Source · CQC inspection

The Princess Alexandra Hospital

Type NHS Healthcare Organisation Region East Last inspected 16 Jun 2023

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 · 3 must-do 3 should-do

Must-do actions (3)

Legal requirements based on regulation breaches identified during inspection.

Must-do action 1 of 3

Must do

Well-led

The trust must ensure there are effective escalation procedures in place in the event of staff shortages.

Regulation: Regulation 17

⚠ The service had processes in place to assess and escalate staffing concerns, however, these processes were not always effective. The inspection team had to escalate concerns around lack of staff triaging patients twice, and a staff member's escalation for support in resus with 4 patients was not acted upon by …

Must-do action 2 of 3

Must do

Safe

The trust must ensure full risk assessment and care plans are completed in line with policy for patients assessed to be at risk during triage.

Regulation: Regulation 12(2)(a)

⚠ Staff did not always update risk assessments for each patient, and full risk assessments and care plans were not completed in a timely manner in line with trust policy for patients assessed to be at risk during triage, including for bed rails, pressure ulcers, and mental health risks.

Must-do action 3 of 3

Must do

Safe

The trust must ensure that patients receive ongoing observations in line with policy.

Regulation: Regulation 12(2)(a)

⚠ Follow up observations were not completed in a timely way in line with policy. For example, 12 electronic patient records showed no regular observations, and four patients with a NEWS2 greater than 3 had gaps of between 1.5 and 3 hours. In children's ED, 3 patients were overdue hourly observations.