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Page 1 of 2. Next page. Recent searches:. This provided assurance that sufficient action had been taken to mitigate any immediate risks to patient safety. We will continue to monitor this information through our routine engagement with the trust. Case records we reviewed showed there were missed opportunities to safeguard children and young people.
Staff understood their responsibilities for safeguarding children and young people. Gaps between systems, and a reliance on staff to remember to check all the systems to build up a full picture of care, meant that sometimes information was missed or not shared with everyone, and children and young people were exposed to the risk of harm.
Safeguarding governance systems and processes were not effective. Trust-wide safeguarding meetings were not prioritised by all staff and were often poorly attended. Issues with the effectiveness of these meetings had not been raised through the appropriate governance processes.
At times staff lacked professional curiosity and did not always follow established systems and processes to recognise and identify child protection issues. Safeguarding training levels had improved since the last CQC inspection but remained below the trust target, particularly for medical and dental staff.
There was an overreliance on individual members of the safeguarding team to ensure that processes to keep children and young people safe were implemented. For example, safeguarding huddle meetings did not take place when a member of the team was not able to lead them, and there were no huddles at weekends when the safeguarding team were not on duty.
Staff were not supported by regular, formal safeguarding peer review meetings and were not always involved in joint meetings with other agencies to provide input into decision-making for children and young people. Learning from incidents was not embedded to ensure that children and young people were protected from similar harm. Even when learning materials had been circulated following incidents, we saw that the same types of incident were still occurring at the time of this inspection.
We carried out a focussed unannounced inspection of the urgent and emergency care services at Rotherham General Hospital on August This inspection was to follow up concerns identified at our previous inspection in September We inspected all five domains - safe, effective, caring, responsive and well led. At our previous inspection, safe and well-led had been rated as inadequate.
Effective, caring and responsive were rated as requires improvement. This inspection was to see whether the required improvements had been made. Our rating of this service improved.
We rated it as Requires improvement overall. Safe and well led had improved and were rated as requires improvement. Caring had improved and was rated as good. Effective and responsive had stayed the same and were rated as requires improvement. Paediatric staffing had improved significantly since our last inspection and we no longer felt that the unit was unsafe. There were enough doctors and nurses in the area to ensure children received prompt treatment.
There was a new leadership team in the department. Experienced, visible leaders were working to raise morale and improve culture and we saw evidence that their work was starting to have an impact. At the last CQC inspection we found that care and treatment did not always reflect current evidence-based guidance. We saw evidence that this had improved and staff had developed new pathways and were using NICE guidelines to achieve outcomes for patients.
Audit planning had improved since our last inspection and there were now plans in place for more external and local audits than at our last visit. Staff showed a caring attitude towards patients and we saw examples of empathetic, supportive care. At our last inspection we found it had been difficult for staff to offer the levels of care and support they might have wished.
This had improved and we saw that staff treated their patients with compassion. Safeguarding children and adults remained a concern and staff did not always recognise abuse and did not always demonstrate professional curiosity. While this had improved since our last inspection, and quality assurance processes were now in place, there was still work to be done to further embed this. This was something that staff were aware of and working to address.
There were still long waits for some patients to be seen by a doctor. Flow remained an issue and the trust was not meeting targets for patients being admitted, transferred or discharged into and out of the department. Incident data showed that some people were not being reviewed by specialist medical staff when needed. Complaints were still taking longer than the trust target to resolve.
Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices.
Details are at the end of the report. Our rating of services stayed the same. We rated the hospital as requires improvement because we rated the domains of safe, effective, responsive and well-led as requires improvement, and we rated caring as good.
We carried out a focussed unannounced inspection of the Rotherham General Hospital. We visited the hospital on 17 July because we identified concerns in relation to: -. The management of non-invasive ventilation NIV patients admitted to the Rotherham General Hospital The management of the deteriorating child in the urgent and emergency care centre at the Rotherham General Hospital We did not rate the service because this was a focussed unannounced inspection looking at specific areas of concern.
Therefore not all of the five domains: safe, effective, caring, responsive and well led were reviewed for each of the core services we inspected. We inspected the paediatric area in the urgent and emergency care centre and visited the medical wards to look at the management of acute non-invasive ventilation NIV patients.
Non-invasive ventilation NIV is the use of airway support provided through a face nasal mask or a similar device. For this inspection we only inspected the safe domain.
The inspection was based on specific key lines of enquiry relating to assessing and managing risk, incidents, medicines management, patient records, environment and equipment, training and competency and medical and nurse staffing.
We requested further information following the inspection to provide assurance that immediate risks to patients were being addressed. We made a formal request for assurance using our powers under Section 31 of the Health and Social Act Section 31 allows the Care Quality Commission to take urgent enforcement action if it has reasonable cause to believe that, unless it acts any person will or may be exposed to the risk of harm. The trust provided a detailed response including improvement actions taken or planned for completion by November This showed that sufficient actions had been planned to address the immediate risks to patient safety within the service.
In the Urgent and Emergency Care service paediatric area , we found that :. There were three serious incidents that highlighted a lack of clinical oversight, poor medicines management and delayed diagnosis and treatment of children in the urgent and emergency care services.
Patient records were not complete and contained errors and omissions. Daily resuscitation equipment checklist records were not always completed by staff. We asked the trust to provide further information following the inspection that immediate risks to patients attending the paediatric urgent and emergency department were being addressed.
The trust provided a detailed response including improvement actions taken or planned for completion by October A multi-disciplinary paediatric task and finish group was established following the inspection to oversee improvements and address the immediate risks to children. The information detailed a number of actions that had been implemented including the completion of a risk assessment, additional recruitment, improvements to staff rotas with consultant and middle grade doctor cover, implementation of staff training and increased monitoring.
Further improvement actions were planned for completion by October There was insufficient management, oversight and governance of the risks to acute non-invasive ventilation NIV patients admitted at the hospital.
Patients did not always receive care in specifically identified area s and nurse staffing levels were not always sufficient to meet the needs of these patients.
In the patient records we reviewed we found that they contained errors and omissions and showed evidence of delayed escalation and delayed or missed observations. Patients did not always have a specialist consultant review within 14 hours of admission and patients did not have a daily consultant review thereafter.
We asked the trust to provide further information following the inspection that immediate risks to non-invasive ventilation patients were being addressed.
This showed that sufficient actions had been taken to address the immediate risks to patient receiving non-invasive ventilation at the hospital. The trust reported following the inspection that from August onwards all patients that commenced on NIV would receive ongoing care and treatment within the high dependency unit HDU.
This would allow NIV patients to receive care and treatment by appropriately trained and competent staff and achieve recommended staffing levels, in line with BTS guidelines. Additional record audits and spot checks were taking place or planned to improve documentation compliance. The roles and responsibilities of the clinical lead for NIV were defined along with support functions. A multidisciplinary NIV task and finish group was also established following the inspection to oversee NIV patient safety.
An additional middle grade registrar position had been added to rosters to support patient reviews at weekends. We carried out a focused follow-up inspection between 27 and 30 September to confirm whether The Rotherham NHS Foundation Trust had made improvements to its services since our last comprehensive inspection in February We also undertook an unannounced inspection on 12 October When we last inspected the hospital in February , we rated the service as requires improvement.
We rated safe, effective, responsive and well-led as requires improvement. We rated caring as good,. These were in relation to the safety and suitability of premises, staffing, supporting staff, records, consent to care and treatment, complaints, care and welfare of people who use services, dignity and respect, need for consent, cleanliness and infection control, management of medicines, safeguarding people who use services from abuse and assessing and monitoring the quality of service provision.
The trust sent us an action plan telling us how it would ensure that it had made the improvements required in relation to these breaches of regulation.
At this inspection, we checked whether these actions had been completed. We found that, although the trust had made considerable improvements, there remained areas that required further improvement.
The trust had not taken sufficient action raised in the inspection to ensure DNACPR forms and mental capacity decisions were documented in line with trust policy, national guidance and legislation.
We wrote to the trust immediately following our inspection to ensure that action was taken promptly regarding the DNACPR forms and mental capacity decisions. The trust initiated a number of actions, which we will continue to monitor. Staff understanding and application of the Mental Capacity Act was inconsistent across most of the services inspected.
There were concerns about the current pharmacy service and the impact on patient care. We wrote to the trust immediately following our inspection to ensure that action was taken promptly regarding the management of discharge medications and service provision. However, there remained staffing shortages most notably in the emergency department, school nursing and medical wards. There was a high use of medical locum staff in some specialties.
Some policies and guidelines were out of date and there was a backlog of incidents in maternity services that had not been reviewed. Access to safeguarding supervision was a concern and was in the process of being addressed. The trust took immediate action to address these following our inspection.
Risk registers were in place, but did not always reflect the risks identified on inspection. The number of cases of C. However, on medical wards, there were concerns about infection control practices and facilities in the refurbished areas. There were areas of notable improvement since the previous inspection. These included safeguarding training and awareness, achieving no mixed sex breaches, improvements to the short-break service, access to sexual health records and improvements to training data.
There had also been improvements in ensuring there were no mixed sex breaches, wherever possible and actions had been implemented to minimise these.
We saw that patients were assessed using a nutritional screening, had access to a range of dietary options and were supported to eat and drink. There were no mortality outliers identified at the trust. We saw several areas of outstanding practice including:. Safeguarding and liaison had a daily meeting with the Emergency Department to identify any safeguarding issues and concerns.
Staff had successfully offered the use of acupins for the relief of nausea, particularly in gynaecology services.
However, there were also areas of poor practice where the trust needs to make improvements. Ensure there are sufficient numbers of suitable qualified, competent and skilled staff deployed in the department. Ensure that facilities on the clinical decision unit are properly maintained in a good state of repair and able to meet patient needs. Ensure all staff are aware of their responsibility to report incidents and ensure learning is shared with all relevant staff.
Continue to take action to ensure there are sufficient numbers of suitably skilled, qualified and experienced staff. Ensure all relevant staff have received appropriate training and development. This should include, mental capacity, safeguarding adults and children, resuscitation and dementia awareness. Ensure all staff have an annual appraisal. Mental capacity assessments and discussions must be clearly documented in patient records.
Critical care. Ensure risks are assessed, monitored and managed in a timely manner to ensure safety. Complete the reviews of maternal and neonatal deaths and implement any further identified actions to support safe practice.
Ensure that identified risks recognised and recorded on the risk register. Ensure that incidents are reviewed and investigated in a timely manner. The Rotherham NHS Foundation Trust is a combined acute and community Trust providing services at Rotherham Hospital and across the borough to a population of , people.
Today, we continue to provide a full range of district hospital and community services to Rotherham and the surrounding area alongside partner organisations. The Urgent and Emergency Care Centre UECC opened in and sees approximately 75, attendees per year, and there are approximately 55, inpatients and , outpatient attendances each year.
We aim to build a healthier future for our patients, their carers and families, our staff, and for anyone we care for. We are committed to implementing a vision that integrates hospital and community services and empowers our clinicians and managers to deliver real benefits to patients and their carers.
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