Victoria Infirmary

⚠ There were not always enough nursing staff with the right qualifications, skills, training and experience to provide care and treatment to children and staffing of children’s nurses was not in line with national guidance. We did not have assurance that the service was mitigating the risk of having qualified staff …

⚠ Although people could access the service when they needed it they did not always receive the right care promptly. Waiting times to treatment and arrangements to admit, treat and discharge patients were not meeting national targets and showed a declining picture.

⚠ Medicines, including analgesia could be administered to patients under a patient group direction. However, we saw that the patient group directions had expired a month previously and a new patient group direction (PGD) had only been signed off by the appropriate committee during the week of our inspection. There had …

⚠ Leaders operated governance processes throughout the service and with partner organisations although the governance structure around audits and their effectiveness in improving outcomes was not robust. The service collected data and analysed it. However, we could not be assured of the accuracy of figures in the daily dashboard performance figures. …

⚠ Whilst the service provided mandatory training in key skills, the number of staff who completed it did not meet trust targets. Whilst staff understood how to protect patients from abuse, the number of staff who completed safeguarding training did not meet trust targets.

⚠ Whilst there had been improvements in nurse staffing levels, not all medical wards had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

⚠ Staff did not effectively monitor or manage risks to people who used services. This was because there were no formalised processes for staff to act upon patients at risk of deterioration or for patients that required medical input. We saw on our inspection that opportunities to prevent or minimise harm …

⚠ Staff did not effectively monitor or manage risks to people who used services. This was because there were no formalised processes for staff to act upon patients at risk of deterioration or for patients that required medical input. We saw on our inspection that opportunities to prevent or minimise harm …

⚠ At our last inspection we found that the service did not monitor the effectiveness of care and treatment or use findings to make improvements to achieve good outcomes for patients; as the service did not undertake local audit. At this inspection we found that there was no audit being undertaken.

⚠ Leaders and teams did not use systems to manage performance effectively. They did not identify and escalate relevant risks and issues and identify actions to reduce their impact.

⚠ The service did not have enough nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Frequent staff shortages increased the risk to people who used services. We reviewed staffing rotas between August 2019 and …

⚠ The service did not make sure all staff were competent for their roles. The service did not hold a complete record of all competencies for all staff that worked at the minor injuries unit, however at the time of our inspection the service was in the process of compiling a …

⚠ Not all staff completed mandatory training, compliance rates for life support modules, fire safety and manual handling were low. At our previous inspection compliance with mandatory training rates were low. Not all staff completed appropriate levels of safeguarding training.