Care Quality Commission Declarations

Published/updated: 21/08/12 11:15

All NHS trusts are required to submit a final declaration to the Care Quality Commission (previously the Healthcare Commission). The declaration is a statement of each trust’s level of compliance with the core standards from April 1st 2008 to March 31st 2009.

20100426-RR1-Core-Standards-Update-Form

Corroborating-Statement-Quality-Account-2010-2011

Provider-Registration

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More of the Care Quality Commission’s (CQC) reports into dignity and nutrition for older people are being published next week (week commencing 13th June) and this includes the CQCs review of Good Hope Hospital.

A summary of the CQC’s findings for Good Hope Hospital:

What we (the CQC) found overall We found that the Good Hope Hospital was meeting both of the essential standards of quality and safety we reviewed, but to maintain this; we suggested that some improvements were made.

The inspection teams were led by CQC inspectors joined by a practising, experienced nurse. The inspection team also included an ‘expert by experience’ – a person who has experience of using services (either first hand or as a carer) and who can provide the patient perspective. The CQC has reviewed all the information held about this provider, carried out a visit on 11 April 2011 to wards nine and ten.

They observed how people were being cared for, talked with 13 people who use services, five staff and one relative and looked at records of people who use services. 

What people said …

People the CQC spoke to were mostly positive about their experiences of care and treatment on both wards. They said that they were treated with respect.

On one ward they received some comments that indicated that not everyone was being respected and their dignity maintained.

One person said: “Staff were busy, reasonably polite but on one occasion they were not very nice. They didn’t always talk quietly and this made her feel cross and feel like shouting back.”

Another person said that they were satisfied in the main but were concerned about the length of time they had to wait before being taken to the toilet. They had spoken with staff and it had improved since.

Most people said that they were happy with the food they received. The food was not too bad and they got enough to eat. They told the CQC that there were choices of hot and cold food on the menu. Some people said that they hadn’t been asked what their likes or dislikes were but had been asked about allergies and if they were vegetarian.

One person said “Sometimes the food was not that warm as the trolley started (to serve food) at the other end of the ward but the food was still enjoyable.”

Another person said “They always tell me to eat meals, and if I want something else they give me a sandwich. Never been a big eater but we have three meals a day and supper with a drink.”

A relative said that they came twice a day to feed their father and the food was “excellent” and they couldn’t fault the staff.

Outcome 1: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run 
Overall, we (the CQC) found that Good Hope Hospital was meeting this essential standard but, to maintain this, we suggested that some improvements were made.

Outcome 5: Food and drink should meet people’s individual dietary needs 
Overall, we (the CQC) found that Good Hope Hospital was meeting this essential standard but, to maintain this, we suggested that some improvements were made.

The CQC has reached one of the following judgements for each essential standard:

Compliant means that people who use services are experiencing the outcomes relating to the essential standard.

minor concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard.

moderate concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard and there is an impact on their health and wellbeing because of this.

major concern means that people who use services are not experiencing the outcomes relating to this essential standard and are not protected from unsafe or inappropriate care, treatment and support.

Outcome 1: Respecting and involving people who use services 
What the outcome says

This is what people who use services should expect.

People who use services:

Understand the care, treatment and support choices available to them.
Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support.
Have their privacy, dignity and independence respected.

Have their views and experiences taken into account in the way the service is provided and delivered.

What we (CQC) found

Our judgementThere are minor concerns with outcome 1: Respecting and involving people who use services

Our findings What people who use the service experienced and told usWe spoke with 13 patients, one relative and four members of staff and observed the care given to people on two wards during our visit to the hospital.

People we spoke to were mostly positive about their experiences of care and treatment on both wards.
Individuals told us they were treated with respect, explanations of why they were there were given and the staff came more or less straight away when called and drew the curtains when assisting them.

On a ward that had been open a relatively short time to deal with winter pressures we received comments from four people that indicated that they did not feel respected and their dignity had not been maintained.

One person said ‘The staff were busy, reasonably polite but on one occasion they were not very nice. They didn’t always talk quietly and this made the person feel cross and feel like shouting back.’

Another person told us ‘They didn’t feel as if they could talk to anyone, not very friendly but staff usually explained things. They felt that the would have liked to know more but felt the staff didn’t have much to say.’

Another person said ‘They were satisfied in the main but were concerned about the length of time they had to wait before being taken to the toilet. They had spoken with staff and it had improved since.’

The fourth comment was about the attitude and behaviour of one particular staff member. We fed this back to the Trust for them to monitor as we were not told who the individual was.

Other evidence

The Patient Environment Action Team (PEAT) assessment scores for the Heart of England NHS Foundation Trust from early 2010 rated Good Hope Hospital overall as “good” for dignity and respect.

Between June 2010 and January 2011 we had received two concerns relating to the care of people in Good Hope Hospital.

During our visit we saw staff treating people with respect. They spoke to them about things other than their needs on the ward. They were asked if they wanted to be assisted with their personal hygiene, if they were sitting comfortably and if they were happy with the care they had received. This showed that people’s views about the care they received were valued.

Staff were mindful when providing personal care to ensure that the privacy curtains were drawn and toilet doors were closed. In a side room the curtains at the window had been partially drawn. This ensured a relaxing environment for someone who was quite poorly.
We observed that although curtains were drawn to ensure a patient’s privacy other people in the ward could hear what help they needed because staff voices could be heard. For example, a nurse was heard to say that the patient would have to be turned to ‘have their pad changed’ whilst they were explaining what they were doing to the patient. Staff needed to be mindful that the curtains did not provide complete privacy.

On some occasions people were not treated with respect and dignity. Examples of this included a comment to a confused patient. They were told to sit down in case they fell adding “We need to see to other people. While we’re with you we can’t see to other people”. Staff were also heard talking about the discharge of one patient whilst assisting another and asking another staff in a loud voice “Has X been done?”

Staff told us that they supported people to make choices such as at mealtimes, asked them what they preferred to be called and where they would prefer personal care to be carried out. Although preferred names, likes and dislikes were not always recorded in assessment records people told us that this happened.

We saw the records of one patient in another patient’s file. This meant that the individual’s personal information was not maintained safely and confidentially.

The majority of people were able to reach their call bells but one could not. We were told that sometimes people had to wait for several minutes for assistance. During our observations we heard the call bell sound. It took three minutes to be responded to. Doctors and nurses present in the bay did not respond to the individual.

People were regularly asked if they were happy with their care. Any concerns raised were addressed at ward level but if this was not possible people were given information about the complaints procedure and the patient advice and liaison service.

Bedside lockers were available for people to store their belongings in on both the wards we visited. This respected each person’s right to privacy.

The structure of the wards ensured that privacy and dignity for people was maintained. There were only female people on ward nine. On ward ten there were both male and female people. Males were allocated one wing and females the other. Toilet and bathing facilities were available on each wing.

Nursing staff told us they had received training in privacy and dignity during their nurse training. They felt that once they had received it they didn’t forget it.

Our judgement

People were helped to make choices in the treatment and support they received. Sometimes their privacy and dignity was not maintained because other people could hear what help they were receiving through the privacy curtains. People sometimes had to wait for assistance when they asked for it and were not always spoken to with respect.

Outcome 5: Meeting nutritional needs

What the outcome says

This is what people who use services should expect.

People who use services:

Are supported to have adequate nutrition and hydration.

 

What we (CQC) found

Our judgement
There are minor concerns with outcome 5: Meeting nutritional needs
Our findings
What people who use the service experienced and told us 
We spoke with 13 people, one relative and four members of staff and observed the meal time on two wards during our visit to the hospital.
Most people told us that they were happy with the food they received. We were told that there were choices of hot and cold food on the menu.
On one ward people told us that when the food trolley was brought to the ward they were asked what they wanted to eat from the available meals. This promoted people’s opportunity to make choices. Sometimes the food was not that warm as the trolley started (to serve food) at the other end of the ward but the food was still enjoyable. Some people told us that they hadn’t been asked what their likes or dislikes were but had been asked about allergies and if they were vegetarian. One person told us that they would have liked more mouth washes.One person told us “They always tell me to eat meals, and if I want something else they give me a sandwich. I’ve never been a big eater but we have three meals a day and supper with a drink.”Another person told us “The food was not too bad and they got enough to eat”.A third person told us “The food was horrible” and their family brought food in for them.’

A relative told us that they came twice a day to help feed their father and the food was “excellent” and they couldn’t fault the staff.
Other evidence

The Trust was rated much better than expected when compared with other similar trusts in respect of people receiving help and the quality of food.

The PEAT survey for Good Hope Hospital for early 2010 rated them as ‘excellent’ overall in respect of menus, choice, availability, quality, portions, temperature, presentation, service and beverages.

Good Hope Hospital was rated similar to expected when compared with other similar services in respect of availability of equipment for measuring people, existence of a trust nutritional screening group, proportion of wards that were using a nutritional screening policy and proportion of wards that operated a protected mealtime policy.

Between June 2010 and March 2011 we had received three concerns about the way in which peoples’ nutritional needs had been met in Good Hope Hospital.

A clinical quality review group report by HEFT indicated that the trust had carried out a catering audit of food in January 2011. This report showed a steady improvement from the patient experience surveys carried out in November 2010.

This report also highlighted a six point check to be carried out by staff before meals were given to those people who needed assistance. These points included the positioning of people before meals, the appropriate positioning of tables, people being assisted where needed, people being offered hand washing opportunities, the use of a red tray system to identify people at risk and the protected meal time being implemented. We found that these points had been implemented

A protected mealtime was in place on both wards we visited. Protected meal times meant that all staff were involved in the mealtime to ensure people received their meals and any assistance they needed. On one ward we saw that the doctors’ ward round continued into the protected meal time thereby impacting on the meal time for some people. We also saw that only people on ward nine were offered hand cleaning opportunities before their meals.

People were given choices at meal times even though different systems were in use on the two wards. On ward nine people were offered choices from the available meals on the trolley. On ward ten people had ordered what they wanted the day before and their meals were plated up as ordered. On ward ten the pudding was served with the main meal but on ward nine it was served after the main meal had been eaten.

A third person told us “The food was horrible” and their family brought food in for them.’

A relative told us that they came twice a day to help feed their father and the food was “excellent” and they couldn’t fault the staff.
Other evidence

The Trust was rated much better than expected when compared with other similar trusts in respect of people receiving help and the quality of food.

The PEAT survey for Good Hope Hospital for early 2010 rated them as ‘excellent’ overall in respect of menus, choice, availability, quality, portions, temperature, presentation, service and beverages.

Good Hope Hospital was rated similar to expected when compared with other similar services in respect of availability of equipment for measuring people, existence of a trust nutritional screening group, proportion of wards that were using a nutritional screening policy and proportion of wards that operated a protected mealtime policy.

Between June 2010 and March 2011 we had received three concerns about the way in which peoples’ nutritional needs had been met in Good Hope Hospital.

A clinical quality review group report by HEFT indicated that the trust had carried out a catering audit of food in January 2011. This report showed a steady improvement from the patient experience surveys carried out in November 2010.

This report also highlighted a six point check to be carried out by staff before meals were given to those people who needed assistance. These points included the positioning of people before meals, the appropriate positioning of tables, people being assisted where needed, people being offered hand washing opportunities, the use of a red tray system to identify people at risk and the protected meal time being implemented. We found that these points had been implemented

A protected mealtime was in place on both wards we visited. Protected meal times meant that all staff were involved in the mealtime to ensure people received their meals and any assistance they needed. On one ward we saw that the doctors’ ward round continued into the protected meal time thereby impacting on the meal time for some people. We also saw that only people on ward nine were offered hand cleaning opportunities before their meals.
People were given choices at meal times even though different systems were in use on the two wards. On ward nine people were offered choices from the available meals on the trolley. On ward ten people had ordered what they wanted the day before and their meals were plated up as ordered. On ward ten the pudding was served with the main meal but on ward nine it was served after the main meal had been eaten.

On ward nine one person who requested salad was unable to have it as there was none left.

On the day of our visit special diets were catered for ensuring cultural and dietary needs were met. We were told that there were limited choices for people requiring pureed meals as these needed to be pre-ordered and could not be chosen from the trolley on the day.
People who were at risk of poor hydration and nutrition were identified through the assessment process on admission and feedback from the multidisciplinary team (MDT) members. The assessment records had sections for recording nutritional likes and dislikes but these were not always completed. Weight records, food and fluid intake charts were reviewed regularly providing information about whether people were receiving adequate nutrition and hydration. Nutritional assessments were kept under review but the scoring did not always correlate to patient’s clinical conditions.

People refusing to eat or if they appeared to be losing weight were referred to the MDT. Dieticians decided if people needed to have supplements or intravenous assistance to prevent dehydration. This ensured that people’s changing needs were identified and planned for.

Sometimes people’s drinks were left on their tables without sufficient prompting to ensure they were drunk.

Staff had received training in food hygiene and nutrition. Some senior staff had received further training to undertake swallowing assessments. Speech and language therapy specialists were available for support. This enabled people to be supported to eat safely.
Food charts did not always indicate accurately how much people had eaten or drank. The Heart of England NHS Foundation Trust had identified this and a new food chart enabling more detailed information to be recorded was being introduced.

Our judgement

People were provided with hot, nutritious meals each day and support to eat if they needed it. There was not always sufficient food to ensure that everyone had access to all the choices available. Protected mealtimes were not observed by all professionals. Hand washing facilities were not made available to everyone. Nutritional assessments were generally well managed but individual preferences were not always recorded.

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