Sturdee Community Hospital

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

Leaders placed emphasis upon keeping patients safe from harm and encouraged staff to be open with reporting concerns. Senior staff appropriately investigated incidents and complaints to identify good practice and lessons learnt. Staff had a good understanding of safeguarding and had received appropriate training. There was a clear process in place with reporting safeguarding concerns. Staff communicated with external agencies as and when appropriate. The hospital had enough qualified, skilled and experienced staff to care for the patients. Although there were some vacancies, managers ensured any gaps were covered by bank or agency staff. The hospital had systems and processes in place for appropriate and safe handling of medicines, which staff generally followed. Where we found gaps in records during the assessment, these had already been identified through medicines audits. Staff had implemented changes to encourage improvement in practice. Staff completed individual patient risk assessments and involved them were possible. Staff updated and reviewed these regularly. Staff had a good understanding of patients’ individual risks and interventions to mitigate and reduce these risks. However, there were a number of patients prescribed enhanced observations and it was evident that this did not always lead to mitigation of risk behaviours. Care records examined did not consistently demonstrate comprehensive reviews had taken place, with the consideration of less restrictive interventions.

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.

Patients we spoke with were aware that staff investigated some incidents although did not comment further regarding any learning from these and how staff share this information with staff and patients.

Staff told us they felt supported by leaders to raise concerns. Staff said managers investigated incidents and complaints, of which outcomes, feedback and learning was shared. Staff said they had regular patient safety meetings where they discussed incidents and confirmed de-brief meetings were available to them post incidents. Managers confirmed de-briefs were undertaken by the psychologist, offering a safe space for staff to discuss incidents, discuss how they felt, focus upon what went well, and what could potentially have been done differently. Leaders also told us they had provided staff with additional training around enhanced observations. The provider had introduced an electronic computer system since our last assessment, which included the use of handheld devices. Staff spoke positively about these and told us the hand held devices were useful as information could be recorded in real time.

Governance meeting minutes reviewed demonstrated there had been an increased focus on learning from incidents. Although the provider had systems and processes in place about the promotion of a learning culture, these had not been consistently implemented and demonstrated. For example, governance meeting minutes from April 2024 stated 3 complaints had been closed. There was no recorded evidence of learning or actions taken as a result. Further information provided by the provider confirmed that 2 of the 3 complaints had related to staff conduct. Staff had identified themes of incidents within their lessons learnt document. However, there was a lack of clarity around any changes in practice and clear lessons learnt. The emphasis was upon standard care, such as communication and staff to follow care plans. During this time the hospital had over 200 incidents reported. We reviewed staff meeting minutes from December, February and March. There was a lack of discussion around learning which had occurred as a result of recent incidents which had taken place.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most patients we spoke with felt safe in the hospital. Of the six patients we spoke with, one patient told us that on one occasion, staff had not checked upon them when they were supposed to. No times nor dates were specified, and this was reported as an isolated incident. This patient told us that on one occasion, staff did not check on them for 3 hours, despite being on hourly checks. One patient reported a safeguarding concern to us which was escalated to the manager, who acted upon this immediately, and took all relevant actions to investigate the concerns. The manager relayed the findings of the concern to us later that day, and ensured the patient felt safe during this process.

Staff demonstrated a good knowledge of safeguarding, how to report, what to report and who to. All staff had received and were up to date with safeguarding training relevant to their role, in line with national guidance. Staff were able to identify different forms of abuse and the signs associated with these. Staff told us they attended regular patient safety and safeguarding meetings where appropriate safeguarding measures were discussed, reviewed and information shared. Leaders were aware of the importance of safeguarding and monitored all safeguarding referrals made. Leaders were keen to hear from staff and patients and operated an ‘open door policy’ to enable any concerns to be raised. However, safeguarding referrals to the Local Authority and to CQC continued to be made regularly after patients engaged in deliberate self harm despite being on enhanced observations.

We saw relevant information about safeguarding displayed across the hospital, visible for staff, patients and visitors. Safe staffing numbers were observed across the hospital during our on-site assessment. We saw staff having meaningful engagement with patients, in a caring and sensitive way. Where patients showed signs of distress, staff supported them appropriately.

We reviewed detailed and comprehensive policies for safeguarding adults and children. These had been reviewed, updated and ratified appropriately. We reviewed safeguarding analysis provided after our on-site assessment covering January to April 2024. This provided high level of detail about each incident. A recurrent theme we noted since November 2023, had been patients engaging in deliberate self-harm while under enhanced observations. Yet the provider had not introduced additional staff training regarding enhanced observations until March, with all required staff having completed this by the end of July 2024. Ward staff meeting minutes viewed did not demonstrate any discussions around safeguarding. However, current and new safeguarding concerns were covered during the regular patient safety meetings.

Patients we spoke with generally felt involved in their care and treatment decisions. One patient told us they were working with staff to reduce their risks and working towards being discharged. Patients on enhanced observations knew why this was and had care plans in place to inform staff.

Staff attempted to keep all patients as safe as possible. Staff demonstrated a person-centred approach, attempting to involve patients with completing and reviewing care plans and risk assessments. Staff said that they always had a least restrictive approach, always trying to use de-escalation and distraction techniques before using any physical restraint. Staff had completed the mandatory restrictive interventions training as expected. As and when staff had to temporarily remove items from patients to prevent harm, they discussed this with the individual patient where possible.

Most staff had received and were up to date with relevant training relating to risk management. We reviewed 10 patient records, all 10 had up to date care plans and risk assessments. They all showed patient involvement and included individualised content such as patient risks and their treatment goals. Community meeting minutes showed staff got patients involved in many different activities, taking suggestions of what patients would like to do. We reviewed the provider observation and engagement policy. This was comprehensive with a clear explanation of each observation level, emphasis upon a person-centred approach, as well as the importance of reducing observations as soon as it is safe to do so.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Some patients told us that staff turnover had been high which had led to inconsistent care due to staff working with them who had not known them well, and were not as familiar with individual needs. However, the patients acknowledged that there had been further recruitment of substantive staff, which had aided familiarity between staff and patients. Patients generally felt there were enough staff on each shift to meet their needs.

Staff said they always had safe staffing numbers on each shift. Managers increased staffing numbers to reflect the needs of the patients on each unit. Staff said that they were rarely short staffed and where appropriate, were able to increase staff at short notice if needed. Staff told us patient activities and leave were sometimes delayed but rarely cancelled due to staffing issues. All staff had a personal alarm which when used alerted staff across the hospital to the precise location of an incident. This allowed extra staff to attend incidents and offer support to maintain the safety of the ward. Leaders said they were looking to use one preferred staffing agency in the future, to provide consistent care across the hospital where possible to help keep patients safe.

We observed appropriate staff numbers for patient observational needs across the hospital. There appeared to be adequate staff numbers to care for and support patients outside of the observational demand. There was always at least one additional staff member on each ward described as a ‘floater’, who met individual needs of patients. We saw different members of the multi-disciplinary team contributing to care and treatment.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff supported patients to receive their medicines in a way which met their individual needs. The multi-disciplinary team discussed each patient’s care and treatment with the patients. Staff regularly monitored patients’ physical health. Where patients were prescribed medicines with known risks, staff monitored them appropriately. All medicines were reviewed regularly as expected. Staff supported patients to manage their anxiety and agitation without the use of medicines where possible. When medicines were needed these were used as a last resort.

Nursing staff were suitably trained to administer medicines. Staff told us they were able to access topic specific training when needed to increase knowledge and understanding in specific areas. The safe and effective use of medicines was supported by an external pharmacy provider who attended onsite and could be contacted remotely as well. Staff told us the pharmacy team provided training on medicines to patients and their families / carers to promote better understanding and concordance with prescribed medicines. Prescribers at the service told us they had a good network around them to support peer discussion and they could seek specialist help when needed for complex cases.

We observed staff were knowledgeable and gave medicines in a person-centred way. Staff stored medicines including controlled drugs safely and securely on the wards. There was a robust monitoring process in place to ensure staff stored medicines in line with national guidance and manufacturers recommendations.

There were processes in place to ensure patients were receiving their medicines safely and as prescribed. There was a robust auditing system in place which had successfully identified and implemented changes to practice where processes had previously not been followed. This included a complete review of monitoring patients following the use of rapid tranquilisation. In previous months staff had not completed these in line with the providers own policy. However, by the time of the assessment, changes had been made to ensure staff had completed patient monitoring appropriately, with each use of rapid tranquilisation being reviewed as expected. There was a good culture of reporting on errors and near misses and sharing learning from these to improve practice.