate guidance, complete level three safeguarding training.
  • Ensure that indicators for managing the changing condition of ill children are consistently used and responded to appropriately on the children’s ward.
  • Ensure that the isolation room used on the children’s ward is free from access to ligature points
  • Ensure that patient records are kept securely in the children’s out patients department.
  • Ensure that checks on emergency resuscitation equipment, are completed and accurately recorded on the neonatal unit.
  • Ensure that secure access to the neonatal unit and children’s ward is maintained at all times by staff, parents and visitors.

In Outpatients and Diagnostic Imaging;

  • Ensure that clear processes and structures are in place for the management and reviewing of governance, quality and risks.
  • Review the processes for managing access and flow for outpatient services to ensure patients are not put at risk.
  • Ensure staff complete mandatory training as per the trust policy.

In addition the trust should:

Urgent and Emergency Services

  • The service should work to embed the forthcoming escalation process to support staff when capacity issues arise.
  • The service should have access to information in languages other than English
  • The service should improve attendance at monthly ED safeguarding meetings

Medical Care (including older peoples care)

  • The service should ensure that patients are discharged as soon as they are fit to do so.

  • The service should ensure that patients are not moved ward more than is necessary during their admission and are cared for on a ward suited to meet their needs.
  • The service should consider improving the environment of the discharge lounge to maintain patient’s privacy and dignity.
  • The service should ensure that patients have access to pressure relieving equipment at all times.
  • Consider implementing formal procedures for the supervision of staff to enable them to carry out the duties they are employed to perform.

Surgery

  • The service should take appropriate actions to maintain safe nurse staffing levels across the surgical wards.
  • The service should take appropriate actions to improve the general environment in the theatre areas.
  • The service should take appropriate actions to improve staff appraisal completion rates.
  • The service should take appropriate actions to improve infection rates following knee replacement surgery.

Critical Care

  • The trust should ensure intravenous fluids are stored appropriately and are not accessible to patients or visitors on the critical care unit.
  • The trust should make every effort to secure funding to expand the critical care unit in order to bring bed spaces within the recommended guidelines, make the flooring safe and to reduce the level of bed occupancy.
  • The Critical Care Governance Team should follow up the request for a review of the risk rating of the lack of a specialist critical care trained pharmacist on a weekend.
  • The trust should ensure that all staff in critical care receive mandatory training so that trust mandatory training targets are met.
  • The trust should ensure that all staff in critical care (especially nursing staff) receive an annual appraisal, in line with trust targets.
  • The service should ensure that action plans arising from audits are kept up to date until complete or actions should be removed.
  • The service should ensure that GPICS guidelines for 50% of nursing staff to have undertaken a post qualification course in critical care nursing is achieved as soon as possible.
  • The trust should for any mitigating actions that could reduce the number of delayed discharges from critical care.
  • The trust should look for ways that Speech and Language therapy (SALT) assessments can be carried out in a more timely manner.

Maternity and Gynaecology

  • The service should improve the recording of the review dates and version control of all policies and procedures.
  • The service should strengthen the risk registers to support the management of risk.
  • The service should improve attendance at governance meetings.
  • The service should consider the safe storage of patient’s notes on the gynaecology wards.
  • The service should consider the safe storage of expressed breast milk on the postnatal ward.
  • The service should consider the dignity and privacy of patients within the clinical areas, especially where curtains are used between bed areas and waiting areas that are positioned near procedure rooms.
  • The service should continue to monitor consultant labour ward presence with an aim of extending weekday and weekend cover.
  • The service should ensure that the capacity within the obstetrics and gynaecology theatres prevent delays in patient procedures.
  • The service should continue to ensure that processes for the storage, recording and traceability of fetal pregnancy remains on the gynaecology wards are robust.
  • The service should improve staff annual appraisal rates.
  • The service should increase staff training uptake for Female Genital Mutilation (FGM) training.
  • The service should work to better understand the variation in unplanned home birth rates to ensure safety of patients and babies.

Services for Children and Young People

  • The service should use an evidence-based dependency tool to manage appropriate staffing ratios for nursing care on the children’s ward.
  • The service should appropriately meet the continuing needs of patients who are admitted for child and adolescent mental health services, with adequate support and training for nursing staff where this is required.
  • The service should accurately record the completed temperature checks for breastmilk fridges and stores on the neonatal unit.
  • The service should maintain appropriate environmental temperatures on the children’s ward.
  • The service should maintain neonatal guidelines in an up to date and accessible format for staff to use on the neonatal unit.
  • The service should that complete and maintain appropriate records for staff supervision and appraisals on children’s and neonatal wards
  • The service should collect patient feedback responses on the children’s ward using the NHS Friends and Family Test

End of Life services

  • The service should improve compliance for mandatory training particularly safeguarding, life support and care of the dying education.
  • SPC staff appraisal rate should meet the trust target of 85%.
  • The service should address the low numbers of registered nurses who were trained in delivery of end of life care, particularly surgical staff.
  • The service should create a system for monitoring numbers of staff trained in syringe driver use to assure competency.
  • The service should consider they take steps to meet the needs of patients by providing a seven day specialist palliative care service.
  • The service should review staffing levels to ensure they are adequate to maintain the excellent results of the donor retrieval team.

Outpatient and diagnostic imaging services

  • The service should continue to monitor and review the procedures for caring for vulnerable patients attending for cancer therapy.
  • The service should consider improving the environment in the Outpatients department to ensure privacy and dignity is maintained.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 14, 15, 18 November 2013

During a routine inspection

This was an unannounced inspection carried out over several days. During the inspection we visited a variety of areas including the hospital’s accident and emergency (A&E) department, the medical assessment unit (MAU), rapid assessment unit (RAU) and a number of medical wards.

We spoke to 31 people who were either using the service at the time of our inspection or had recent experience of it. We also spoke with over 40 staff members who included domestic assistants, nurses, health care assistants, doctors and senior managers.

The vast majority of discussions we held were very positive. Most people who were using or who had recently used the service, expressed satisfaction with their care and treatment. However, we did receive a small number of negative comments. The things people told us included:

‘’I have had absolutely first class care. They have all been brilliant!’’

‘’The staff have been very kind and caring.’’

‘’I cannot thank them enough. They have been wonderful.’’

‘’The doctors have been fine and the nurses have been very friendly.’’

‘’The bay in A & E wasn’t very private, people can hear everything!’’

‘’They need to improve the way they communicate with patients!’’

‘’I felt forgotten about while I was waiting but when I did see the consultant he was brilliant.’’

During the inspection we looked at the care people received and how their welfare was promoted. We found that the vast majority of patients received safe and effective care that met their needs. However, we also found people’s experiences were variable in relation to having a lot of ward moves or not being on the correct ward to meet their needs.

We inspected the area of cleanliness and infection control and found the Trust had good arrangements in place to help ensure that people were cared for in a clean, hygienic environment and were protected from the risk of infection.

We assessed staffing levels. We found there were safe staffing levels in most areas and that the Trust had implemented a number of positive measures to maintain safe staffing levels. However, we did find that not all areas of the service used procedures for responding to unexpected, short notice requirements effectively.

Arrangements for the monitoring of quality and safety were assessed. We saw there were good processes in place that enabled managers to monitor standards, identify risk and respond appropriately to adverse incidents.

We looked at how the Trust enabled people to raise concerns and their processes for responding. We found this area was in need of improvement.

Inspection carried out on 14 February 2013

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

We spoke with four patients about their medicines. Everyone we spoke with was positive about their stay. One patient we spoke with about medication handling told us, “they’re really, really good, they explained how everything worked”. Documents for assessing and supporting patients to self-administer medication were available and in use. Patients choosing to do so were; where possible, supported to look after their own medicines. Patients told us that they had enough information about the medicines they were taking and about any changes to their medicines.

Inspection carried out on 15, 16 October 2012

During a routine inspection

During this inspection we looked specifically at the maternity services provided at the hospital. The hospital provides a full range of maternity services including a 52 bed ward and 12 labour rooms.

We spoke with 12 patients who were receiving care and 18 staff members including midwives, health care assistants and managers.

We received very positive feedback from the majority of patients we spoke with. Patients told us that they were happy with the care they had received and the way they had been treated.

Comments included;

‘’We are very pleased with everything. The staff have been brilliant.’'

‘’They seem very competent and professional, but they are nice with it.’’

‘’I was really pleased with the way they looked after me in labour. They were lovely.’’

‘’I have no complaints. I’ve found everything really good.’’

We looked at six areas during the inspection including the ways in which patients were enabled to make decisions about their care, the quality of care provided and the way in which patients' medicines were managed. Other areas included arrangements for the safeguarding of patients from abuse and staff training. We also looked at how the Trust monitored the safety and quality of the service.

The Trust were able to provide evidence of compliance with the majority of areas we inspected. However, some concerns were identified in relation to the management of medication. We have asked the Trust to take action to address this.

Inspection carried out on 20 March 2011 and 20 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 24 January 2012

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

During our visit we were able to speak with a number of patients and in some cases, their relatives. People that we spoke with were very complimentary about the care and treatment they had received at the hospital and spoke highly of staff providing their care.

Comments from patients included;

‘’We have such a laugh with them (the staff), it passes the time away.’’

‘’So far, everyone I have had looking after me has been great.’’

‘’They can’t do enough for you – whatever you ask for they will try to sort out.’’

One patient commented, ‘’They are so very kind and attentive. I will be sad to be going home.’’

Visiting relatives also expressed satisfaction with the care their loved ones were receiving and told us that they had felt fully involved at all times. One relative said, ‘’You can tell they really care about the patients here. They always seem to have time for people.’’

Other relatives’ comments included;

‘’The staff here are so good. I come in every day and see everything going on and I can tell you this is a good place.’’

‘’They are great and they make you feel so comfortable.’’

No person that we spoke with during our visit expressed concerns about any aspect of the care they or their loved one had received. People told us that staff took time to understand their individual needs and that their requests for assistance were always answered promptly.

Inspection carried out on 29 March 2011

During a themed inspection looking at Dignity and Nutrition

The majority of people we spoke with were very complimentary about the care they were receiving and spoke highly of staff. Comments included;

‘’I feel lucky to be here, they are absolutely brilliant with me.’’

‘’I felt scared when I came but they soon put my mind at rest.’’

‘’We are treated very well, if the younger generation are treated as well as us then this is a very good place.’’

Most people felt that their care needs were met well and that they were cared for in a way that they wanted.

People told us that they felt their dignity and privacy was respected and everyone we spoke with told us that they had never been made to feel embarrassed during their stay.

Whilst people were generally very positive about their care, some did express concerns. Some people commented that, at times, they had to wait a long time to get assistance and generally felt that this was due to staffing levels sometimes being low.

We received generally positive feedback about the quality and variety of meals available. People told us that they thought there was a good choice of food made available. However, several people told us that they didn’t always get the meals they had ordered.

People said that they were confident that staff understood their nutritional needs. One patient told us that she had been very underweight on her admission but had managed to achieve a steady weight gain throughout her stay.

Inspection carried out on 22 June 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.