At our last inspection at the end of June 2013 we found that people were not protected against the risks associated with medicines because arrangements in place for the safe storage of some medicines were not always followed. A warning notice was served. During this inspection we found that suitable action had been taken to address the issues raised.

People on the wards told us that they found staff very kind and caring, and the nurses were lovely. They told us that the treatment and care was very good.

Patients we spoke to were positive about the meals, one told us that the food was marvellous, especially the soups. We saw that meals were served as soon as they arrived on the ward and that patients were not interrupted whilst eating their meal.

We observed a notice on the door to the elderly care wards advising visitors that if they would like to assist their relative then to feel free to speak to the nurse in charge.

Some patients, on the renal ward, told us they were cold and we saw that staff turned up the heating when this was mentioned to them.

All areas were well maintained and we did not see any clutter in corridors.

Sleeping accommodation in all wards was provided in single sex bays and there were designated male and female bathroom facilities. This included the acute stroke unit and emergency medical unit.

We did not see people being treated on trolleys in the emergency department corridor but staff told us that, although there has been some improvement, it still happened due to lack of space.

Patients told us were very satisfied with the care they received at Dorset County Hospital, describing it as very good or excellent most of the time. They said they had been treated with courtesy and respect and that their privacy and dignity had been well protected. They said they and their families were given clear information and explanation and had been involved in decisions about their care and rehabilitation. However, some patients told us that at times staff had been slow in responding to call bells.

Patients told us they felt their nutritional needs and dietary preferences were well met. They gave positive feedback about the quality, range and availability of food, including drinks and snacks. Patients who required assistance with eating or drinking were satisfied with the way staff supported them. However, some patients told us that the food is not always very hot and that sometimes mealtimes are a bit busy.

We spoke to patients in the accident and emergency department (A&E), the emergency medical admissions unit, two elderly care wards that specialise in stroke and dementia care respectively, one medical ward and one surgical ward.

Comments we received from patients we spoke with varied, but patients were generally positive about their experience.

For example one person said: ‘the staff are very helpful, it is an excellent hospital.’ This individual also raised concerns that the staff seemed ‘rushed off their feet particularly at weekends.’

One person commented that: ‘staff are very busy, but always have time to explain.’

Patients that used the service considered that food provision was good and no concerns were raised with us about the quality or quantity of food. One comment received about the quality of food was; ’food is OK, but not as good as my cooking.’

Some patients found that fluid intake was not always monitored. One person commented that: ‘[Their relative] was dehydrated over a weekend because of staff shortages.’

One person who used the service told us that ‘each time I have been in, they have asked my point of view’ about the care given.

None of the patients we spoke to during our visit raised any concerns or complaints. They were aware that they could report issues to members of staff.

Our rating of services improved. We rated it as good because:

• Staff treated people with the kindness, dignity and respect. Individualised, person centred care was delivered by a workforce who recognised and valued their responsibilities towards people using the hospital. Teams were well integrated and took a multidisciplinary approach to ensure people’s needs were met.
• There was a strong culture of doing what was right for patients, for keeping them safe and involving them in decisions which affected their treatment and care. Patients and relatives spoke highly of staff and the standards and quality of care. They were informed of investigations and treatment plans, and how these would affect them.
• Services were planned and arranged to meet the general and specific needs of local people. Staff carried out a range of risk assessments and safely managed these in line with national and professional guidance. The trusts safeguarding arrangements assisted in keeping vulnerable people safe and protected them from avoidable harm.
• The systems and processes available to support staff in their clinical practices were well organised and structured. Professional guidance was easily accessible and used to inform decision making around patient needs.
• The arrangements for reporting, investigating and learning from incidents was supported by a positive culture of improving patient care. Further, the trust used safety monitoring, audit results and patient outcome information to drive improvements in services.
• Although parts of the hospital environment appeared worn, they were in generally visibly clean. Most staff followed infection prevention and control procedures and routine standards of cleanliness and hygiene were maintained.
• Leaders had the skills, knowledge, experience to oversee services. We found improvements had been made in the leadership of maternity and end of life services since the last inspection. A non-executive with responsibility for end of life care had been appointed to the trust board.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff were encouraged and supported to access training and development opportunities.
• Departments planned and reviewed staffing levels and skill mix so people received safe care and treatment. Where professional recommendations for staffing at particular grades were not met, there were arrangements to minimise possible risks.
• The trusts vision and values were understood by staff. Local service objectives had been developed and staff committed to achieving these.
• There were effective governance arrangements within departments and information was communicated upwards through various committees to the board. Information was shared with staff in an open and transparent manner, which helped staff to feel valued and respected.

However:

• Mandatory safety related training rates did not meet the target of 85%.
• Staff did not always make timely entries in patient records with respect to their care and treatment. There were gaps in the recording of information which indicated the patients’ overall health and wellness status. Best interest decisions and mental capacity assessments were not always carried out and documented where expected.
• Infection prevention and control practices related to cleaning of patient equipment were not always sufficiently acted upon.
• The physical environment of some areas presented limitations and challenges to the provision of optimum facilities and managing increased capacity.
• There were some difficulties with computerised systems, which impacted on accessibility and ease of use for patient records.
• Complaints were not always followed up within the required timeframe.
• Equipment checks and stock replacement was not undertaken to a consistent level.
• Medicines storage and management of nitrous oxide was not managed to a sufficient standard in maternity.
• The reporting of images was not always completed as the trust expected.
• Patients could not always access outpatient services as quickly as would be expected. Some services did not meet the national target for referral to treatment time.

• There were systems to support governance but these were not always effective for the outpatient services.
• While there were processes to manage risk and performance issues for the outpatient service, these did not always ensure sufficient oversight and mitigation of key risks to the department.
• Some outpatient areas had plans for improvement and a strategy supporting development, there was no overarching strategy for the whole outpatient service.
• There was no system for quality assurance through audit in the outpatient’s departments. There was no clear evidence of learning from audit which had led to changes in practice.