1. STAFF BRIEFING Care Quality Commission (CQC) Essential Standards of Quality and Safety Preparing for inspection

2. THE ROLE OF THE CQC: Independent regulator of all health and social care services in England Care provider registration Sets National Essential Standards of Quality and Safety Compliance monitoring against standards through: Review of intelligence gathered about providers Trust ‘Quality Risk Profiles’ Inspection – to assess if standards are being met Action – where standards are not being met

3. NATIONAL STANDARDS: Five Domains - 16 Essential Standards (Clinical)

4. INSPECTION METHODOLOGY Inspections can be announced or unannounced Will be informed by the intelligence gathered about a Trust May be in response to concerns or May be themed or routine across a number of standards

5. During an inspection the CQC Inspectors will: Ask people (and relatives) about their experiences of receiving care Talk to staff (multidisciplinary teams) Observe patient care to check that the right systems and processes are in place, treated with kindness, dignity and respect Look for evidence that care is meeting national standards Look at documentation – have observations been done, medication given, risk assessments completed, plans of care Observe staff interaction – are teams supportive and respectful of each other Look at environment – is it clean, uncluttered Look at patient information available – are notice boards up to date, relevant, tidy INSPECTION METHODOLOGY

6. Following an inspection, a provider will be judged to be either ‘Fully complaint’ or ‘Non-compliant’ Compliance will be judged against each standard or outcome inspected Impact or ‘outcome’ of non-compliance upon the patient is the primary consideration and can be minor, moderate or major: Minor impact – people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening Moderate impact – people who use the service experienced poor care that had a significant impact on their health, safety or welfare or there was a risk of this happening Major impact – people who use the service experienced poor care that had a serious current or long-term impact on their health, safety and welfare, or there was a risk of this happening INSPECTION METHODOLOGY

7. Where a provider is non-compliant the CQC can take a number of actions: Issuing a notice of required improvements (short time period). Restricting the services that the provider can offer. Stopping admissions into the care service Issuing fixed penalty notices. Suspending or cancelling the service’s registration Prosecution Leading to a loss of confidence for our patients and stakeholders IMPLICATIONS OF NON-COMPLIANCE

8. Team of inspectors over two days Several wards (adult and paediatric) inspected Eight outcomes inspected and the trust was found to be non-compliant with six: Three non-compliant with minor impact Three non-complaint with moderate impact UNANNOUNCED INSPECTION St George’s Hospital site, January 2013

9. UNANNOUNCED INSPECTION St George’s Hospital site, January 2013 Standard inspectedOutcomeImpact Respecting and involving people who use services Action neededModerate Care and welfare of people who use services Action neededModerate Meeting nutritional needs Action neededMinor Safeguarding people who use services from abuse Met this standardn/a Cleanliness and infection control Action neededModerate Staffing Action neededMinor Supporting workers Met this standardn/a RecordsAction neededMinor

10. THE CQC FOUND MUCH TO COMMEND Of the patients they spoke with the overwhelming majority said that they had a good experience at St George’s and were very positive about the care they received from staff They recognised a high standard of care in most cases “When asked about staff, a patient in A&E said: ‘They can't do enough for us, even though you can see how busy they are’” “The women we spoke with on Maternity were pleased with their care and spoke very highly of the midwives in particular” “The people we spoke with told us that they felt safe receiving care and treatment in the Accident and Emergency Unit. They described staff as ‘Professional and supportive’” However, this was not consistent across all areas… EXTRACTS FROM CQC REPORT

11. “On one ward bay there was a 15 minute period when no staff entered the bay to check that patients were comfortable and safe even though one person was trying to get the attention of staff by calling out and staff were observed to be within earshot” “On xxx Ward the notes were left on top of the counter at the nurse's station and were not stored in a cabinet” “On two occasions we saw a senior member of staff walk away from a patient with vision and hearing impairment whilst the patient was in mid conversation with them” “During another incident, the [visually impaired] patient asked a cleaner if they were a nurse. They responded that they were not without any further explanation. When the patient asked again who was there, the staff member responded "Only me darling" EXTRACTS FROM CQC REPORT

12. Action plan to address issues of non-compliance – this has been shared with the CQC The trust will be re-inspected July onwards An intensive 6 week programme of work is also underway to prepare for re-inspection including: Self-assessment of compliance at ward and departmental level (theatres, outpatients, pharmacy, therapies etc) to inform action and ensure readiness Mock unannounced CQC inspections – late June A re-inspection will look at standards of non- compliance but may include other standards and/or wards and areas not previously inspected NEXT STEPS

13. ALL STAFF What does this mean in your daily practice? The CQC Inspector can and will approach any staff member including doctors, nurses, managers, hotel services, allied health professionals, administrative staff If approached or observed by a CQC Inspector would you be able to answer these questions? Be prepared! CALL TO ACTION

14. BE PREPARED: ASK YOURSELF Do I involve patients in their care, ensuring they understand and have agreed to their treatment plan? Do I understand (and record) when to take written or verbal consent? Do I actively protect patients’ privacy and dignity in every way possible? Do I ensure patients are supported where needed with food and drinks? Do I ensure I keep timely, complete and accurate patient records? Do I know when and how to raise a concern about adult (including learning disabilities) or child safeguarding?

15. BE PREPARED: ASK YOURSELF Do I always wash my hands or use hand gel between patients? Do I follow Trust policies in relation to medication? Do I report/act on concerns about unsafe equipment? Is my mandatory training and knowledge of Trust policies up to date? Have I had an appraisal? Do I know how to resolve or advise a patient who has concerns? Do I know how to report a safety incident? Do I ensure written and electronic patient information is kept secure? CALL TO ACTION

16. CONCLUSION We must meet the essential standards, for the sake of our patients We got much of it right in January We need to get it right, everywhere, for all of our patients – consistency This is our responsibility to our patients