Royal Cornwall Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Although the evidence for this ward indicated good practice, as we only looked at 1 ward during this assessment, this does not change the key question safe rating of requires improvement for the medical care (including older people’s care) assessment service group as a whole. We assessed 6 quality statements. People felt safe and supported by staff and most felt listened to. Senior staff shared handover information and learning from incidents with staff in regular huddles. On admission, patients were assessed for risks and individualised care plans were centred around the needs of the individual. The environment was clean and free from clutter, although in need of modernisation and updates to be more suitable for people living with dementia and to improve staff visibility of the enhanced care bays . Leaders had increased staffing levels on the ward and support was available to staff from the care group leads when needed.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt they were receiving considerate support delivered by competent staff. No-one we spoke to was aware of any safety issues or mistakes made with their care, but all felt supported by staff and most felt that staff listened to them.

Staff knew how to escalate deteriorating patients. They took part in morning and evening huddles in which patient events were discussed and learning was shared. Staff felt that the morning and evening handover documentation was sufficient for this purpose. To compliment in-house training and to assist in the change of this ward to a ward providing older people’s care, the ward sister had arranged for poster displays to be installed. These highlighted important learning areas for staff such as for falls, nutrition/hydration and pressure injuries. The delirium display had won a trust competition held in light of World Delirium Awareness Day (delirium is a mental state where a person can be confused, disorientated and unable to think or remember clearly).

A handover sheet was printed and discussed at staff changeover. This contained all the relevant information about each patient. A Nurse in Charge checklist was also completed daily to compliment this. After the group discussion, the individual teams moved to the area where they were working for a more formal handover for their patients. All staff were aware of the patient care given and required for their shift.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People on the ward felt safe and supported. There were also several positive comments in the patient survey that highlighted how kind the staff were, even though under pressure.

Staff were aware of their role in keeping people safe. When a patient was at high risk of falls, this was discussed and documented in the staff handover information. Healthcare assistants knew that they needed to stay with patients in the enhanced care bays and to request help from the nursing staff when needed (enhanced care is a closer level of supervision used when patients who, without additional supervised observation, could be at increased risk of harm).

As well as handover information being shared by staff at the end of each shift, there was a multi-disciplinary meeting held every morning to fully discuss the care plan for each person on the ward. There was a trust standard operating procedure that provided staff guidance on the assessment of falls risk and management. Staff were aware of this and understood what to do when a patient had a fall. There was also a falls folder and escalation policy poster in the nurses’ station for staff to use as a guide.

Most people we spoke to felt they were always listened to by staff, and everyone felt that staff listened when they did not feel well.

Staff knew their responsibilities in completing risk assessments and creating care plans that were individualised for each patient. They were confident in completing and documenting bedside checks at the required frequency.

On admission, staff followed the trust standard operating procedure to complete a holistic assessment and determine a patient’s risk of falls. This allowed staff to set the most appropriate care plan. The bedside checks were paper-based and were kept updated by nursing staff. When people moved to another location, all electronic records were easily transferred to the receiving location to ensure all staff were up to date.

People thought the ward was clean, free from clutter and fit for purpose. If equipment was needed, this was always available.

The ward took part in monthly cleaning audits which, although below the trust target of 90%, had improved from 63% to 85% in the period from February 2024 to July 2024. The main environmental issues on this ward highlighted by staff were a lack of visibility into the enhanced care bays, the lack of day area for patients, and safety updates to the bathrooms. The investment request submitted by senior leaders for this work states that this project would demonstrate that the trust is meeting one of the Integrated Care System’s priorities to improve dementia care.

The ward was clean and relatively uncluttered. However, it looked tired and in need of modernisation. Only required equipment was kept in the corridor, such as observation machines. All other equipment was kept in a designated storeroom. The environment was not dementia-friendly, but there were plans for this to be addressed in the future.

Staff had completed both an environmental audit and a Patient Led Assessment of the Care Environment (PLACE) audit to determine the necessary environmental improvements needed. Concerns were recorded on the trust’s risk register. Senior staff had submitted an investment request for an environmental upgrade and to make the ward more dementia friendly.

People sometimes felt there were not enough staff as they felt they needed to wait to be taken to the toilet. However, there was no context around this, and we did not know what was happening on the ward at the time. We looked at the staffing rotas and found very few days when staffing levels were not at the planned staffing establishment levels.

The ward sister commented that staffing levels were much improved since the ward had changed to a ward providing older people’s care, and there were no nursing vacancies. A Safe Nursing Care Tool data collection process started in May 2024, which resulted in 2 extra members of staff for the morning and afternoon shifts. The care group met twice daily to ensure staffing was equitable across the group for the acuity of the patients. There were 3 clinical educators based on the ward who covered the whole care group and assisted with staff training. All healthcare assistants had completed the Care Certificate. Staff had dedicated time for training on-shift and study days were offered when possible.

Staff gave care in a kind and compassionate way. Staff worked together and went out of their way to ensure that people were comfortable. People were helped and encouraged at mealtimes and staff always followed good hand hygiene practice. There was 1 dedicated healthcare assistant in each enhanced care bay, and when extra staff were needed to care for these high-risk patients, they called in other members of the team.

We reviewed the staff duty roster covering 29 April to 21 July 2024 which showed that daytime staff levels were mostly in line with requirements. Nighttime staffing was sometimes short at the healthcare assistant/Band 4 level, however registered nurse cover was good. Staff compliance for most of the mandatory training modules was over 75% (the trust target was 90%), although the compliance level was lower for some training courses. However, staff we spoke to were competent in their roles and the leadership team were making efforts to improve compliance, with help from the clinical educators. All staff had completed bespoke falls prevention training provided by the Falls Prevention team. The combined appraisal compliance for all ward staff was 38%. However, at the time of our assessment, only the ward sister could complete staff appraisals. The service had plans to improve appraisal compliance rates as the 2 Band 6 nurses were going to undertake training for appraisals.

People we spoke to told us that the ward was clean, and they regularly saw cleaners cleaning the ward. They also saw staff washing their hands.

The ward sister explained that monthly cleaning audit results had improved from 63% to 85% in the period from February 2024 to July 2024 (the trust target was 90%). However, concerns about an increased risk of infection had been raised to the trust’s risk register as Zennor Ward was supporting 5 to 6 patients in each bay compared to the standard of 4-bed bays across the trust.

The ward areas were clean and tidy. The equipment was clean and labelled with ‘clean’ stickers, so staff understood when they had been cleaned. All commodes that we checked were clean.

As well as the monthly cleaning audits, we also reviewed the hand hygiene audits in the period from January 2024 to July 2024, which consistently exceeded the trust target of 80% (100% in July).

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.