Central Middlesex Hospital

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

• Staff had limited understanding of the practical application of care for patients with deprived liberties.
• There was limited interaction or stimulation for patients with dementia or cognitive impairment. The ward spaces were not dementia friendly.
• Children and young people services and medical care services did not have a clear vision or strategy.
• Flow out of the service was poor. There was a significant population of medically fit patients who could not be discharged due to difficulties in arranging care and support in the community.
• The senior leadership team recognised the sometimes poor relationship between its staff and local authority staff, but there had been no action to address this.
• Some staff did not always formally report incidents and, in particular, near misses.
• Records of mandatory training for medical staff were poor and unreliable.
• Compliance rates for mandatory training and safeguarding training were below trust targets.
• Managers did not always effectively appraise all staff’s work performance.
• Nurse vacancy rates were high in surgical services.
• Waiting times from referral to treatment were not always in line with national standards in surgical services.
• We did not see any evidence of improvement following the previous rating of requires improvement in children and young people services.
• The children and young people service did not control infection risk well. We found the Rainbow Unit untidy, we could not be assured that children’s toys were regularly cleaned and there was of a lack of infection prevention information for children.
• There were facilities for disabled and baby changing in the Rainbow unit but staff told us they believed that the Rainbow unit was shut.
• Staff we spoke with in Recovery Stage One told us that children were cared for in a mixed four bedded recovery bay with adults
• Staff did not use a nationally recognised tool to identify deteriorating patients, such as Paediatric Early Warning Signs (PEWS) or a validated acuity score system to assess patients.
• We were not assured that the children and young people service was fully geared up to deal with a paediatric emergency. For example, there was no separate paediatric resuscitation trolley in pre-assessment Area One. The trust subsequently told us that there was a grab bag.
• We were told that not all medical staff had European Paediatric Life Support (EPLS) or Advanced Paediatric Life Support (APLS) training.
• There was no paediatrician available on-site at the hospital. Staff had to refer to the consultant of the day or week, who was based at a different hospital in the trust. Some staff were not aware of this arrangement.
• Records were clear, but sometimes children were seen with an incomplete set of records. Following the inspection, the trust told us, in the event that a child was seen with a temporary set of notes at pre-operative assessment (POA), the complete record was requested straight away from the clerks.
• Storage of medicines complied with national guidelines. However, fridge temperature monitoring in the recovery ward was not recorded and we could see no evidence that temperatures were being monitored. However, fridge monitoring in ACAD paediatrics was recorded.