13/10/2021 & 24/11/2021
During a routine inspection
Our rating of this location went down. We rated it as requires improvement because:
- The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
- Staff provided good care and treatment and assessed patients’ food and drink requirements. The service met agreed response times. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and supported them to make decisions about their care.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
- The service took account of patients’ individual needs and made it easy for people to give feedback. People accessed the service when they needed it and did not have to wait too long for treatment.
- It was easy for people to give feedback and raise concerns about care received.
However:
- The service did not always use systems and processes to safely administer and store medicines.
- The service did not always manage the risk of infection well. There was no processes to screen patients for some infectious diseases and staff did not always have access to or training on the correct level of personal protective equipment.
- Leaders did not operate effective governance processes, throughout the service.
- Systems for monitoring the effectiveness of care and treatment were not fully embedded.
- The service had a mission statement for what it wanted to achieve but no coordinated strategy or vision.
- Managers did not review competency of staff.
- Leaders and teams did not always use systems to manage performance effectively or identify and escalate relevant risks and issues to reduce their impact.
- Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear, up to date or detailed enough to ensure good care.