Dental Hospital

⚠ There was evidence that incidents were not always being reported and investigated in a timely way in line with trust policy and national guidance. Initial reviews of serious incidents had not always taken place in a timely manner and there was evidence that incidents were not always being reported in …

⚠ We found a number of incidents reviewed during the inspection where the trust was not fully compliant with duty of candour legislation. It was also unclear if the trust audit reflected the requirements of being open as it looked at incidents that were avoidable and unavoidable not unintended or unexpected. …

⚠ The trust had not always collected, analysed, managed and used information well to support all its activities. This was because information that was provided to CQC before, during and after the inspection had not always been accurate. Information that was used to monitor performance or make a decision could not …

⚠ Staff did not always understand how and when to formally assess and record whether a patient had capacity to decide about their care. We found that capacity had not always been documented when it should have been. There were times when a capacity assessment had not been undertaken before deprivation …

⚠ The department did not consistently deploy enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. There were high vacancy and turnover rates for both registered nurses and medical staff. There were no paediatric registered …

⚠ Services had not always completed and updated risk assessments for patients. We found that risk assessments such as those for falls or pressure ulcers had not always been completed where required. The department did not adequately assess or respond to the risk of service users and there was an inconsistent …

⚠ Medication and controlled drugs were not always securely stored or prepared in line with trust policy, national guidance and legislation. Medicines were not always stored safely within the department or prepared in a suitable environment. For example, we found staff preparing medications on a nursing counter which had not been …

⚠ The service had suitable premises and equipment but had not always looked after them well. This was because we found substances that were hazardous to health that had sometimes been left in unlocked areas, meaning that patients or members of the public could access them, particularly on gerontology wards where …

⚠ The service had not always completed and updated risk assessments for patients. Out of 26 records, we found that risk assessments such as falls or pressure ulcers had not been completed on six occasions and that patient observations had not been taken in a timely manner on six occasions.

⚠ The trust had not ensured that there had been sufficient numbers of suitably qualified staff available in endoscopy to recover patients. We had concerns that patients who had undergone general anaesthesia would not be recovered in line with guidelines from the Association of Anaesthetists (2013); Immediate Post Anaesthesia Recovery, which …

⚠ Staff kept detailed records of patient’s care and treatment, but had not always ensured that patient records had been stored securely. This was because patient record trollies had been left unlocked on most ward areas that we visited and that patient records had been left at patient bedsides in ward …

⚠ Staff did not always understand how and when to assess whether a patient had capacity to decide about their care. We found that capacity had not always been documented when needed, meaning that it was unclear if this had been fully assessed. The service had not operated an effective system …

⚠ Controlled drugs were not securely stored in line with trust policy, national guidance and legislation.

⚠ Antibiotic medication were not always reviewed in line with trust policy and best practice guidelines. Antibiotic review dates and end dates were not always recorded in line with trust policy and best practice guidance.

⚠ The waiting list for the dental paediatric department was excessive. The referral to treatment (percentage within 18 weeks) compliance for October 2018 was 41.9%. This had worsened since October 2017 when the compliance was 54.7%.