Source · CQC inspection

Sunderland Royal Hospital

Provider City Hospitals Sunderland NHS Foundation Trust Type NHS Healthcare Organisation Region North East Last inspected 17 Apr 2018

Overall rating: Good  View full CQC report

Domain ratings

Five CQC key questions
Safe
Requires Improvement
Effective
Good
Caring
Good
Responsive
Good
Well-led
Good

Earlier inspection findings

pre-2024 framework · 8 must-do 14 should-do

Must-do actions (8)

Legal requirements based on regulation breaches identified during inspection.

Must-do action 1 of 8
Must do
Safe
Ensure that staff adhere to the hand hygiene policies and procedures are adhered to by all staff at all times
Regulation: Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment
⚠ Infection control procedures were not always followed in relation to hand hygiene and use of personal protective equipment. Infection control policies were not always followed and we saw medical and nursing staff with nail varnish and false nails working in the department. There was poor compliance in medical staff with …
Must-do action 2 of 8
Must do
Responsive
Have a proactive approach about how to improve the unplanned re-attendance rate of patients other than mental health patients.
⚠ The trust was much worse than the England average for unplanned re-attendance rates in the emergency department. Between January 2017 and December 2017, the trust’s unplanned re-attendance rate to ED within seven days was generally worse than the national standard of 5% and generally worse than the England average.
Must-do action 3 of 8
Must do
Safe
Ensure there are sufficient qualified, skilled and experienced nursing and medical staff on medical wards. This is to include provision of staff out of hours, bank holidays and at weekends.
Regulation: Regulation 18 HSCA (RA) Regulations 2014 Staffing
⚠ Staffing levels were reviewed three times each day and staff were moved from wards with higher levels of staffing to cover those working at less than safe levels. This was designed to ensure patient safety but had caused concern over the lack of continuity of care from staff moved at …
Must-do action 4 of 8
Must do
Safe
Ensure consistency of staffing across wards through the introduction of an acuity tool to determine accurate staffing levels.
Regulation: Regulation 18 HSCA (RA) Regulations 2014 Staffing
⚠ Ward managers told us that staff moves were not based on a specific patient acuity tool and this led to inconsistency.
Must-do action 5 of 8
Must do
Safe
The service must ensure safe staffing levels in order to deliver safe harm free care for patients.
Regulation: Regulation 18 HSCA (RA) Regulations 2014 Staffing
⚠ Fill rates for staff were consistently poor in some ward areas. There had been episodes of patient harm which were related to poor staffing levels. Data showed that between 1 October 2017 and 31 March 2018 the wards D41, D42, and D48 had 56.6%, 44.5% and 63% (consecutively) unfilled shifts.
Must-do action 6 of 8
Must do
Safe
Ensure controlled drugs are checked and monitored in line with NICE guidelines
Regulation: Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment
⚠ There was inconsistent practice across wards regarding the management of medicines, for example drug fridge temperatures were not consistently recorded on some wards. Controlled drugs were not always checked as per the hospital policy.
Must-do action 7 of 8
Must do
Well-led
Ensure lessons learned from Never Events are shared across the whole surgical division and not just within the surgical speciality where the incident occurred.
Regulation: Regulation 17 HSCA (RA) Regulations 2014 Good governance
⚠ Lessons learned after two never events in 2017 were not shared across all surgical areas after each of the events. Not all relevant staff were aware of the lessons learned from Never events.
Must-do action 8 of 8
Must do
Safe
Ensure the safe storage of dirty linen on wards to reduce the risk of infection
Regulation: Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment
⚠ We saw clean equipment stored in ward sluice rooms next to bagged dirty linen.

Should-do actions (14)

Recommended improvements to enhance service quality.

Should-do action 1 of 14
Should do
Safe
Record daily checks on resuscitation equipment and supplies to ensure there is evidence of checks being carried out.
Should-do action 2 of 14
Should do
Safe
Work towards improving compliance to mandatory training.
Should-do action 3 of 14
Should do
Safe
Ensure all eligible staff have signed patient group directives (PGDs).
Should-do action 4 of 14
Should do
Safe
Ensure all staff have undergone the most appropriate level of life support training for their grade as per the Royal College of Emergency Medicine.
Should-do action 5 of 14
Should do
Effective
Have robust processes in place to demonstrate compliance with RCEM clinical audit requirements and show improvements in compliance when standards are not being met.
Should-do action 6 of 14
Should do
Caring
Consider providing staff with additional training about working with people with mental health conditions to ensure such patients are treated with dignity and respect at all times.
Should-do action 7 of 14
Should do
Safe
Ensure consistent practice and compliance across wards with trust policies regarding the management of medicines.
Should-do action 8 of 14
Should do
Safe
Ensure mandatory training compliance rates meet trust targets.
Should-do action 9 of 14
Should do
Effective
Ensure the input from a consultant cardiologist identified in the heart failure audit meets national targets.
Should-do action 10 of 14
Should do
Safe
Investigate the causes of the failure to meet the aspirational standards for vision assessment, blood pressure assessment, assessment for the presence or absence of delirium and the proportion of patients with a call bell in reach identified in the national audit of inpatient falls.
Should-do action 11 of 14
Should do
Responsive
Ensure the division meets the trust target for the investigation and closure of complaints.
Should-do action 12 of 14
Should do
Safe
The service should continue to work towards the national guidelines of 1:28 midwifery staffing ratio.
Should-do action 13 of 14
Should do
Effective
The service should ensure that all clinical guidelines that are past their review date have been reviewed and if approved issued with a revised review date.
Should-do action 14 of 14
Should do
Effective
The trust should continue to reduce the percentage incidence of Apgar scores of less than seven at five minutes to bring it into line with or below the England average.

Location details

CQC ID: RLNGL
Local authority: Sunderland
Region: North East

Inspection report

Type: Comprehensive inspection
Date: 17 April 2018
Rating: Good
Actions: 8 must-do 14 should-do
AI-extracted 2 Jun 2026