Stamford and Rutland Hospital was opened in 1828 as the result of a bequest by local surgeon and benefactor Henry Fryer and has a long history of providing healthcare for the town. Today it forms part of the Peterborough and Stamford Hospitals NHS Foundation Trust and provides inpatient services for up to 22 patients, outpatient services, day surgery services and a minor injuries unit.

The hospital clearly has its own identity within the trust and staff and patients enjoy working there and using the services it provides. Feedback from patients shows that they appreciate having a small and dedicated hospital that serves the local communities. The minor injuries unit sees approximately 30 to 40 patients a day and is a dedicated nurse-led unit. At our inspection on 5 March 2014, we found that the hospital was meeting expected standards of care.

The hospital does not provide main accident and emergency (A&E) services; however, the minor injuries unit is reported under this section as staff rotate between the two areas.

Stamford Hospital was last inspected in July 2013, when it was found to be non-compliant in respect of ‘Outcome 4: Care and welfare of people who use services’, ‘Outcome 13: Staffing’ and ‘Outcome 16: Assessing and monitoring the quality of service provision’. These regulations relate to the assessment of patients’ needs, completion of care records and adequate staffing being available to provide care. At this inspection, we found that all actions taken to address these breaches in regulation had been taken and that both hospitals were compliant.

Staffing

The staffing levels maintained at the hospital were appropriate to meet the needs of patients using the service. Emergency nurse practitioners in the minor injuries unit rotated through the trust’s main hospital A&E department, which allowed them to maintain their skill base. The ward manager in the John Van Geest unit had used her staffing budget in innovative ways to ensure that the needs of patients were met by sufficient numbers of staff on duty. The outpatients department had the appropriate number of staff on duty and they were familiar with the procedures and specialties that held clinics at the hospital.

Cleanliness and infection control.

The hospital was clean and tidy throughout. The John Van Geest unit had its own housekeeper who ensured that the ward was kept clean and free of clutter. Staff in the minor injuries unit reported that cleaning staff were quick to respond to ad hoc cleaning requests and this ensured that the department was able to function effectively. Cleaning schedules were in line with national guidance and there have been no reported methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia or Clostridium difficile (C. difficile) infections since May 2013. The average cleaning score on the John Van Geest unit was 99.4%.

People told us what it was like to be a patient in Stamford and Rutland 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 second inspector, an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service and a practising professional.

We visited one ward at Stamford and Rutland Hospital that provided care and some rehabilitation services to older people prior to them returning home or going to alternative accommodation. Patients we spoke with were positive about the service they received. They said staff members were kind and that they were well cared for. Staff members always called them by their preferred name, their call bells were usually answered quickly and staff did not rush care that they gave.

Patient’s privacy dignity was mostly respected, although some patients had experiences where their dignity was not fully considered. For example, one patient received care from a member of the opposite sex when they would have preferred not to. Another patient felt unable to leave their seat due to an alarm that sounded, which caused them distress and anxiety.

Not all of the patients we spoke with knew why they were at the hospital, although patients who did know stated that they were involved in decisions made about their care. They confirmed they did not have access to their care records but stated that did not feel the need to see them.

Care records did not contain enough information to provide adequate guidance for new or agency staff to properly care for patients. Not all of the confidential and personal information about patients was stored securely away from public access, which means that confidentiality was not maintained.

Patients received enough to eat and drink, and they stated there was a choice. Although not everyone we spoke with knew what was on the menu.

One patient was able to confirm that they felt safe and would be able to report any concerns if they had them.

Patients we spoke with felt there were enough staff members available, they were not rushed by staff and call bells were answered. However, we found that there were not enough staff members available, which led to staff not having enough time to speak with patients or help them when they needed assistance. This resulted in patients falling asleep at the dining table and being assisted to eat a meal that had gone cold.

Patients received the care and support they required to improve their health and well-being. Care records were usually written in enough detail to provide guidance to staff members, although guidance for one person’s mental health needs was not available.

Staff rotas showed there were not always enough staff members working during afternoon shifts. Patients told us that they had to wait if they required the assistance of two staff members.

Systems were in place to regularly check and monitor the way the service was run, although these did not support a quick response when issues were identified.