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Care Services

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BMI The Manor Hospital, Biddenham, Bedford.

BMI The Manor Hospital in Biddenham, Bedford is a Diagnosis/screening and Hospital specialising in the provision of services relating to caring for adults over 65 yrs, diagnostic and screening procedures, physical disabilities, sensory impairments, surgical procedures and treatment of disease, disorder or injury. The last inspection date here was 4th July 2018

BMI The Manor Hospital is managed by BMI Healthcare Limited who are also responsible for 46 other locations

Contact Details:

    Address:
      BMI The Manor Hospital
      Church End
      Biddenham
      Bedford
      MK40 4AW
      United Kingdom
    Telephone:
      01234364252

Ratings:

For a guide to the ratings, click here.

Safe: Good
Effective: Requires Improvement
Caring: Good
Responsive: Good
Well-Led: Good
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2018-07-04
    Last Published 2018-07-04

Local Authority:

    Bedford

Link to this page:

    HTML   BBCode

Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

10th October 2013 - During a routine inspection pdf icon

During our inspection of BMI The Manor Hospital on 10 October 2013, we saw that people who use the service were provided with suitable and sufficient information including pre-admission and discharge packs. People told us the information was very useful. They said they'd received good explanations about their care and treatment and felt fully informed. They told us they felt well looked after throughout the course of their care and treatment and this had included undergoing an assessment process before and on arrival at the service.

Our review of their care files confirmed this. We saw that the explanations provided to people including the risks and benefits involved in any procedures were well documented. People had received a review of their medical histories and allergies in all the cases we looked at and were having specific risk factors reviewed and updated regularly.

The people we spoke with said they found staff to be friendly and competent. The staff we spoke with said they were completing a program of training relevant to their roles and received appraisals of their competencies and development. The documentation we looked at confirmed this.

We saw that the service appeared clean during our inspection. However, we found that some infection control processes and practices were lacking.

People told us they had no complaints about the service. We saw the service had a complaints process in place and people's complaints were responded to appropriately.

22nd January 2013 - During a routine inspection pdf icon

We visited BMI The Manor on 22 January 2013 and found the environment welcoming and relaxed, with friendly staff.

We spoke with two of the seven patients during our visit, and one person’s relative. All those we spoke with told us they were very happy with their experience at the hospital and the care provided. One person said they were very scared of hospitals, and that staff at BMI The Manor had been “....very good to them” to ease their anxiety. We observed positive, friendly interactions between staff, patients and relatives, and saw people were treated respectfully at all times.

We spoke with staff on duty in most areas within the service, who told us they enjoyed working there.

We saw the service had processes in place to manage people’s assessment and care needs, as well as obtaining consent for treatment or surgical procedures. The two people we spoke with said they had been fully informed about their treatment and what they should expect to happen during their stay.

15th November 2011 - During a routine inspection pdf icon

People we spoke with said that their experience at the hospital had been as they had expected as they had received clear information prior to attending. They said that the nurses and the doctors explained procedures clearly and that they had answered all of their questions.

We were told by the people that we spoke with that all of the staff at the hospital, whatever their role, were polite and friendly. They said that the nursing staff were respectful of their privacy and that they were treated with dignity. They said that the nurses responded very quickly to the call bell. One said, "The staff are excellent, I can't complain at all". Another told us, "The nurses are very attentive".

People told us that they had been asked to complete a patient satisfaction survey and to include any additional information they wanted to with regard to the service that they had received

1st January 1970 - During a routine inspection pdf icon

BMI The Manor Hospital is operated by BMI Healthcare. The hospital is registered for 23 inpatient beds. Facilities include one operating theatre with laminar flow, a dedicated endoscopy unit, and outpatient and diagnostic facilities.

The hospital provides surgery, outpatients and diagnostic imaging. We inspected surgery, outpatients and diagnostic imaging.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 24 and 25 April 2018, along with an unannounced visit to the hospital on 8 May 2018.

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.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

See the surgery section for main findings.

Services we rate

We found safety, caring, responsive and well-led was good. Effective required improvement. This led to a rating of good overall.

Summary of main findings:

  • There were systems in place to keep patients safe, including the reporting and investigation of incidents. Learning from incidents was cascaded to all staff.

  • Staffing levels were sufficient to meet the needs of patients and there was an effective multidisciplinary approach to care and treatment. Staff worked well together to benefit patients.

  • Staff were proud of the hospital and were committed to providing the best possible care for their patients. We observed positive interactions between staff and patients. All patients spoke highly of the care they had received.

  • The hospital was focused on providing quality care and had a defined strategy, which was aligned to its vision. Staff were committed to providing a positive patient experience.

  • The executive director was well respected, visible and supportive. Staff felt valued by their departmental managers and confident to report concerns.

  • There were effective governance structures in place to ensure that risk and quality were regularly reviewed and actions were taken to address performance issues, where indicated.

  • There was a comprehensive complaints management process with a culture of being open and honest with patients. There was a complaints policy and complaints were taken seriously, investigated and learning was shared with staff.

  • When things went wrong, staff apologised and gave patients honest information and suitable support.

  • There were effective arrangements in place for the management of medicines.

  • Patients’ views and experiences were gathered and acted on to shape and improve the services and culture.

  • Staff ensured that patients’ privacy and dignity was maintained at all times. Chaperones were available for patients during procedures as required.

  • However

  • There was a lack of consistency with the consent process, with some patients being consented when they were admitted for treatment. This was not in line with national guidance. We raised this issue with the senior management team, and immediate action was taken to address our concerns.

  • Mandatory and training completion rates were below those expected by the organisation.

  • Some corporate policies and local standard operating procedures had expired their review date. This meant there was a risk that staff may not be following the latest evidence based guidance.

  • Local risk registers lacked details and we were not assured they were regularly reviewed. However, we found the hospital risk register was detailed and included actions taken to minimise the risks identified.

  • Not all staff had received an annual appraisal.

We found areas of good practice in relation to surgery:

  • Patients had access to care and treatment in a timely way and cancellations to surgery were minimal.

  • Patients were appropriately assessed prior to surgery and there were processes in place to transfer patients should they require a higher level of care.

  • Audits were completed in line with the corporate audit programme and actions were taken to improve outcomes where indicated.

And some areas for improvement:

  • Some competency frameworks were out of date and the assessment process was not robust in all areas.

  • Not all staff were aware of feedback from audits.

  • Some departmental managers did not always feel sufficiently supported and one-to-one sessions, which they found beneficial, were often cancelled.

We found areas of good practice in relation to outpatient care:

  • There were robust systems in place to ensure that patients and staff were protected by adherence to national guidelines relating to ionising radiation and diagnostic imaging.

  • Patient care and treatment was delivered in line with national guidance.

  • There was bespoke written information provided to patients in the physiotherapy department.

And some areas for improvement:

  • The outpatient risk register did not include all risks identified within the department and staff were referring to an out of date paper version.

  • Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Inspector of Hospitals

 

 

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