Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Patients felt safe on the wards. Ward areas were clean, and staff completed and updated environmental risk assessments regularly. Patients were involved in the admission process, assessing risks and the discharge process. However, staff told us ward meetings did not always take place and adequate post incident debrief did not always take place. Patients and staff felt there was not always sufficient staff on wards to help facilitate safe patient observations and staff breaks. We observed administrative staff assisting ward staff complete observations so they could take breaks. We found a breach in regulation under safe staffing and under good governance. All staff did not have all mandatory training in place and there were not adequate processes in place to identify when staff were not following medication administration guidance. We have asked to trust to improve staff mandatory training compliance and their processes to identify when staff are not following medication administration guidance.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 2 patients who both said they were happy with care on the wards.

We spoke with 15 staff; they reported that ward meetings were not taking place, and they felt they were not kept informed or updated. Staff said they were concerned that debriefs were not taking place following incidents. We were told that staff attended the Thursday falls safety huddle which focused on reviewing recent falls and strategies to manage these, such as medication reviews and aimed to prevent further occurrence.

We attended the daily safety huddle and observed incidents reported in the previous 24 hours were discussed at this meeting. Effective processes were no in place to ensure learning was taking place and staff were supported after incident. Effective learning was taking place when medicines were not administered in line with guidance and processes were not in place to ensure staff received the support required after incident through supportive debriefs.

We spoke with 2 patients they were waiting to be discharged home and said staff had been supportive and kept them informed on their progress.

Staff we spoke with said the acuity and complexity of clinical need of patients had significantly increased, particularly those requiring mental health support. Leaders told us patients were admitted out of hours which caused additional pressure on ward teams.

The hospital had discharge coordinators who had good links with outside agencies such as housing and adult social care. The hospital also had a dedicated worker 3 days per week from Age UK to support patients.

We spoke with 2 patients, both said they felt very safe on the ward and staff were very kind.

All staff we spoke with were able to demonstrate how they would identify and raise a safeguarding issue. There was a safeguarding lead at the hospital that they could contact for advice.

We saw all patients had a completed holistic assessment on admission, which included aspects of safeguarding including a routine enquiry of risk of domestic abuse. The trust had a safeguarding policy in place, we saw a notice board which was dedicated to safeguarding information.

Patients said staff had involved them in completing the admission risk assessment and involved families where appropriate.

Staff we spoke with said they involved the patient and families in assessing risk whenever possible.

We looked at 7 patient care and treatment records across the wards we assessed. They were all comprehensive and had updated risk assessments in place. The records showed patient involvement and the patient’s voice was evident throughout. However, management did not have appropriate oversight of staff training compliance in hospital life support training, with staff training compliance in this area being 38% on Castle ward. This would mean not all staff were trained to respond to emergencies.

We spoke with two patients and one carer, all said the ward was lovely and they especially liked the dining room on John Proctor ward which was “homely and welcoming”.

Staff we spoke with said they were very proud to work at Lings Bar Hospital as it was a homely, safe and good environment to work in.

We saw both John Proctor and Castle wards were bright, airy and appropriately furnished.

We saw audits of the ward environment had been undertaken monthly.

Patients we spoke with said that staff did a great job but were always rushing around and there could be more staff around.

Staff told us they frequently felt unsafe on the wards and often felt guilty and worried that they were unable to provide the level of care required. Staff told us sickness on the wards was high, over the 3 months prior to the onsite assessment sickness levels were at 10% and above on Castle ward. Staff said the wards were regularly short staffed and said the ward managers were used in ward numbers on a frequent basis. We were told staff were allocated to observe patients on an enhanced basis due to fall risks, these staff said they were often unable to take comfort breaks and felt isolated. Staff said the ward administrator had occasionally “stepped in” to observe patients to enable the allocated staff to take a break. They felt, this was outside of their job description. Staff we spoke with said the daily staffing numbers had been reviewed and had been reduced by one per shift. They said this had been very challenging, particularly for healthcare support workers who may be allocated a group of patients to care for single handedly for periods of time. Despite data showing high compliance, we were told that both registered and unregistered staff were not receiving supervision.

We saw staff supporting patients in respectful manner throughout the onsite assessment.

We attended the daily safety huddle where staffing levels for the next couple of days were reviewed. We noted that both bank and agency staff were used on the wards. Not all staff had appropriate mandatory training in place. Staff training compliance rates showed only 60% of staff and 34% of staff on Castle ward had completed Infection Prevention and control training at the time of the assessment. Only 38% of staff on Castle ward had completed Hospital Life Support training at the time of the assessment. We reviewed staff sickness levels on Castle ward and found the average staff sickness levels between April and July 2024 was high at 11%.

Patients we spoke with said staff worked hard to ensure the environment was clean and homely.

Staff we spoke with described how they managed infection prevention control on their respective wards. They said they had appropriate amounts of protective equipment and could access support from infection prevention and control experts within the trust.

We saw staff adhered to infection control practices. All staff were bare below the elbows according to trust policy.

Cleaning schedules were completed, and audits of cleanliness were undertaken, the results of which were displayed on the ward noticeboards for staff and patients to see. However, management did not have appropriate oversight of staff training compliance in infection prevention and control, with staff training compliance in this area being 34% on Castle ward.

We spoke with the senior nurses on all wards, who were able to tell us in detail how they managed medicines using the medicines administration system. Staff told us they receive medicines training and are assessed for their competency to administer medicines safely. Staff told us they were well supported by clinical pharmacists who visited the wards and the wider pharmacy team for the supplies of medicines.

We observed a medicines round where the medicines administration system ensured that the right people were getting the right medicines. Some medicines that needed to be taken at specific dose intervals were not being administered in accordance with these directions. We reviewed 4 patient records over a 10-day period and found staff were not abiding with the 12-hour administration time interval between doses as recommended by the manufacturer 80% of the time. There was no process in place to identify when staff had not followed medication administration guidance. We also observed the administration of a controlled drug. We observed the controlled drugs records were being completed to confirm patients had received these medicines before they had been given to the patient. This was not in line with the Trust’s policy. All medicines, including controlled drugs were stored securely. The temperature monitoring of those medicines required cold storage conditions were ensuring medicines were being stored at between 2°C and 8°C.

We looked at medication records for 15 patients across the two wards. These records were accurate and able to demonstrate people were receiving their medicines as prescribed. In all cases allergy statuses were recorded. Audits carried out by ward managers and pharmacy staff demonstrated that medicines are managed safely. The audits in place did not identify staff had not followed medication administration guidance. We found staff did not always follow the Trust’s policy as they completed the controlled drugs records to confirm patients had received medicines before they had been given.