During our visit we spoke with 18 members of staff, 17 patients and four visiting relatives. We pathway tracked nine sets of patient medical and nursing notes. We visited four inpatient wards; ward 14 (gynaecology), ward 17 (cardiology and medicine), ward 23 (stroke unit and medicine) and ward 34 (orthopaedics).

Patients said that staff were approachable and explained their care and treatment to them in a way they could understand. Patients told us privacy and dignity had been respected by staff. They told us that staff were friendly, polite and respectful. We saw and heard staff treat patients with patience and respect. We saw staff took time to talk with people to offer support and reassurance. Staff were frequently heard to ask people’s opinions and check that they were satisfied.

Without exception, patients spoke very positively about the support, care and treatment they received. They felt that staff provided safe and appropriate care, treatment and support to meet their needs. Their comments included “a really good clean friendly hospital” and “all the staff here are polite and professional.” We found that medical and nursing records and risk assessments were in place and clearly recorded.

We found that people who used the service were protected from the risk of abuse. Patients spoken with told us that they felt safe in the hospital.

We found that relevant training and support was provided to staff so that patient's welfare and safety was promoted.

This visit was a follow up inspection to the inspection we made in March 2012.Our Inspection in March 2012 was part of a targeted programme to inspect services that provide the regulated activity of terminations of pregnancy. The focus of that visit was to assess the use of the forms that are used to certify the grounds under which a termination of pregnancy may lawfully take place. We found the provider was not fully complying with the regulations at that visit. We asked the provider to send us a report within 7 days of them receiving that report, setting out the action they would take to improve.

We did not speak to patients who used this service as part of this visit. We looked at a random sample of medical records.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Some patients on the wards we visited have some conditions that mean we had difficulty talking with them. Other patients were able to express their views clearly, others we were not able to verbally communicate with. Due to patients communication needs we used informal methods of observation during our visit. We sat near patients, observed care practices and saw how staff and patients interacted with each other.

Throughout our observations we saw staff treat patients with respect and courtesy.

Patients that were able told us that overall they were very happy with the treatment and support they were receiving.Individual comments included :“I can’t praise the staff enough,they are wonderful.” “Excellent staff here.” “The staff are so helpful.”

Patients we spoke to said that overall they were satisfied with the quality and choice of food served on the wards. Patients’ individual comments included:” I’m offered lots of drinks during the day.”

“The quality and choice of food is good and it’s always piping hot when it comes.” “The ‘tea lady’ is great; she knows just how I like my cuppa.”

Some patients on the wards we visited have conditions that mean they have difficulty talking with people and therefore have varied methods of communication. Some patients were able to express their views clearly, others were not able to verbally communicate with us. Due to people’s communication needs, during the site visit we sat near some patients and observed them closely. This meant we were able to ascertain the levels of care and support they received.

Staff spoke to people in a kind and friendly manner and carried out personal and nursing care tasks in a respectful way.

Patients we spoke with were very positive about their experiences of care and treatment. Patients stated that they were kept informed and were involved in making decisions about treatment options. They also commented that they were given enough information both written and verbally to help with this process. Patients also said that they had their care needs met and had been treated respectfully.

Individual comments from patients included:

“I’m very happy with my care”, “The staff are lovely, they really care”.

Patients we spoke to said they had no concerns or complaints about their care or treatment at the hospital.

Relatives said “The staff are fantastic at this hospital, the care is very good”.

On the wards we visited, they had strategies, policies and procedures in place to ensure patients’ nutritional needs were met. However these strategies were not always being fully implemented by staff which meant that some people’s nutritional needs were not being fully met.

We have asked the trust about the improvements they must make to ensure all patients are supported to receive adequate nutrition. The trust responded in a timely manner to the concerns we raised and submitted an action plan within 48 hours of the inspection highlighting how they are going to address these concerns.

The majority of patients said they were very happy with the quality and choice of the food provided. Those patients who needed assistance to eat were helped by staff in a very positive way. Staff took their time, communicated in a friendly way with patients and showed sensitivity when supporting them with their lunch.

The lunchtime meal time service in some areas of the wards was relaxed and patients were given time to enjoy their meals.

However, in other ward areas, meals were interrupted. During this period we heard staff asking patients what they wanted for breakfast the next morning. We also saw that staff were being interrupted from serving meals by having to frequently answer the telephone.

Our rating of these services improved. We rated them as good.

A summary of services at this hospital appears in the overall summary above.