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Provider: Royal Berkshire NHS Foundation Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 7 January 2020

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

  • Overall, we rated safe, effective, caring, responsive and well led as good. We rated one of the trust’s nine services as outstanding and eight as good.  In rating the trust, we considered the current ratings of the six services not inspected at this time.
  • We rated well-led for the trust overall as good.

Royal Berkshire Hospital:

  • We rated three of the trust’s services at Royal Berkshire Hospital as good. Overall, we rated this location as good.
  • We rated safe, effective, caring, responsive and well led as good at the Royal Berkshire Hospital. Safe was rated as requires improvement in two of the three core services we inspected, and good in the other core service. All three core services were rated good for effective, caring, responsive and well led.
  • Gynaecology services had previously been rated with maternity services, at this inspection we rated the service separately to maternity in line with our new approach to inspection of this core service. We rated safe, effective, caring, responsive and well led as good,
  • Medical care service at Royal Berkshire Hospital had dropped its ratings from outstanding to good in caring responsive and well led, from good to requires improvement for safe, but stayed the same for effective we rated this as good.
  • Maternity services had previously been rated with gynaecology services, at this inspection we rated the service separately to gynaecology in line with our new approach to inspection of this core service. We rated safe as requires improvement. Effective, caring, responsive and well led were rated as good.

West Berkshire Community Hospital:

  • This was the first inspection at West Berkshire Hospital, we inspected one core service, medical care. which overall, we rated as good.
  • We rated safe, effective, caring, responsive and well led for medical care at West Berkshire Hospital as good.

 The Windsor Dialysis Unit

:

  • This was the first inspection of medical care at the Windsor dialysis unit. This location only provided dialysis care which was inspected under the core service of medical care, which overall, we rated as good.
  • We rated safe, effective, caring, responsive and well led as good at Windsor Dialysis Service.

In rating the trust, we considered the current ratings of the six services not inspected this time.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RHWZ/reports.

Inspection areas

Safe

Good

Updated 7 January 2020

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

  • Most services had enough nursing, medical and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction.
  • There were systems and processes to managed patient safety incidents. Staff recognised and reported incidents and near misses. Incidents were investigated, and lessons learnt shared with the whole team and the wider service.  When things went wrong, staff apologised and gave patients honest information and suitable support.
  • The service used systems and processes to safely prescribe, administer, record and store medicines. Patients’ medicines were reviewed, and any changes were discussed with the patients’ consultants.
  • The service generally controlled infection risks effectively. There were systems in place to prevent and protect people from a healthcare-associated infection that were in line with national guidance. Staff used equipment and control measures to protect patients, themselves and others from infection. Most of the equipment and premises were visibly clean.
  • Most patients received care and treatment in a well- maintained environment, that considered patients’ diverse needs. The environment was easily accessible for patients with limited mobility and wheelchair users.
  • The service used monitoring results to improve safety. Staff collected safety information and shared it with staff, patients and visitors.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had access to training on how to recognise and report abuse, but not all had completed it.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date. Most were stored securely and easily available to all staff providing care.
  • Staff completed and updated risk assessments for each patient and took action to remove or minimise risks. Staff identified and quickly acted upon patients at risk of deterioration.

However:

  • Not all staff had completed the mandatory training provided and the trust’s mandatory training targets were not met for all areas or staff groups.
  • Not all medical gases were safely stored to reduce the risk of unauthorised persons accessing these.
  • Medicines were not always checked in line with the trust’s medicine management policy.
  • At the time of the inspection staff told us there was no process in place to manage patient’s own controlled drugs. Following our inspection, the provider told us they had a policy in place which informed how these medicines should be managed.  Staff we spoke with were not aware of the policy on patients’ own controlled drugs..

  • Most facilities and premises were appropriate for the services being delivered.

  • Mixed sex accommodation was not effectively managed or in line with national guidance.

Effective

Good

Updated 7 January 2020

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

  • The services provided care and treatment based on national guidance and best practice. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. Most services used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care. Staff held regular and effective multidisciplinary meetings to discuss patients and improve their care.
  • Key services were available seven days a week to support timely patient care.
  • Staff gave patients practical support and advice to lead healthier lives. Staff provided health information to support patients improve their health and wellbeing.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

However

  • Not all policies and procedures published on the trust intranet were up to date. While these were reviewed to ensure they reflected current national guidance, they were not all approved by the appropriate group and loaded onto the trust’s intranet in a timely manner.
  • The endoscopy service did not meet the JAG accreditation standards it was assessed against prior to our inspection.
  • There was a lack of evidence that all maternity care and treatment outcomes were effective for all women and babies There were areas of the maternity red, amber, green (RAG) traffic light dashboard that were consistently not meeting the trust’s key performance indicators (KPI).
  • Although staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Training rates for the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were below the trust’s target in some areas.
  • Consent for the use of bed and chair alarms used on the elderly care wards was not formally obtained or recorded. Where a person lacked capacity to agree to the use of a falls alarm, no best interest decision was recorded. Consideration was not given as to whether this might deprive people of their liberty.

Caring

Good

Updated 7 January 2020

Our rating of caring went down. We rated it as good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Feedback from patients and their families was consistently positive about the way staff treated them.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • Staff took time speaking with patients and their family members offering reassurance during their care and treatment. Patients and their family members were encouraged to ask questions and offered explanations as to the treatment options available to patients.
  • Staff understood the emotional and social impact that a person’s care, treatment or condition had on their wellbeing and on those close to them.

  • Patients and their families could give feedback on the service and their treatment and staff supported them to do this.

Responsive

Good

Updated 7 January 2020

Our rating of responsive went down. We rated it as good because:

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care
  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • Most people could access services when they needed to and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were mostly in line with national standards.
  • Patients mostly had timely access to initial assessment, test results, diagnosis and treatment. Patients with the most urgent needs had their care and treatment prioritised. Action had been taken to minimise the length of time patients had to wait for care, treatment or advice.
  • The service treated concerns and complaints seriously, investigated them, including patients in the investigation of their complaint and shared lessons learned with all staff. The service followed the trust procedures and patients were given the opportunity to have face to face meetings as part of the complaint’s investigation. Patients were provided with a response to their complaint in a timely manner.
  • Facilities and premises were appropriate for the services being delivered.

However:

  • Some medical care referral to treatment times were below the England average.
  • The number of occasions the midwifery led unit was suspended for four hours or more had been ‘red flagged’ for nine out of 12 months from April 2018 to March 2019.

Well-led

Good

Updated 7 January 2020

Our rating of well-led stayed the same. We rated it as good because:

  • Leaders had the integrity, skills and abilities to run services. They understood and managed the priorities and issues the services faced. They were visible and approachable for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The services had a vision for what they wanted to achieve, developed with all relevant stakeholders. These visions were understood by staff, who had signed up to this. Staff felt they were part of the wider trust.
  • The services’ visions and strategies were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
  • The culture of the services provided were centred on the needs and experiences of patients who used services. They had an open culture where patients, their families and staff could raise concerns without fear.
  • Staff felt respected, supported and valued. The services promoted equality and diversity in daily work and provided opportunities for career development.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • The managers were focussed on improvement and shared outcomes of incidents and lessons learnt with the teams and trust wide to effect learning when things went wrong.
  • Leaders and teams used systems to manage performance, identifying and escalating relevant risks and issues. They developed and reviewed action plans to reduce and mitigate their impact.
  • There was a culture of collective responsibility between teams and services and positive relationships between staff and teams.
  • The service had plans to cope with unexpected events and staff were aware of actions they needed to take to achieve safe continuity of services.
  • Data or notifications were consistently submitted to external organisations as required.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • There was a monthly team brief delivered by an executive or a senior manager from the trust, which were informative. A copy of the team brief was available to other staff who may not be able to attend.
  • All staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research and staff were committed to learning and improving services.

However:

  • While there were systems for identifying risks, planning to eliminate or reduce them, not all risk registers included dates for actions to be completed by.
  • Although staff could access the data they needed, in easily accessible formats, to understand performance, make decisions and improvements, this data was not always accurate or reliable. Work was in progress to integrate information systems.
Assessment of the use of resources

Use of resources summary

Good

Updated 7 January 2020

Please see the separate use of resources report for details of the assessment and the combined rating. The report is published on our website at www.cqc.org.uk/provider/RHW/Reports.

Combined rating

Combined rating summary

Good

Updated 7 January 2020

Our rating of stayed the same. We rated it as good