Sulis Bath Hospital Limited Also known as Circle Bath

Updated 24 April 2017

Circle Bath is operated by Circle Hospital Bath Ltd. The hospital opened in 2010. It is an independent hospital located in Peasdown St. John in Bath. The hospital primarily serves the communities of Bath and North East Somerset. It also accepts patient referrals from outside this area.

At the time of the inspection, a new manager had recently been appointed and was registered with the CQC in November 2016.

The hospital was inspected in January 2014, and we found the hospital was not meeting all standards or quality and safety it was inspected against. We found that Regulation 12 HSCA 2008 (Regulated Activities) Regulation 10: Cleanliness and infection control was not being met. Some parts of the fixtures and fittings in the hospital had excessive dust from a lack of effective cleaning. Some cleaning equipment and storage areas were not as clean as they should have been.

Updated 24 April 2017

Circle Bath is an independent hospital operated by Circle Hospital Bath Ltd. The hospital has 30 inpatient beds and 22 day surgery unit ‘pods’. Facilities include four operating theatres, and outpatient and diagnostic facilities (including magnetic resonance imaging (MRI), x-ray, ultrasound and computed tomography (CT) scanner).

The hospital provides surgery and outpatients and diagnostic imaging. We inspected both services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 and 21 December 2016, along with an unannounced visit to the hospital on 7 January 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

Services we rate

We rated this hospital as good overall.

We found good practice in relation to surgery:

• The service managed staffing effectively and services always had enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
• Patients spoke of high quality, compassionate care by all staff.
• The service carried out thorough root cause analysis and learning when things went wrong.
• Patients had good outcomes in line with national average, and care and treatment was planned and delivered in line with evidence-based guidance, standards and best practice.
• Staff provided care that was compassionate and treated patients with dignity and respect at all times.
• Services were planned and delivered in a way that met the needs of the local population.
• The service had an effective system to effectively investigate, monitor and evaluate patient’s complaints and concerns, and learning was shared throughout the hospital.
• Comprehensive governance arrangements were in place.

However, we found areas of practice that required improvement:

• We observed patients’ notes unattended outside a patient’s room while nursing staff attended a patient.
• The service was not meeting its target of 90% of patients receiving treatment within 18 weeks of referral.

Across the hospital staff were overwhelmingly positive about the strong and visible leadership. Staff felt engaged.

We found areas of outstanding and good practice in outpatients and diagnostic imaging:

• There was outstanding care provided to patients. Staff treated patients with dignity, kindness and respected. Feedback from patients was overwhelmingly positive, and patients and those close to them were involved as active partners in their care.
• The outpatients and diagnostic imaging service had a good track record on safety. Staff were encouraged to report concerns and incidents, and investigated them to identify and share learning.
• People’s needs were assessed and their care and treatment delivered in accordance with legislation, standards and evidence-based guidance.
• Services were responsive to the needs of the population and ensure flexibility, choice and continuity of care, and premises and facilities were appropriate for the services that were planned and delivered.
• The local leadership team was well respected, visible and accessible. Staff were inspired by and supported by a strong and cohesive leadership team.

However, we found areas of practice that required improvement:

• The availability of chaperones to accompany patients during consultations and examinations was not publicised in outpatient departments.
• There was no private space available in outpatients, which could be used by, for example, breast feeding mothers or people who wished to have private conversations.

• Patient information on medical conditions and treatments was available in English only.
• The outpatient department had not recruited to the unit lead position, which had been vacant for over 12 months. The deputy lead had taken over managerial responsibilities but had little protected time to fulfil these responsibilities.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Edward Baker

Updated 24 April 2017

We rated this service as good because it was safe, effective, responsive to people’s needs and well-led, and outstanding in caring.

• The service had a good track record on safety. There was an open culture; staff were encouraged to report concerns and incidents. Incidents were investigated and used to identify learning.
• Risks to patients were assessed and appropriately managed. Comprehensive pre-operative assessment ensured patients’ suitability for surgery at Circle Bath.
• Departments were appropriately staffed to keep people safe.
• Staff were trained in and complied with safe systems to protect people from avoidable harm.
• People had their needs assessed and their care planned and delivered in line with evidence-based, guidance, standards and best practice, including during assessment, diagnostics and referral to other services
• Staff, including those in different teams, worked together to provide seamless and coordinated care.
• Staff were suitably qualified and experienced to undertake their roles and received regular supervision and appraisal.
• Feedback from patients and those close to them was consistently positive. The department received overwhelmingly positive feedback from patients and this was consistent with the feedback we received during our inspection. Patients we spoke with were fulsome in their praise for staff. We heard of numerous examples where staff had “gone the extra mile” to support people.
• Staff treated patients with dignity, respect and kindness during all interactions. Patients told us that staff took time to listen to them and felt supported by them.
• Patients and those close to them were involved as partners in their care. Patients told us that their conditions and treatment options were explained to them in a way they could understand.
• Staff showed compassion when people were distressed or anxious.
• Patients could access care and treatment at a time which was convenient to them. Cancellations and delays were minimal.
• Premises were accessible and comfortable.
• People’s complaints and concerns were listened to and responded to. Learning from complaints was used to improve the quality of care.
• The local leadership team was well respected, visible and accessible. Staff were inspired by and supported by a strong and cohesive leadership team.
• Staff enjoyed working at Circle Bath. Staff morale was high; they expressed pride in their service and they were optimistic for the future.
• Team work was cited by many staff as the best thing about working at Circle Bath. We saw excellent cooperative working within and between departments.
• There were effective governance arrangements. Information was regularly monitored to provide a holistic understanding of performance, including safety, quality and patient experience.
• Patients and the public were engaged and involved. Their views were captured and acted upon to improve the service.
• Staff embraced the hospital’s improvement plan and were encouraged and empowered to raise concerns and drive improvement.

However:

• There was no private space available in outpatients which could be used by, for example, breast feeding mothers or people who wished to have private conversations.
• Patient information on medical conditions and treatments was available in English only.
• The availability of chaperones to accompany patients at consultations was not publicised in departments.
• The outpatient department had not recruited to the unit lead position, which had been vacant for over 12 months. The deputy lead had taken over managerial responsibilities but had little protected time to fulfil these responsibilities.  

Updated 24 April 2017

Surgery was the main activity of the hospital. Where our findings on surgery also apply to other services, we do not repeat the information but cross-refer to the surgery section.

We rated this service as good because it was good for safety, effective, caring, responsive to people’s needs and well-led.

• Staff supported and treated patients with dignity and respect, and patients were involved in decisions about their care and treatment.
• Patients spoke of a high standard of compassionate and competent care by nurses, allied health professionals and medical staff.
• Staff monitored patient safety and investigated incidents and shared learning from reported incidents to improve care.
• All areas we observed were well organised and visibly clean.
• Staffing levels were sufficient and were planned and maintained to safely meet the needs of patients. The hospital had competent staff who worked as an effective team to care for patients. Staff told us that they were supported with training and were given time to attend. Staff were up to date with their mandatory training and understood the safeguarding policies and procedures for vulnerable adults.
• Staff responded compassionately when patients needed help.
• We observed patient notes unattended outside a patient room, on a drugs trolley while the nursing staff was attending a patient.