7 June 2022 - 17 June 2022
During a routine inspection
We rated acute wards for adults of working age and specialist eating disorder wards as requires improvement overall. We rated the substance misuse ward as good overall.
We rated Nightingale Hospital as requires improvement because:
- Staff completed ligature risk assessments for wards, but these were missing important details, confusing and lacked clear plans in place to mitigate risks identified. Some staff we spoke with did not know how to find the risk assessment.
- Staff developed care plans but did not always reflect patient risks, needs and goals on the acute and eating disorder wards. We found that staff reviewed care plans on a regular basis but there was no evidence that these reviews were meaningful in terms of making appropriate changes in line with patients’ current presentation. Care plans for day patients in eating disorder had not been reviewed after they were discharged from the ward, so were not an up to date reflection of their care.
- The service had systems and processes in place to provide assurance and deliver the organisation’s services safely, but these were not always effective. We found areas for improvement in their governance processes. Although performance data was collected, there was limited evidence of improvements. For example, the quality of some essential patient records were still not adequate and could lead to unsafe care and treatment.
- The service had not documented a specific risk assessment for a patient under 18 years old admitted to an adult ward, including consideration of risk related to their age and vulnerability.
- Staff did not use a recognised risk assessment for patients in terms of their tissue viability (to monitor their risk of developing pressure ulcers) on the eating disorders ward and the ward did not have a safe and appropriate chair for patients who needed feeding by naso-gastric tubing.
- Patients in eating disorder ward described some variability in the way different staff treated them, with some staff not understanding their individual needs, and not treating them with compassion and kindness and respecting their privacy and dignity.
- Although records showed that staff checked emergency equipment weekly some of it had expired, removed from the emergency kit and not been replaced. A defibrillator was noted to have had a low battery since May 2022. It was not clear from the paperwork or from talking to staff how this identified issue had been actioned.
- Some prescription charts on the acute wards did not record the name of the patient or the name of the prescriber, which meant there was a risk of patients being given the incorrect medicines.
- Staff did not always document discharge plans or approximate dates of discharge for all the care records we reviewed on the acute, obsessive compulsive ward and eating disorder wards. It was difficult to ascertain whether these discussions had happened with the patients by looking at their records.
- The overall vacancy rate at the hospital for clinical staff was 29%. The hospital had used long term contracts with bank and agency staff to fill these roles. Staff vacancies had been filled with long term locum staff. This had the potential to affect continuity of patient care.
- The service was not smoke-free in line with best practice.
- The services used closed circuit television (CCTV) in all communal areas but did not have signs to make people aware of the use of CCTV. We raised this with the staff who promptly added the signs.
- Female patients on the substance misuse service mixed sex ward did not have access to a female only lounge.
- The provider had not developed staff competencies for key tasks specific to treating patients with eating disorders and autism.
- Clinic room temperatures in the substance misuse ward were above 25 degrees, which is above the recommended temperature for the storage of medicines.
However:
- Staff in substance misuse service, acute wards and obsessive compulsive disorder wards treated people with compassion and kindness and understood their individual needs.
- The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team.
- The daily handover sheets were very informative and had key patient information that staff reported to be useful.
- Patients on acute and substance misuse wards felt that nurses were responsive, any issues raised are promptly addressed and patients enjoyed therapy groups.
- All records we reviewed in the substance misuse ward included a comprehensive assessment of patients’ drug and/or alcohol dependence level, healthcare and other needs.
- The substance misuse ward met the needs of all patients – including those with a protected characteristic. The ward had recently held an LGBT+ event on the ward, where advice and information about services that support the LGBT+ community was shared.