Archived: The Raphael Hospital

Updated 15 April 2019

The Raphael Hospital is operated by Raphael Medical Centre Limited (The). The hospital opened in 1983 and is a private hospital in Hildenborough, Kent. Referrals are accepted from across the south-east of England. The majority of the referrals are received from the clinical commissioning groups (CCG’s) for NHS patients. The hospital also accepts private patients, funded by patients themselves or insurance companies.

The hospital specialises in the neurorehabilitation of adults following acquired brain injury. It provides a service for people over the age of 18 years, both male and female. The service does not treat children or young people.

The Raphael Hospital is registered with the Care Quality Commission to provide the following regulated activities:

• Treatment of disease, disorder or injury

• Diagnostic and screening procedures

• Assessment or medical treatment for persons detained under the Mental Health Act 1983

The hospital has been registered since 1983. There is a Controlled Drugs Accountable Officer at the location.

The service employs 134 whole time equivalent clinical staff including doctors, nurses, therapists and rehabilitation assistances. The hospital also has a step-down facility. The step-down facility was not inspected on this occasion.

Updated 15 April 2019

The Raphael Hospital is operated by Raphael Medical Centre Limited (The), an organisation that also provides social care services for people with acquired brain injuries. The Raphael Hospital is an independent hospital specialising in neuro-rehabilitation of adults with complex neurological disabilities with cognitive and behavioural impairment.

The long-term conditions service at the hospital focuses on the care, treatment and rehabilitation of people with acquired brain injuries. There are facilities to accommodate a total of 60 patients. There is space for 31 patients in two wards in the main building and 21 patients in Tobias House which is designated as an area for the treatment of prolonged disorders of consciousness. There is a further capacity to treat eight patients in the special care unit for neurobehavioral rehabilitation and this unit also accommodates patients admitted under the Mental Health Act. Facilities available at the hospital included a physiotherapy gymnasium, a hydrotherapy pool, therapy rooms, consultant rooms and common areas.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 15 January 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

Our rating of this hospital/service stayed the same. We rated it as Requires improvement overall.

• The service did not have managers at all levels with the necessary experience, knowledge and skills to lead effectively. The main house was managed by an experienced ward manager who had been in post since 2015. However, during inspection it was identified that three out of four of the wards did not have a ward manager.

• Managers could not demonstrate adequate systems and processes that assured us they had full oversight of the service in terms of risk, quality, safety, and performance.

• The service used a systematic approach to continually improve the quality of its services and safeguarding high standards of care, but there were areas that were not fully effective.

• The systems used to identify risks, and eliminate them, were not always carried out in a timely manner. Although there was a risk register, there was no robust way of ensuring effective risk reduction strategies had been undertaken, or potential risks not fully recognised.

• The service provided mandatory training in key skills to all staff; however, not all staff were up to date with their training.

• Infection control issues identified in the last report remained. Although there was a plan to make changes, the pace of making sure compliance with infection control regulations was slow.

• The service generally had suitable premises, but the design, maintenance and use of facilities and premises did not always keep people safe.

• The service audit programme was not robust; although audits were undertaken, non-compliances were not always rectified and we saw the same non-compliances repeated on multiple audits.

• Staff and patients did not always have access to call-bells to get help. Communal areas such as the lounge, activity room and corridors did not have call points available

• Emergency buzzers were available, but staff we spoke with were unaware if these had been tested or whose responsibility this was.

• Staff on the special care unit were not able to communicate effectively, particularly in an emergency. Two-way radios were available, but we found only two were working and of the two working radios, only one could make and receive calls.

• Best interest meeting notes, were not completed consistently, and the least restrictive option was not always clearly identified.

However:

• Staff in different roles worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide care. Staff respected their colleague’s opinions.

• Staff cared for patients with compassion. Feedback from patients confirmed staff treated them well and with kindness.

• Staff provided emotional support to patients to minimise distress. Staff were on hand to offer emotional support to patients and those close to them. Patients told us they felt able to approach staff if they felt they needed any aspect of support.

• Staff involved patients and those close to them in decisions about their care and treatment. We saw effective interactions between staff and patients.

• There were systems and processes to assess, plan and review staffing levels at the location, including staff skill mix.

• There were systems and processes to protect people from abuse and harm. Staff understood their responsibilities and the process to take in the event of any safeguarding concerns.

• The service gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time.

• Staff gave patients enough food and drink to meet their needs. Nutritional assessments were completed on admission.

• Staff monitored and assessed patients regularly to see if they were in pain.

• The service took account of patient’s individual needs.

Nigel Acheson

Deputy Chief Inspector of Hospitals

( London and South Regions)

Updated 15 April 2019

Neuro-rehabilitation of adults with complex neurological disabilities with cognitive and behavioural impairment, were the main activity at the location. We rated this service as requires improvement in the safe, effective and well led domains. Good in caring and responsive.

Updated 21 April 2016

We found that the outpatient service was not providing a safe, effective and responsive service. There were concerns abut the quality of leadership and some aspects of caring were not good.

Safety was not a sufficient priority. There were inadequate systems in place for staff to assess, monitor or manage the risks to people who used the services.

There was insufficient assurance to demonstrate people received effective care based on current evidence-based guidance, standards and practice. There was no monitoring of people’s outcomes of care and treatment.

The governance arrangements and their purpose were unclear with ineffective arrangements for the systematic provision of assurance to the board that risks were being adequately assessed or managed.

The majority of patients we spoke with gave positive feedback about the way staff treated them but people’s emotional and social needs were not always viewed as important or reflected in their care and treatment.