All patients were fully informed about their treatments or procedures. People told us they had all their questions answered and felt involved in the decision making around their care. All patients had signed consent forms. We found that the discharge of patients was planned and discussed appropriately.

People we spoke with told us they were happy with the care and treatment they received from the staff. We were told the staff were caring and professional and treated people in a respectful manner.

The hospital took steps to ensure it was a safe place for people to receive treatment. All staff undertook training in adult protection and contact information was available to staff should they have a need to report a concern.

Staff attended regular courses to ensure they were up to date with the required mandatory training. They also had opportunities to undertake courses to develop their professional skills.

The hospital had effective systems to monitor and manage risk. Processes were in place that audited the quality of service delivered and there were opportunities for staff to contribute their ideas or raise concerns.

The hospital had an effective complaints procedure in place that was well advertised to patients. Regular feedback was also sought from patients.

We spoke to three patients and reviewed their care records. We also spoke with nine members of staff and reviewed other documentation. Patients said that the care they had received at the hospital was “Excellent”, “Brilliant” and that staff were “Attentive.” Patients also felt fully informed of their treatment options and the care that they were receiving.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed the records of three patients and found these to be appropriately documented and updated.

People were cared for in a clean, hygienic environment. The hospital has systems in place to ensure that infection control is monitored. Appropriate cleaning procedures are in place to prevent the spread of infection.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff recruitment is robust and new staff feel supported in their new roles. Training and development is available for all new staff.

People were made aware of the complaints system. This was provided in a format that met their needs. The patients we spoke to were aware of how to complain but had not needed to.

Patients told us they were satisfied with their care and treatment and were treated with respect by hospital staff.

Information was provided prior to admission and good clear information given about procedures and the services the hospital provided.

Patients said they felt safe whilst visiting the hospital or staying for treatment.

Staff were described as professional, caring and encouraging.

Staff told us they were well supported by their colleagues and managers within the hospital and received appropriate supervision and appraisals.

We were told that an open culture was encouraged and people felt confident about reporting concerns or issues that needed addressing to improve the service or protect the patients.

The management of the hospital undertook to regulallrly audit all aspects of the service and take action to address identified shortfalls.

The registered provider BMI Healthcare provided regular external visits and audits to promote safety and good practice.

BMI, The Ridgeway Hospital is operated by BMI Healthcare Limited . The hospital provides outpatient, diagnostics, surgery and medical care including oncology and endoscopy services to adults and children and young people (CYP). Treatment is provided to privately funded and NHS patients.

Specialities offered by the service for inpatients and outpatients include gynaecology, ears, nose and throat (ENT), breast and cosmetic surgery, chemotherapy and oncology, paediatric services, refractive eye surgery, and other laser surgery.

We inspected this service using our focused inspection methodology. We carried out an unannounced inspection on 19 and 20 March 2018, and a further unannounced inspection on the 28 March 2018.

We focused on specific parts of the service which were highlighted as concerns to the CQC from staff and members of the public. Additionally, we focused our inspection on areas previously identified as needing improvement in our last inspection. The key questions we asked during this focused unannounced inspection were, was it ‘Safe’ in surgery, and children’s and young people’s and was it ‘Well Led’ in medicine, surgery and children’s and young people’s.

Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate. As this was a focused inspection, new ratings were only awarded for the key questions that were inspected. The overall rating for the service was not changed.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We found areas of practice, which required improvement in surgery, medicine and children and young peoples services.

• Issues such as sickness and performance management within the theatre department, had compromised staff morale and the running of the department.

• Infection control practices were not always in line with policy and guidance.

• Resuscitation and anaesthetic equipment was not always checked in line with hospital policy.

• Staffing shortages across pharmacy meant not all audits were completed. This impacted on the providers awareness of the safety of the service it delivered.

• Not all staff had completed their mandatory training within the timeframes expected by the hospital.

• The hospital did not have an in-date service level agreement with the local NHS Trust, for emergency transfer of children and young people and adults.

• Not all staff in the endoscopy unit took part in the World Health Organisations surgical safety checklist in a fully compliant manner and patient checks were not fully completed prior to medication being given.

• Chemotherapy team meetings were not held regularly and we could not be assured that there was an effective governance framework to support the service.

• The out of hours and on-call arrangements for chemotherapy services were not safely arranged.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with requirement notices that affected surgery, children and young people and medicine. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals.