Nightingale Hospital

Patients we spoke with felt safe at the service, and that staff took any concerns about their safety seriously. Most relatives of people using the service were positive about staff care and treatment and approach in keeping their relatives safe. However, some raised concerns about incidents that had occurred on or off the hospital premises. They had been in contact with the hospital management to discuss ways in which systems could be improved. Staff confirmed that managers debriefed and supported them after any serious incident. Staff had easy access to clinical information about patients. Staff we spoke with knew the needs and risks of patients and were able to provide examples of how they had supported patients with their needs and risks. Managers had conducted their own gap analysis of the service and had identified areas for improvement in the physical environment, and further recruitment of staff. We observed a staff handover meeting at the end of an evening shift focussing on safety and continuity of care. Risk assessments and treatment plans were updated and reflected current risks and needs and goals patients were working towards. Staff we spoke with showed a commitment to taking immediate action to keeping people safe from abuse and neglect and felt comfortable and safe to do so. Patients told us that staff helped them to prepare for stepping down to being day patients with appropriate advice and consideration of risks that they would face. However, some patients and carers described some inappropriate interventions from bank or agency staff who did not know their needs well. Patients and staff completed risk assessments on a daily basis and discussed any differences in scoring. Risks were also reviewed at weekly ward rounds, including feedback from both patients and staff. Staff demonstrated a good understanding of the management of risk and reducing restrictive interventions, and provided crisis support numbers for patients prior to discharge from the unit. We reviewed recent community meeting minutes and found that people using the service were able to raise their concerns about restrictions within the unit. As required at the previous inspection in June 2022, staff conducted a risk assessment for patients in terms of their skin integrity using a recognised assessment tool. They took appropriate action according to the assessment including the use of pressure relieving mattresses, and regular reviews. Care plans did not always fully reflect the changing circumstances of patients who had stepped down from being an inpatient to a day patient (only detailing support provided when they were on the premises) as required at the previous inspection in June 2022. However, patients were clear that they were well prepared for stepping down or working towards discharge and the risks that they would face. The environment was clean, well maintained, with the facilities and equipment to meet patients’ needs. Staff told us that they regularly completed daily security and environmental checks to ensure the environment was safe for patients. At the time of the inspection, recruitment was ongoing with vacancies for 2 registered nurses and 2 registered nurses on long term sickness. The ward manager could adjust staffing levels according to the needs of patients. However, patients raised concerns about the number of bank or agency staff that worked with them, who did not always support them sensitively. Patients were aware of actions being taken by the ward manager to address their concerns about bank and agency staff, providing them with improved inductions and training. Overall, mandatory training rates for staff were 86%. We looked at the recruitment records for 3 staff working in different roles on the ward and found that these included all appropriate checks. As required at the previous inspection in June 2022, the provider had purchased a new and more appropriate chair for naso-gastric feeding.