Source · CQC inspection

The County Hospital

Type NHS Healthcare Organisation Region West Midlands Last inspected 28 Feb 2024

Overall rating: Requires Improvement  View full CQC report

Domain ratings

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

Earlier inspection findings

pre-2024 framework · 4 must-do 5 should-do

Must-do actions (4)

Legal requirements based on regulation breaches identified during inspection.

Must-do action 1 of 4
Must do
Safe
The provider must ensure it is assessing the risks to the health and safety of patients of receiving care or treatment and doing all that is reasonably practicable to mitigate any such risk through carrying out and documenting regular observations, clinically-led navigation of patients through the department provided by trained and experienced staff, managing patients medicines on time, assessing and responding to deteriorating patients and responding to any risks such as sepsis, pressure ulcers, falls or patients in pain.
Regulation: Regulation 12 (2)(a)(b): Safe care and treatment
⚠ The provider was not assessing risks to health and safety of patients, including through regular observations, clinically-led navigation, timely medicine management, and response to deteriorating patients (sepsis, pressure ulcers, falls, pain). Non-clinical staff were navigating patients, and the department layout meant some patients were not visible. There was a risk …
Must-do action 2 of 4
Must do
Safe
The provider must ensure it has sufficient numbers of suitably qualified, competent, skilled and experienced staff who receive such appropriate training to carry out the duties they are employed to perform and ensure staff are trained to the right competency in safeguarding and life support. The provider must have sufficient medical staff to run the department safely and effectively including a paediatric emergency medicine consultant.
Regulation: Regulation 18 (1)(2)(a): Staffing
⚠ The provider did not have sufficient numbers of suitably qualified, competent, skilled, and experienced nursing and medical staff, including a paediatric emergency medicine consultant, to safely and effectively run the department. There was a significant shortfall in recommended consultant numbers. Not all staff had updated life support, safeguarding, or IPC …
Must-do action 3 of 4
Must do
Safe
The provider must ensure it is assessing the risks to the health and safety of patients of receiving care or treatment and doing all that is reasonably practicable to mitigate any such risk through effective and safe care to patients needing ongoing treatment but unable to have timely access to a hospital bed.
Regulation: Regulation 12 (2)(a)(b): Safe care and treatment
⚠ The provider was not effectively assessing and mitigating risks to patients needing ongoing treatment but unable to access a hospital bed in a timely manner. Poor hospital flow, capacity issues, and delays in discharge meant patients remained in the department for long periods, often in crowded, unsuitable areas like corridors …
Must-do action 4 of 4
Must do
Well-led
The provider must ensure there are systems and processes to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activities. It must assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others who may be at risk which arise from the carrying on of the regulated activity. The service must have an effective governance system, risk profile and audit programme to be assured it is providing safe quality care and knows and addresses where it should improve.
Regulation: Regulation 17 (1)(2)(a)(b): Good governance
⚠ The provider's governance processes were ineffective, failing to consistently assess, monitor, and improve the quality and safety of services. There was a lack of regular and consistent audit, risk management, and learning from incidents. Where audits occurred, action plans were often missing or not implemented, and staff were unaware of …

Should-do actions (5)

Recommended improvements to enhance service quality.

Should-do action 1 of 5
Should do
Safe
The service should improve the safe and proper management of medicines are stored safely and appropriately.
Should-do action 2 of 5
Should do
Caring
The service should ensure improved arrangements for offering food and drink to patients who have been waiting a long time to be seen, transferred or discharged.
Should-do action 3 of 5
Should do
Safe
The service should consider how it uses patient identification, such as wristbands, to determine if this is working effectively.
Should-do action 4 of 5
Should do
Well-led
The service should consider improving the response when requesting patient feedback.
Should-do action 5 of 5
Should do
Caring
The trust should ensure the privacy and dignity of all patients is maintained at all times.

Location details

CQC ID: RLQ01
Local authority: Herefordshire, County of
Region: West Midlands

Inspection report

Type: Location
Date: 28 February 2024
Rating: Requires Improvement
Actions: 4 must-do 5 should-do
AI-extracted 3 Jun 2026