Hospital inspectors have told South Warwickshire NHS Foundation Trust that it must make improvements on patient risk assessments, safeguarding and mental health capacity awareness.
The Care Quality Commission has given the trust an overall rating of “requires improvement”, based on its latest inspection in March this year.
“Patient risk assessments were not fully completed on admission”
It was also rated “requires improvement” for being safe, effective and well-led, but “good” for being caring and responsive. The trust’s community health services were rated as “good” overall, as well.
The CQC told the trust that risk assessments must be completed appropriately on admission to medical wards and repeated regularly to identify any changes in risk of harm.
“This includes bed rail and mobility assessments and nutritional assessments for patients receiving end of life care,” the regulator stated in its report on the trust.
In addition, it said all staff must receive safeguarding children training in line with 2014 intercollegiate guidance and all staff must have a full understanding of the Mental Capacity Act 2005.
Ellen Armistead, deputy chief inspector of hospitals for CQC’s central region, said: “Patient risk assessments were not fully completed on admission and generally not reviewed at regular intervals throughout the inpatient stay.
“This included incomplete risk bed rails risk assessments resulting in the use of bed rails without a completed risk assessment,” she said.
“The trust had no strategy for end of life care,” she added. “The governance processes for end of life care were not established and the care planning tool to replace the Liverpool Care Pathway was not embedded.”
These issues had resulted in the CQC judging leadership for end of life care, both at its main acute site and in community services, to be “inadequate”.
However, inspectors also said they witnessed some “outstanding practice” across the trust.
“We were particularly impressed by the trust’s emergency department”
The hospital’s rehabilitation unit had developed an assessment tool called Sensory Tool to Assess Responsiveness (STAR), which was aimed at providing an accurate diagnosis of prolonged disordered consciousness and establishing any means of communication in the patient.
Meanwhile, the work of the community nursing service in reviewing patients who were insulin dependent diabetics had been recognised by Diabetes UK at the Patient First conference in London.
Diabetes UK asked if they could work alongside the group and share the trust’s good practice. The project has also been put forward for the Nursing Times Awards 2016.
The CQC also commended the use of reminiscence therapy within the emergency department for patients with learning disabilities, dementia and mental health conditions was outstanding.
In addition, the regulator highlighted processes and procedures that had been developed for women on the postnatal ward to self-administer some medication if they opted to do so.
Ms Armistead also said the flow of patients into and through the hospital was “well managed with all areas of the trust taking responsibility for this”.
“We were particularly impressed by the trust’s emergency department and services for adults which were rated outstanding for being responsive,” she said.
“All staff were passionate about providing the best possible service to patients,” she said. “Patients told us they felt safe and cared for and that staff were respectful of their needs and preferences and took time to understand personal requirements or to explain the care being delivered.
“In addition, there was an extremely positive culture within the trust and staff felt respected and valued,” she added.
However, in a statement the trust said it was appealing the overal rating of “requires improvement”, noting that the regulator had highlighted much good practice.
It stated that the inspection report only cited three findings that the CQC listed as “important” and these related to some specific staff training for safeguarding and the mental health capacity act.
The other finding related to risk assessments linked to bed rails for patients and all three have been addressed since the visit five months ago, it said.
It also said the overall rating was “contrary to many other national indicators that place the trust in the top 20% across the country”.
“The trust is appealing the overall rating and seeking it to be changed or an early re-inspection to be scheduled,” it said.
Helen Lancaster, the trust’s director of nursing, added: “Prior to the inspection we highlighted to the CQC that there were areas we wanted to improve to support patients at the end of their lives. In October 2015 we recruited a new lead consultant in palliative care.
Trust told to up its game on patient risk assessment
“In the report there are no immediate actions that the CQC has highlighted to the trust, however we will use our Quality Summit to discuss this area further with our partner organisations,” she said.
The trust provides district general hospital services at Warwick Hospital, community inpatient care at Stratford-Upon-Avon Hospital, Leamington Spa Rehabilitation Hospital and Ellen Badger Hospital.
It also provides neuro rehabilitation to young adults at the Central England Rehabilitation Unit, based at Leamington Spa Rehabilitation Hospital.
In addition, the trust provides a range of health services to a community of approximately 270,000 in South Warwickshire and the surrounding areas.