Excellence in specialist and community healthcare Care Quality Commission (CQC) Fundamental standards update May 2015

Staff briefing: The purpose for this briefing is to: Refresh staff understanding of the CQC inspection model Explain the Key lines of enquiry (KLOEs) and the new fundamental standards that came into force on 1 st April 2015 Provide practical advice on how to prepare: Yourself Your team Your ward or department …for a follow up inspection QI Briefing May 2015 / St George’s University Hospitals NHS Foundation Trust

The role of the Care Quality Commissioner: Independent regulator of all health and social care services in England The independent regulator of all health and social care services in England Care provider registration Set National (Fundamental) Standards Compliance monitoring and regulation of services against standards through:  Data and surveillance pre inspection and at regular times during the year  Direct observations and interviews at inspection Take action – where standards are not being met. Presentation title / St George’s University Hospitals NHS Foundation Trust

February CQC inspection  The Care Quality Commission (CQC) inspected the Trust in February (St Georges Hospital, Queen Mary's Hospital, St John’s Therapy Centre and some Health Centres where we provide services).  Overall the Trust was rated as ‘Good’ but there were two issues of non-compliance where the Trust must take action:  Ensure that all staff understand the requirements of the Mental capacity Act 2005 and how this relates to vulnerable adults in terms of best interest decisions and informed consent (QMH)  Ensure that medical records are available within the outpatient department Presentation title / St George’s University Hospitals NHS Foundation Trust

February CQC inspection  A number of further areas for improvement were also identified at inspection, these are examples:  Review and address staffing shortages in certain areas  Improve learning and feedback from incidents  Improve discharge planning and avoid mixed sex accommodation breaches  Improve signage and environment in some clinics/areas  Ensure staff are up to date with mandatory training – particularly fire and manual handling  Develop a Trust End of Life Care Strategy  A Trust wide action plan to address these issues is in place - this is monitored by the CQC, Monitor and our commissioners on a quarterly basis. Presentation title / St George’s University Hospitals NHS Foundation Trust

CQC Inspection model The CQC use a number of KLOES to inspect which are aligned to five domains They use the findings to provide a rating for services Presentation title / St George’s University Hospitals NHS Foundation Trust 5 inspection questions Are they safe? Are they effective? Are they caring? Are they well led? Are they responsive Four point scale used for all ratings Outstanding Good Requires Improvement Inadequate

CQC Inspection model During an inspection the CQC Inspectors: Observe patient care to check that the right systems and processes are in place, and patients are treated with kindness, dignity and respect and staff work well and communicate effectively with each other and patients 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 and safe Look at patient information available – are notice boards up to date, relevant, tidy.  In addition they hold focus groups with services users, staff and meet with stakeholders to inform their inspection findings Presentation title / St George’s University Hospitals NHS Foundation Trust

Are we safe?: CQC Key Lines of Enquiry Presentation title / St George’s University Hospitals NHS Foundation Trust What does this mean in your daily practice?

PRACTICAL APPLICATION  Complaints posters  Learning from incidents  Audits - Results and where to improve  ID bands in place  IC - Hand gel & hand washing/ equipment  Sluice - clean and tidy  Call bells near patient  Clutter free ward - Dump the junk  Handling linen  Safe surgery checklist  Patient surveys Presentation title / St George’s University Hospitals NHS Foundation Trust POLICES AND PROCEDURES Mental Capacity Act Independent Mental CA Safeguarding Adults Safeguarding Children Infection Prevention and Control Medicine Safety Monitoring Drug and Fridge Temperatures Health and Safety Waste Management Medical Equipment Safe Staffing

What does this mean in your daily practice? Do I report/act on concerns about unsafe equipment? Do I know how to report a safety incident? Do I always wash my hands or use hand gel between patients? Do I follow Trust policies in relation to medication? Do I know how to resolve or advise a patient who has concerns? Do I ensure written and electronic patient information is kept secure? Do I keep the information available to patients up to date? Do I observe the dress code or uniform policy including bare below elbows Do encourage patients to provide feedback on our services? Do I complete all appropriate risk and document assessments ? Do I assess patient acuity / dependency at handover and ensure there are sufficient staff to cover the required work for the shift Do I know the procedure to follow for a patient who might have a lack of mental capacity? Do I provide bank, temporary, agency or junior staff with adequate support at the start of a shift? Presentation title / St George’s University Hospitals NHS Foundation Trust

Are we effective?: CQC Key Lines of Enquiry Presentation title / St George’s University Hospitals NHS Foundation Trust What does this mean in your daily practice?

PRACTICAL DEMONSTRATION  Safe storage of records  Clear documentation  Accurate records  Assessing pain  Incident reporting  Up to date charts  Lock trolleys  Who is who in the trust  Confidentiality  Keep all informed Presentation title / St George’s University Hospitals NHS Foundation Trust POLICIES AND PROCEDURES Information Governance Consent Records Management Access Policies

What does this mean in your daily practice? Is my mandatory (MAST) training up to date? Do I keep the information available to patients up to date? Do I document verbal discussions about care, treatment and support on the patient’s file? Do I link new patient records with any previous records that exist for that patient? Do I ensure that all patient records are up to date, accurate, and kept confidential? Are records stored and transferred securely according to our policy? Have I completed Record Keeping training? Do I know where to access all mandatory policies relating to quality, safety and clinical governance? Presentation title / St George’s University Hospitals NHS Foundation Trust

Are we caring?: CQC Key Lines of Enquiry Presentation title / St George’s University Hospitals NHS Foundation Trust What does this mean in your daily practice?

PRACTICAL DEMONSTRATION  Privacy & dignity  Tone of voice  Attitudes & behaviour  Listen to patients  Noise at night  Support at mealtimes  Learning disability/ vulnerable patients  Dementia patients  End of life care and DNAR  Access to Interpreters  Intentional rounding Presentation title / St George’s University Hospitals NHS Foundation Trust POLICIES AND PROCEDURES  Equality and diversity  Interpreting Service  Complaints  Communicating effectively with patients  End of life care and DNAR  Patient Information  Friends and Family Test  DNAR properly documented and communicated

What does this mean in your daily practice? Do I give relevant information leaflets/contact details to patients? Do I involve patients in their care plans by explaining their treatment, options and care? Do I help patients to understand what is going to happen to them and why Do I give patients information about the risks and benefits of alternative treatments? Do I effectively communicate with a patient’s relatives to ensure they are involved in the decision-making about the patients care? Do I document in the patient’s record when they have discussed their treatment options or when they have given them information? Do patients sign their care plan/assessment to confirm that they have been involved and understand their treatment? Am I up to date with my Equality and Diversity training? Does the care environment make patients/families feel safe, comfortable and private? Do I ensure multi-disciplinary team handovers include all parties to ensure consistence of care – including relatives? Do I always pull curtains properly around the bed? Do I always introduce myself ? Do I always check what patients liked to be called? Presentation title / St George’s University Hospitals NHS Foundation Trust

Are we responsive?: CQC Key Lines of Enquiry Presentation title / St George’s University Hospitals NHS Foundation Trust What does this mean in your daily practice?

PRACTICAL APPLICATION  Call bells answered in a timely way  Discharge planning  Clinical leadership  Team working  Decision on mental capacity  Handing over vital information from shift to shift  Staff safety forums  Quality rounds  Ward information  Don’t take your troubles home - resolve concerns and issues proactively Presentation title / St George’s University Hospitals NHS Foundation Trust POLICIES AND PROCEDURES Adverse incidents Nutrition and hydration Intentional rounding Productive ward

What does this mean in your daily practice? Do I take account of patients’ needs and wishes so that they are ready to leave hospital at the right time? Do I provide patients and their families with the sufficient information to leave hospital with? Do I ensure nutritional and hydration needs are met (red trays, red beakers and water jugs with red lids)? Do I ensure multi-disciplinary team handovers include all parties to ensure consistence of care – including relatives? Do I take account of patients needs at each stage of their treatment? Do I ensure the patient has made adequate arrangements for leaving hospital? Do I encourage patients to complete patient survey's or signpost to make complaints? Do I ensure the welfare needs of patients extends beyond the hospital back in to the community? Presentation title / St George’s University Hospitals NHS Foundation Trust

Are we well led?: CQC Key Lines of Enquiry Presentation title / St George’s University Hospitals NHS Foundation Trust What does this mean in your daily practice?

PRACTICAL APPLICATION  Who is your Matron?  Who is your Head of Nursing/DDNG  Tidy ward  Up to date notice boards  What are patients saying?  Assistance at mealtimes  White boards above bed Presentation title / St George’s University Hospitals NHS Foundation Trust POLICIES AND PROCEDURES  Supporting Staff  Temporary Staff  Mandatory training  Information governance

What does this mean in your daily practice? Have I had an appraisal? Am I up to date with my MAST training? How do I keep my knowledge and skills up to date? Do I know what the trust values are? What areas of my work am I proud of? What worries me? How am I addressing my concerns? Presentation title / St George’s University Hospitals NHS Foundation Trust