The Care Quality Commission found improvements at Teddington Memorial Hospital in west London, following an unannounced inspection earlier this year.
The hospital, part of Hounslow and Richmond Community Healthcare NHS Trust, was inspected in January and February 2017.
The purpose of the inspection was to follow up on concerns, particularly looking at the safe and caring domains which CQC had judged Inadequate in an inspection in 2016.
The rating for the trust remains as Requires Improvement overall. However, the ratings for being effective, caring and well-led, have improved from Requires Improvement to Good.
The rating for Teddington Memorial Hospital Inpatient Unit has improved to Good. As we inspected here within six months of the publication of the previous report, we carried out this review in order to update the provider's ratings.
CQC’s key findings included:
The inpatient unit had been restored to its intended function as a bedded rehabilitation unit.
There was regular oversight of the inpatient unit by members of the executive team.
Staff had received additional training in areas that had been identified as weak at the previous inspection: consent, the mental capacity act, infection control. All healthcare assistants had obtained the care certificate.
Patient admissions and discharges were appropriately planned and managed.
Inspectors found no issues associated with privacy and dignity in the accommodation, and inspectors observed staff seeking patients’ consent for treatment, including for daily activities such as washing and dressing.
Rehabilitation patients achieved good outcomes, 97% improving their functional scores by the time of discharge.
Feedback from patients and visitors was positive. Patients were complimentary about their care and treatment and of the kindness of staff.
Staff did not always report incidents or near misses in all areas of the trust.
High vacancy rates in community nursing were impacting on the service.
The trust must now:
- Ensure incidents are reported and analysed effectively, so that lessons can be learned and shared with relevant staff.
- Review existing governance arrangements to ensure that incidents are reported and investigated in line with national standards.
- Ensure detailed records are sufficiently made on each patient treated.
- Make sure all pertinent information in service user records are immediately available to practitioners on the electronic record system, across localities.
- Reduce the staffing shortages and high turnover of staff.
- Ensure the staff vacancy rate does not compromise patient care.
The trust should also ensure that staff at Teddington Memorial Hospital, know where to find the originals of Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) forms and know the process for managing active DNACPR orders.
The trust should also ensure that hand hygiene audits at Teddington Memorial Hospital Inpatient Unit improve to meet the trust’s target of 95%.
The trust should do more to meet its own waiting time targets for services including podiatry, continence, diabetes and musculoskeletal services which were consistently breaching trust targets.
England’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“We inspected the inpatient unit because inspectors were aware that the trust had made significant changes since the inspection in March 2016. The inpatient unit is much improved and was now meeting the regulations that had previously been breached and was providing a good service in all areas."
“We found one area of outstanding practice. The rapid response and rehabilitation team acted as a single point of access for admissions and was also involved in discharge ensuring that patients were supported to continue their rehabilitation after discharge home.”
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