The people we spoke to at St Albans City Hospital told us that they were happy with the care they got and that staff were very kind, caring, friendly and gentle. However some people said that senior staff were not as friendly and were not as easy to talk to.

Overall the people were happy with the food though some people told us they found it a little bland and lacking taste and “we could do with a better variety". They majority said that they enjoyed the food and thought they had a wide selection on the menu to choose from. Everyone we spoke with said the food was always warm and nicely presented.

Some of the people we spoke to felt management tried to discharge them before they were ready to be discharged. They felt they were ‘rushed to make space.’ We found no evidence of this.

Staff told us that they felt they worked within a very supportive team and that management team were very approachable.

We found that the people admitted to St Albans City Hospital had a full assessment of their health needs prior to admission. They were offered classes pertaining to the treatment of their condition and were given instructions on how to manage their recovery. People who attended these classes were found to recover faster.

We found that people's nutritional needs were recognised and met. There were sufficient numbers of trained staff to care for the people.

At this inspection, we inspected urgent and emergency care. We did not inspect surgery or outpatients at this inspection, but we combine the last inspection ratings to give the overall rating for the hospital.

Our rating of services went down. We rated it them as inadequate because:

• Our rating for safe went down to inadequate overall. There remained no formalised process for clinically assessing patients presenting to the minor injuries unit, outstanding from previous inspections. Patients could wait for period of up to three hours before being seen by a healthcare professional.
• Our rating for effective remained requires improvement overall. There remained a lack of monitoring of patient outcomes and compliance with evidence-based protocols. This had previously been identified by the Care Quality Commission as an area which required improvement.
• Our rating for caring remained good overall. Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Our rating for responsive went down to requires improvement overall. Supporting services including diagnostic imaging were not commissioned to mirror the opening times of the minor injuries unit. This meant patients were either required to reattend the service between 9am and 5pm Monday to Friday for an x-ray, or patients were directed to the emergency department at Watford General Hospital, or the urgent treatment centre at Hemel Hempstead.
• Our rating for well led went down to inadequate overall. Whilst there had been changes to the leadership team with the addition of a senior emergency nurse practitioner to oversee and manage the minor injuries service, there remained little oversight of the service at divisional level.