The Care Quality Commission (CQC) has rated The County Hospital run by the Wye Valley NHS Trust as requires improvement following an inspection in October.
Inspectors undertook an unannounced focused visit of the trust’s surgery and medical care wards, including older people's care. The inspection took place to check whether improvements had been made since CQC issued the trust with a warning notice.
The County Hospital’s overall rating remains requires improvement. The ratings for how safe, effective, responsive and well-led the hospital is remains as requires improvement and it remains good for being caring.
The surgical services have improved from inadequate to requires improvement for being safe and well-led. CQC didn’t rate the effective, caring or responsive domains at this inspection. Therefore, surgery remains rated as requires improvement overall as there was not enough areas looked at to update this rating.
The medical care (including older people’s care) is rated requires improvement for being safe and effective. CQC didn’t rate the caring, responsive or well-led domains. Therefore, medical care is rated as requires improvement overall.
Amanda Lyndon, CQC head of inspection, said:
“On our return to The County Hospital, we found insufficient improvements had been made and people were still at risk from poor care. The biggest issue we found was that assessments weren’t being carried out effectively and this was putting people’s safety at risk.
“People’s risk assessments, and surgical evaluations weren’t being carried out effectively meaning they were at risk from potential harm from things like avoidable falls and blood clots. We also found Mental Capacity Act assessments designed to protect and empower people who may lack mental capacity, weren’t routinely completed for people requiring them.
“It was also concerning that staff didn’t always document the reason for missed medications and there was no system in place to assess the impact of missed medications to people.
“Staff told us they were stressed and also concerned about the new system for admissions and discharge. People awaiting discharge who were fit to sit, would be moved to a chair for a person to take their bed space. This didn’t enable staff to maintain people’s dignity.
“It was great that the services we visited had enough staff and knew how to keep people safe from abuse, however training across the trust was inconsistent putting people at risk of harm. Levels of staff training didn’t meet the trust target, including basic life support. The trust told us low levels of staff training on one ward was as a result of prioritising training for new starters and where training expiry dates had lapsed.
“We have reported our findings to the trust leadership, which knows what it must do to improve. We will return to check on the trust’s progress.”
Inspectors found the following during this inspection:
- Risk assessments for venous thromboembolism and falls were not completed and updated promptly putting people at risk of falls and blood clots
- Theatre forms were not completed efficiently, this meant that important medical data could be missed, such as; medication sensitivities and equipment checks
- Trolleys that held people’s records were lockable using a key. This made it difficult for everyone to gain timely access to notes when required, and therefore, the trolleys were usually open. This meant unauthorised personnel were able to access confidential information
- The trust had not met mandatory training target levels for staff. This meant that staff didn’t always have the right training and skills to keep people safe
- People’s medication charts showed that they had missed doses, and this had not been audited to understand the impact.