We carried out this inspection to check whether the hospital had made improvements since our last inspection in June 2013. At our last inspection we had found that patients on Canterbury ward were not always being treated with dignity and respect and some patients did not receive adequate explanations of their care and treatment. Assessments of patients' needs had not always taken place in a way that supported the planning and delivery of appropriate care and treatment. We also found there were not always sufficient staff available to meet patients' needs in a timely manner. Systems in place to assess and monitor the quality of services had identified shortfalls but had not been effective in bringing about prompt improvements in care and treatment.In addition, during this inspection we looked at other outcomes we had not inspected for some time including procedures for obtaining the consent of patients, support and training for staff and infection control and cleanliness.
We carried out inspections of the hospital over a four day period and involved seven inspectors, three nurse advisors, and an operating theatre specialist advisor. We visited the urgent care centre, out-patient clinics, older people's assessment unit, three wards and the operating theatre suite. We inspected an additional three wards in respect of their cleanliness and infection prevention and control measures. We spoke separately with individual doctors and met with senior managers and a non-executive director of the Trust Board.
We spoke with more than 50 patients and relatives using hospital services about their experiences of care and treatment. We found that improvements had been made in all the areas in which we had previously made compliance actions. There had been a significant improvement in patients' experiences on Canterbury ward since our last inspection. Patients told us their privacy and dignity had been respected by staff and they had received clear explanations of their care and treatment. A patient on Canterbury ward described nursing staff as 'very good and very attentive.' Another patient said that care on the ward was 'marvellous.' A patient on Bramley ward said they would rate their experience as '95 out of 100%.' Another patient on the ward told us that care was 'very good indeed.'
Staff assessed patients' needs and planned and delivered care compassionately and safely. We saw many positive, caring and compassionate interactions between staff and patients on the wards during periods of structured observation. Staff were proactive in approaching patients to check whether they needed anything and responded promptly to requests for assistance. Staff gave time and were comfortable providing care to patients with dementia. Patients told us they were asked for their consent before staff provided care or carried out a procedure. For example, a patient told us, 'all the staff are polite and ask before they do things.'
There were sufficient numbers of staff available to provide care to patients and minimise risks to their safety. Staff received appropriate training and support to enable them to provide the care and treatment that patients needed. The trust was well-led and responsive to people's needs. Systems were in place to assess and monitor the quality of service that patients received and ensure care was provided safely and effectively.
However, although we found that all wards were clean, with good standards of infection prevention and control, we identified concerns in respect of standards of cleanliness in the theatre suite. We found a mop bucket stored inappropriately, dust accumulating on equipment and some items of equipment that were torn, making them difficult to clean effectively. As a result patients were not being appropriately protected against the risks of infection by means of the maintenance of appropriate standards of cleanliness in theatres.