People told us what it was like to be a patient in South Bristol NHS Community Hospital. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We visited the two rehabilitation wards at the hospital and spoke to 12 patients and eight members of staff. Both of the rehabilitation wards had 30 beds.

People told us they were cared for in a manner that respected their dignity and privacy. That staff involved them in making decisions about their care. Eight of the people we spoke with told us that they had been informed about their care pathway and were involved in decisions around their discharge from hospital. However, two people told us they felt that they had not been kept informed of what was happening to them.

Most of the people we spoke with commented positively on the food that was made available to them. One person said “could not wish for better even if I went to a hotel, I have no complaints about the food”. Another person said “I am asked what I would like to eat every morning and the staff assist in completing the form for me, the food is generally very good”.

Both of the wards were made up of 14 single rooms and four bays containing four beds in each bay. The majority of the people we spoke with liked the single rooms although some people told us that they felt a bit isolated and preferred to be around other patients.

People told us they were encouraged to be as independent as possible. They told us that they were supported to do this by the staff and health professionals such as the occupational therapists and physiotherapists, who they saw regularly.

People told us that they liked the staff and felt safe at the hospital. Most people knew how to raise concerns or complaints. One person said “nurses never seem to rush, but they are busy, there is a nice variety of staff working on the ward” another person said “the staff are kind and caring”.

South Bristol Community Hospital was situated in the Hengrove area of Bristol to the south of the city centre. It provided acute services to a population of approximately 300,000 in central and south Bristol.

We carried out this comprehensive inspection as part of our in-depth inspection programme. The trust moved up two bands in our ‘intelligent monitoring’ system from a low risk to a medium risk between March 2014 and July 2014. We inspected South Bristol Community Hospital on 10 and 11 September 2014.

South Bristol Community Hospital provided day surgery, outpatient clinics and a rehabilitation service where people were able to stay as inpatients. The hospital also provided a community dental service. There was an urgent care centre for minor illnesses and injuries on the site; however, this was managed by another NHS trust.

Overall, this hospital was rated as good and provided a safe, effective and caring service to patients. The hospital was responsive to patients’ needs and was well led.

Our key findings were as follows:

• We found that services were safe.
• There was good awareness among staff of how to report incidents and there was evidence of feedback and learning being disseminated.
• Actions as a result of serious incidents and never events occurring within the trust were implemented in the hospital. There was heightened awareness of and focus on the use of the World Health Organization surgical safety checklist within operating theatres.
• The hospital was clean and staff observed infection control procedures throughout the hospital.
• There were sufficient nursing and medical staff to meet patients’ needs in all areas of the hospital.
• National best practice and clinical management guidelines were reviewed and incorporated into local guidance to ensure that patients’ needs were met. Guidance from the National Institute for Health and Care Excellence (NICE) was specialty-based within each department. We saw copies of the relevant guidance for staff to access on the wards and in departments.
• Although the trust collated data on patient outcomes, this was not in sufficient depth to reflect the outcomes for patients at South Bristol Community Hospital.
• Patients received appropriate pain relief and nutrition and hydration to meet their needs.
• Staff throughout the hospital were kind and seen to provide compassionate care.
• Patients had access to outpatient services within times set by national guidelines. Patients were kept informed of waiting times in outpatient departments. There were systems in place for patients to leave the department and return later if their appointment was delayed.
• There was a high bed occupancy rate within the hospital, and this had an effect on the ability of the hospital to respond to the demand for inpatient beds. This meant that patients could not be transferred from the Bristol Royal Infirmary in a timely manner to South Bristol Community Hospital to continue their rehabilitation following a stoke.
• The operating theatres within the hospital were being used for only a quarter of the available time and the outpatient department was used for only approximately 55% of the available sessions.
• There were governance systems in place to monitor risks and the quality of the service.
• We observed good local leadership on the wards and in departments, with senior nurses demonstrating a commitment to patient safety and the management of risk. Staff reported feeling supported by managers.

We saw several areas of outstanding practice. These included the following:

• Patients waiting for outpatient appointments were given a bleep if their appointment was delayed. This meant that they could be contacted effectively by staff if they wished to leave the department and so were not restricted to staying in one place for long periods of time.
• Frail, elderly patients waiting for hospital transport home were given pressure-relieving cushions to sit on and provided with food and drink.

However, there were also areas where the trust needs to make improvements.

The trust should:

• Collate information and data about patient outcomes so that outcomes for patients at South Bristol Community Hospital can be reviewed
• Utilise more effectively the operating theatres and outpatient departments in order to support other areas of the trust.

Professor Sir Mike Richards

Chief Inspector of Hospitals