The Care Quality Commission (CQC) has issued a warning notice to Gloucestershire Hospitals NHS Foundation Trust, to protect people needing emergency care following a recent inspection at Gloucestershire Royal Hospital.
CQC carried out an unannounced inspection to look specifically at the safety of urgent and emergency services at Gloucestershire Royal Hospital in December following concerns CQC received from people using the service, its staff, and visitors. These concerns were around cleanliness, including that the cubicles were dirty and spilt bodily fluids had not been cleaned up, and also that there had been a small electrical fire in the department, but fire exits were blocked.
Following this inspection safety in the department was again rated as requires improvement, and they were issued a warning notice to make rapid and widespread improvements in fire safety to keep people safe. Its overall rating remains requires improvement.
CQC also carried out an unannounced focused inspection of the Children’s Centre in September, in response to information provided by the trust, which prompted concerns about the safety and quality of the services for children and young people.
The concerns raised to CQC by the trust related to the use of physical restraint and the administration of emergency sedation of young people.
Due to the focused nature of the inspections, the overall ratings of both the hospital and the trust remain unchanged from requires improvement.
Catherine Campbell, CQC deputy director of operations in the south said:
“We inspected two services at Gloucestershire Royal Hospital following concerns raised by people using the service, staff, and the trust itself. Following the inspections we have issued the trust with a warning notice, in urgent and emergency services, to concentrate its attention on making rapid and sustained.
“A visitor raised concerns about a fire in the urgent and emergency department. During the inspection we found poor environmental safety standards with fire doors that were blocked, and one door had been locked shut. Local fire procedures and the management of exits put people at risk of harm during a fire or other emergencies requiring an evacuation.
“Members of the public and staff also raised concerns with us that the department was dirty, and areas weren’t being cleaned even after people were treated in them when bodily fluids were spilt. However, at our inspection we found the services were clean and leaders were able to provide evidence of cleaning audits, although staff weren’t always completing their infection prevention and control training.
“During our inspection of the trust’s services for children and young people, we were concerned to see that bedrooms where young people were staying had no screens to protect their privacy and dignity. We were given examples of when agency staff had de-escalated situations using restraint, without ensuring the privacy of young people. Staff expressed concerns that on occasions like this the incidents could have a traumatic effect on other vulnerable young people who could see what was happening.
“Staff did support young people by completing or arranging assessments when they were thought to be at risk of self-harm or suicide. However, the enhanced care notes required to document their restraint, observation, or the administration of rapid sedation needs weren’t detailed enough. Also, they didn’t provide evidence of de-escalation techniques that were to be used or provide clarity about why emergency sedation medication was to be administered.
“We will return to follow up on the progress of the improvements we’ve told them to make. If we have further concerns, we will not hesitate to take further action to keep people safe.”
In urgent and emergency services, inspectors found:
- There were systems and processes in place to report and learn from incidents however local fire procedures were poor despite the recent fire in the department
- Although staff completion rates of infection prevention and control training were low, this improved in January 2024 following the inspection.
In the Children’s Centre, inspectors found:
- The privacy and dignity of young people receiving care could sometimes be compromised as the gender of the staff undertaking the enhanced observations was not always the same as the gender. However, personal care was carried out by a staff member of the same gender
- Care plans and records did not reflect national guidance for restraint, observation, and emergency sedation. Staff also weren’t always following the trust’s medicines policy and procedures around emergency sedation
- Staff hadn’t completed all mandatory training for safeguarding and on the mental health needs of children and young people
- There were concerns over the competencies of registered nurses supplied by the agency to provide specialist mental health care to the young people
- However, staff were responsive when caring for the young people. Inspectors were given examples of how ward staff took time to interact with the young people in a respectful and considerate way outside of clinical interventions.