- Community healthcare service
Wokingham Community Hospital
Important:
This service was previously managed by a different provider - see old profile
All Inspections
10 and 11 September 2019
During a routine inspection
This service is rated as Good overall. (Previous inspection July 2018 – Requires improvement)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Good
We carried out an announced comprehensive inspection at Wokingham Community Hospital also referred to as Westcall Out of Hours on 10 and 11 September 2019. We undertook this inspection due to a previous rating of requires improvement from the inspection undertaken in July 2018. At the previous inspection we asked the provider to take actions due to breaches of regulation. We have issued a new rating as a result of this inspection.
At this inspection we found:
- The service had systems to identify and manage risks to patients and staff.
- The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
- Staff involved patients in their care and treated people with compassion, kindness, dignity and respect.
- Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
- Since the July 2018 inspection, the service had strengthened existing governance and quality frameworks to make improvements. These frameworks aligned to the strong focus on continuous learning and improvement at all levels of the organisation.
We saw an area of outstanding practice:
- There was a clear, systematic and proactive approach to seeking out and embedding new and innovative models of care within the out of hours care setting. This included processes to improve patient care and the operational performance. For example:
-The provider followed through on their own blood tests undertaken during OOHs care. They analysed and reviewed each patient who had a blood test within the service to ensure effective follow up and communication with GP practices. Point of care blood testing was also available.
-Sepsis pathway care was developed to provide initial treatment on OOHs sites prior to admittance to hospital where sepsis was identified as a potential condition. This was audited for effectiveness
-Advance care plan (ACP’s) templates were we placed on all GP practice computers in West Berkshire so that they could be uploaded via a shared record system. The service monitors monthly figures of deceased patients, assessed the relevant ACPs and report to the CCG so that they can monitor care planning effectiveness
-A flu prophylaxis service was initiated by Westcall OOHs for local care and nursing homes and has become a commissioned service after this proactive initiative.
The area where the provider should consider improvements:
- Continue to consider and how to meet the potential various communication needs of patients, including those with visual or hearing impairments.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
5, 12 & 20 July 2018
During a routine inspection
This service is rated as Requires improvement overall. (Previous inspection December 2015 – Good with requires improvement for Safe. Follow up inspection in October 2016 - Good)
The key questions are rated as:
Are services safe? – Requires improvement
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Requires improvement
We carried out an announced comprehensive inspection at the registered location (Wokingham Community Hospital, locally known as Westcall) on 5, 12 & 20 July 2018. This inspection was planned to coincide with the provider Trust (Berkshire Healthcare NHS Foundation Trust) inspection as part of our inspection programme.
At this inspection we found:
- The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes. However, we found not all incidents or events had been reported in line with service policy.
- Evidence of safeguarding training had not been collected for all GPs and some staff had not received safeguarding children training to the appropriate level for their role.
- Infection control audits were not available for all service sites and we found dusty surfaces at two of the premises used by Westcall.
- Care and treatment was delivered according to evidence- based guidelines.
- Clinical audits were limited and did not drive quality improvement.
- Staff involved and treated people with compassion, kindness, dignity and respect.
- Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
- Some governance processes were inconsistently applied and leaders did not have oversight of all the information required to safely deliver the service.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider must make improvements as they are in breach of regulations are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
The areas where the provider should make improvements are:
- Review and maintain oversight of emergency trolley checking procedures at all sites.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
14 April 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
In December 2015, we found concerns related to the management of medicines during a comprehensive inspection of Wokingham Community Hospital- Westcall Out of Hours, Wokingham, Berkshire. The service was rated as good overall with a requires improvement in the safe domain. Following the inspection the provider sent us an action plan detailing how they would improve the areas of concern. The previous inspection in December 2015 had found one breach of the regulations relating to the safe delivery of services.
We carried out an focussed inspection at Wokingham Community Hospital in April 2016. This is the registered location of Westcall Out of Hours Service. This inspection was to follow up on concerns with the safety and management of prescriptions at the previous inspection December 2015.
Following the improvements made since our last inspection in December 2015; the practice was now meeting the regulations that had previously been breached. The practice is rated as good overall.
Specifically the practice was:
- Operating safe systems in relation to management of medicines. This included clear and robust processes relating to the security of prescriptions had been implemented since our inspection in December 2015.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
9 and 10 December 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Wokingham Community Hospital. This is the registered location of Westcall Out of hours on 9 and 10 December 2015. Overall the service is rated as good.
Our key findings across all the areas we inspected were as follows:
- There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
- Risks to patients were assessed and well managed. However, some systems to address these risks were not implemented well enough to ensure patients were kept safe. For example, infection control risks and prescription security.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Information about services and how to complain was available and easy to understand.
- The service had good facilities and was well equipped to treat patients and meet their needs.
- There was a clear leadership structure and staff felt supported by the management and Berkshire Healthcare NHS Foundation Trust leaders. The service proactively sought feedback from staff and patients, which it acted on.
- The provider was aware of and complied with the requirements of the Duty of Candour.
We saw two areas of outstanding practice:
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The service had introduced two near patient testing kits for diagnosing deep vein thrombosis (a blood clot in one of the deep veins of the body) and sepsis (where the body’s immune system triggers a series of reactions including widespread inflammation, swelling and blood clotting). Both kits provided clinicians with the tools to make an early diagnosis and provide early intervention to prevent the worsening of the condition or even death. The use of these kits had prevented unnecessary hospital admissions and provided better outcomes for patients.
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17,000 patients had advanced care plans, which contained care and treatment information about the individual patient. The development, usage and completion of these care plans was driven by Westcall leaders and clinicians. The initial care plans were entered by individual surgeries and hosted on the Adastra system. This included medicines, end of life care, palliative care needs, allergies etc. With the individuals consent these records could be accessed and updated by Westcall clinicians and staff, emergency department staff in Berkshire, district nurses, palliative care nurses and other health professionals, so up to date care and treatment could be provided 24 hours per day.
The area where the provider must make improvement is:
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Printed prescription pads were securely stored, but there was no system in place to record the use of prescriptions to minimise misappropriation or misuse. The security of blank prescription forms required improvement as there was no system in place to monitor the use and movement of these.
The areas where the provider should make improvements are:
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Introduce a system of recording the cold chain for when medicines requiring refrigeration are transported between sites.
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Ensure all nursing staff have received chaperone training and the chaperone service is clearly advertised to patients in both primary care centres.
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Appoint a lead nurse to ensure appropriate support for nurses and, where appropriate, ensure appraisals are undertaken.
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Review the provision and utilisation of nursing staff to allow greater responsibility and support for the care and treatment of patients, reducing the impact on GPs.
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Review the infection control procedures to ensure a robust audit is undertaken, regular checks are in implemented and actions taken.
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Improve patient communications about the service and how the appointment system works at the Reading primary care centre.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
19 February 2013
During a routine inspection
We found that people were involved in their treatment and care planning. They told us that no decisions were taken without their involvement and they were consulted ''every step of the way''. People told us that they had witnessed people with dementia being treated with ''great respect and dignity''.
We found that people were appropriately cared for. People told us that they were 'very, very well looked after' and it ''was the best hospital experience'' they'd had.
We found that staff were appropriately trained and were knowledgeable about how to keep people safe. People told us that they felt ''very safe'' in the hospital and never had any concerns about the way they or others were treated.
We found that medicines were managed safely and people were given their medication appropriately.
We found that there were enough appropriately qualified staff on duty. People said that they felt there were 'plenty' of staff to meet their needs. They told us that ' there's always a nurse there to help you when you need them'.
We found that the provider had ways of continually checking the quality of the care they offered. People were involved in the quality checks.