a CARE Quality Commission inspection has found Pendle Community Hospital was failing to meet two of the five required essential standards, a report into the August inspection says.
But neither of the failings – into respect shown to patients and the safety of people’s personal records – were serious enough to warrant enforcement action being taken against the hospital in Leeds Road, Nelson.
Standards in food and drink meeting the dietary needs of patients; protecting people from abuse and respecting human rights; and staffing levels were all being met, the inspectors found.
The report said the hospital, which comprises of three wards each accommodating up to 24 patients and provides nursing care and medical oversight for people with long-term conditions and a rehabilitation service for people following illness or injury, had received good reports from many patients.
One said: “I can’t fault anything and I have no concerns or worries” and another said: “They’re okay and they’re looking after me”.
The inspectors’ report said: “We found patients experienced some good care and treatment. However we observed some practices which did not effectively promote patients’ dignity, consultation and involvement. Patients told us they liked the variety and quantity of the meals provided at Pendle Community Hospital. We found the catering arrangements offered a variety of meals and choices. Patient’s individual food preferences were catered for as far as possible. Eating and drinking sufficient amounts was encouraged and promoted. Consideration was being given to individual nutritional needs and specific dietary requirements.
“Patients told us they felt safe and comfortable in the hospital. Although some patients spoken with were uncertain what they would do if they were worried or concerned about anything, we found there were notices displayed throughout the wards on how to make a complaint.
“We found there were sufficient staff on the wards to respond to patients’ needs. Patients told us the staff treated them well.”
On patient respect, the report said the non-compliance had a moderate impact on people who use the service.
“Although we found patients’ individual needs and preferences were considered during their pre-admission assessment, this information was not transferred into their care plans.
“We overheard staff speaking by telephone in the corridor at a nurse’s station about patients’ needs. This compromised patients’ confidentiality. We also overheard a small group of staff in one dining room discussing their own personal issues, with no regard to the patients who were waiting for their lunch, this presented as discourteous.
“The hospital provided segregated male and female bedroom areas on all three wards. These areas had access to separate toilets and bathing facilities which were designated for male and female use. We found patients were not provided with their own lockable facilities for the safekeeping of personal items; however arrangements could be made for valuables to be kept in a secure area.
“Staff told us they had discussed the care plans with patients, however, most of the patients spoken with had not seen or discussed their care plan and they had not signed their plan to indicate their participation and agreement. Staff told us each patient’s individual preferences in respect of their personal care needs, were discussed within team handover meetings. However there were no records in support of this practice.
“We noted one patient had a DNAR (do not attempt resuscitation) form in place. Although the patient was able to clearly express their wishes, according to information on the form the patient had not been consulted and may therefore have been unaware such a directive existed. The issuing of a DNAR form without patient consultation is contrary to good practice guidance.
“We also noted the DNAR had not been reviewed in line with the trust’s policies. This meant there was the potential for the hospital to act contrary to the patient’s wishes and place their wellbeing at significant risk. Senior representatives from the trust ensured a review of this DNAR directive was undertaken during the inspection.”
On the subject of records, the inspectors found all the patients had a care plan in place which had been produced by a qualified member of staff. “However, not all records we saw were complete or accurate. There were no records of signatures to show patients or their representatives had been involved with making decisions about their care and treatment.
“We found patients’ individual food preferences and preferred term of address were not recorded in their care plans.
“Some of the information in care plans was brief and did not always include details of patient’s personal preferences about how they wished to be supported. There was also limited information about their individual programme of rehabilitation and their personal goals. Senior representatives of the Trust explained work was in progress to develop further the care plan process.
“One patient’s DNAR form had not been properly completed and reviewed. This lack of attention to appropriate record keeping meant there was a significant risk that the patient’s needs and preferences may be neglected.”
The hospital has been asked to send the CQC a report in how the matters raised have been dealt with.