Cobalt Hospital

Updated 29 February 2024

We undertook this inspection as part of our age of rating inspection programme. The hospital was last inspected on 29 to 30 June 2016 and 8 July 2016.

Cobalt Hospital is part of Ramsay Health Care UK.

The hospital provides surgery, medical care, outpatients, and diagnostic imaging services. It has a purpose built 6 bedded day-case facility with no overnight beds. The hospital does not provide any services for children and young people aged between 0 and 18 years. The hospital does not admit emergency patients.

The hospital had a registered manager in post at the time of inspection.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 10 to 11 January 2024.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Updated 29 February 2024

Our rating of this location stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available five days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However, in Diagnostic imaging we found,

• The Ionising Radiation (Medical Exposure) Regulations IR(MER)R referrers document appendices were out of date.
• There was no record of the environmental monitoring planned for September 2023 having been conducted.
• Controlled area handover forms had not been completed.
• Equipment and had not been signed back into use or marked as tested and satisfactory for use since September 2023.
• There was no functional testing of the equipment before being used and no documented requirement for it.
• The service did not have local diagnostic reference levels (DRLs) in place.
• Competency forms to use the C-arm were signed off by a manager who did not have a radiographer background.
• Gaps in information in relation to staff competencies were missing in some of the staff files.
• There were no records of staff having completed radiation safety training.

Updated 29 February 2024

We inspected but did not rate this core service.

• The endoscopy service performed well for cleanliness. The design of the environment followed national guidance. The department had suitable facilities to meet the needs of patients.

• Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. Staff supported patients to make informed decisions about their care and treatment.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.

• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

The service only provided endoscopy under the medical care core service and therefore is a small proportion of hospital activity. The main service was surgery. Where arrangements were the same, we have reported findings in the surgery report.

Updated 29 February 2024

We were unable to obtain enough evidence to rate this service.

The hospital does not have an on-site diagnostic imaging department. They do not employ radiologists and radiographers.

The only diagnostic imaging procedures were carried out by consultants trained in other specialisms using a C-arm which was infrequently used.

A C-arm machine is a fluoroscopy system. Fluoroscopy is a method providing real-time X-ray imaging, which is particularly useful for guiding various diagnostic and interventional procedures. C-arms are generally not used in diagnostics, they are made for surgery.

At the time of this inspection no surgical procedures supported by use of the C-arm were carried out.

The service is required to be registered with the Care Quality Commission for diagnostic and imaging services to enable staff to use the C-arm during surgical procedures.

We found,

• The Ionising Radiation (Medical Exposure) Regulations IR(MER)R referrers document appendices were out of date.
• Equipment and had not been signed back into use or marked as tested and satisfactory for use since September 2023.
• There was no functional testing of the equipment before being used and no documented requirement for it.
• The service did not have local diagnostic reference levels (DRLs) in place.
• Competency forms to use the C-arm were signed off by a manager who did not have a radiographer background.
• Gaps in information in relation to staff competencies were missing in some of the staff files.
• There were no records of staff having completed radiation safety training.

Updated 29 February 2024

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available 5 days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and helped them understand their conditions. They provided emotional support to patients, families, and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported, and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Outpatients was a smaller proportion of hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

We rated this service as good because it was safe, effective, caring, responsive, and well led.

Updated 29 February 2024

Our rating of this service ​stayed the same​. We rated it as ​good​ because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.

• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

We rated this service as good because it was safe, effective, caring, responsive, and well-led.