11 December to 10 January 2019
During a routine inspection
Our rating of the trust went down. We rated it as requires improvement because:
- We rated effective and caring as good and safe and responsive as requires improvement.
- We rated well-led for the trust overall as good.
- We rated six of the 12 services inspected this time as requires improvement. In rating the trust, we also took into account the current ratings of the services not inspected this time.
- Some of the issues identified during the previous inspection, which impacted on the safety and responsiveness of services, had not been yet been addressed by the trust.
- Mandatory training for staff in key skills, including safeguarding, fell below the trust’s target for compliance.
- Staff did not consistently follow best practice when prescribing, giving, recording, storing and disposing of medicines.
- Services did not always have sufficient numbers of staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment.
- We were not assured that there were effective systems and processes in place to prevent avoidable patient safety incidents from reoccurring.
- People did not always have prompt access to services when they needed it.
- Best practice guidelines for the care and treatment of patients with additional support needs were not always consistently followed.
- Whilst the trust had effective systems for identifying risks and planning to reduce them, risks were not always being dealt with in a timely way.
- Whilst the majority of staff felt the culture of the organisation had improved and described the leadership team as accessible and supportive, there remained a culture of bullying within the operating theatres.
However:
- The service managed patient safety incidents well.
- The hospital generally controlled infection risk well.
- The service provided care and treatment based on national guidance and evidence of its effectiveness.
- Staff worked together as a team to deliver effective, patient-centred care and improve patient outcomes.
- Staff treated patients with kindness, dignity and respect.
- Most staff felt well supported by managers and told us that they encouraged effective team working across the hospital.
- The trust was committed to improving services by learning, promoting training, research and innovation.
Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RAL/reports.