The trust has nine hospitals providing community inpatient services and during our inspection we visited seven of these services. To help us understand and judge the quality of care in the hospitals we used a variety of methods to gather evidence. We observed care and the environment and looked at records, including patient care records. We attended staff handover meetings, multidisciplinary meetings and looked at a wide range of documents, including audit results, action plans, policies, and management information reports. We spoke with approximately 59 patients and five relatives. We spoke with in excess of 60 staff including operational managers, ward sisters, matrons, doctors, staff nurses, nurses, healthcare assistants, facilities staff, chaplains, volunteers, therapists and support staff.
Overall we judged community in-patient services to be effective, caring, responsive and well led. However, we considered that some elements of safety required improvement.
We found that some aspects of medicine management needed improvement, however patients received their medicines safely when they were prescribed.
Patient records generally contained the information required to ensure safe levels of patient care although they were not consistent across all hospitals and not easy to navigate. We had concerns that care support plans were of a generic nature and did not reflect, evaluate or sufficiently record the needs and treatment of individuals. Therefore, this meant that information was not easily accessible for staff to maintain appropriate levels of care to individual patients. We found that confidential patient nursing records were not stored securely in some ward areas. Forms concerning information relating to patient’s wishes regarding resuscitation were not always completed correctly.
The inpatient facilities were clean and well maintained and staff recognised and practiced infection control procedures. There were adequate numbers of suitably qualified and experienced staff to meet patients’ needs and to keep them safe with the exception of therapy staff. This meant that in some hospitals patients were waiting longer for therapeutic interventions to aid their rehabilitation. In some instances this resulted in cancelled therapy sessions and delayed discharges .
We found that opportunities for ensuring that hospital environments were suitable for people living with dementia had not been instigated and some therapy rehabilitation facilities were not conducive for the rehabilitation of bariatric patients particularly at The Kleinwort Centre.
Robust systems for assessing and mitigating risks were in place and when incidents did occur there was evidence to show that staff understood how to report them. We saw that incidents were appropriately investigated with changes made to practice to reflect lessons learnt, both at local level and across the trust.
Patients received care that followed the latest published guidance and best practice with outcomes that were generally in line with national averages. Patients received adequate pain relief, although we were unable to see that there was a universal use of pain management assessment tools. Patients were supported to eat and drink suitable food in sufficient quantities and in line with their dietary and cultural preferences.
Staff received adequate training to safely undertake their roles and participated in performance appraisals. Patients received their care from a multi-disciplinary team who worked cohesively to deliver the best care to meet their needs.
Patients were positive about their care experience and told us they received compassionate care that respected their privacy and dignity and we observed care being delivered in a kind and respectful way. Patients told us they felt involved in decision making about their care. Where patients lacked capacity to make decisions for themselves, staff acted in accordance with legal requirements.
The geographical locations of the hospitals was well placed to meet the diverse needs of patients and was committed to providing care as close to patients homes as possible. The environment in all of the inpatient hospitals would benefit from being made more dementia friendly.
Admissions to the inpatient service were generally well managed to minimise risk to patients and to maximise the rehabilitation experience. Discharge from the service was well planned and co-ordinated to ensure that the needs of patients would continue to be met.
There was a shared vision and philosophy of care in the service with a strong rehabilitate ethos and we observed a caring and positive culture. Staff expressed confidence in their leaders, who were visible and said they felt supported to do their job well. All staff were aware of the trust vision and strove to demonstrate this through their daily work and there were arrangements to ensure they were engaged in the running and development of the service.