KIMS Hospital is operated by KIMS Hospital Ltd. The hospital has 99 beds, 72 of which are currently in use. Facilities include five operating theatres, three of which were laminar flow, an endoscopy suite, an interventional lab/suite, and X-ray, outpatient and diagnostic facilities.

The hospital provides surgery, medical care, and outpatients and diagnostic imaging (including services for children and young people). We inspected surgery, medical care, outpatients, and diagnostic imaging.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 10 and 11 January 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, major incident planning – also apply to other services, we do not repeat the information but cross-refer to the surgery core service.

Services we rate

We rated this hospital as good overall.

We found good practice in relation to medical care:

• Patients were supported, treated with dignity and respect, and were involved as partners in their care.

• Patient records were written and managed to keep people safe. They were clear, legible and risk assessments were completed in all of the records we reviewed. Notes were organised and stored in a lockable trolley.
• Staffing levels were planned and reviewed to keep patients safe and staff were flexible and happy to adjust their shifts to suit patient need.
• The hospital used a quality dashboard and routinely collected and monitored information about patient outcomes. The hospital took part in national audits and staff created action plans to improve patient outcomes.

We found good practice in relation to surgery:

• The hospital had a clear incident reporting process and staff had good knowledge of this. Staff were encouraged to report incidents and felt they could report incidents openly. They provided examples of learning and where changes had taken place.

• The service had introduced strong processes to ensure consultants only operated within their scope of practice. Staff had evidence of up-to-date appraisal to provide assurances around their skills and competencies.

• The service actively involved patients and their relatives in their treatment, such as by providing an educational pre-operative “joint school”.

• Governance and performance management arrangements were proactively reviewed and reflected best practice.

  We found good practice in relation to outpatients and diagnostic imaging:

• The hospital had safeguarding leads, a named doctor and a named nurse for adults at risk and children and young people. Staff could name the key people and had knowledge of what to do if they had to raise a safeguarding concern.

• Staff managed medicine safely and followed hospital policy and national guidance. Medicines were stored securely and were within their expiry dates.

• There was effective multi-disciplinary team working with teams of all services throughout the hospital.

We found an area of outstanding practice in medical care:

• The cardiac catheterisation laboratory carried out comprehensive risk assessments for all patients. We saw a pre-assessment and discharge checklist and specific pathways for each procedure. Based on risk assessments, staff had included additional checks to the World Health Organisation ‘five steps to safer surgery’ checklist.

We found areas of outstanding practice in the hospital as a whole:

• The hospital had volunteers known as ‘KIMS' angels’ who spent time in departments talking to patients. This was introduced to enhance patient care and support patients so that they felt listened to.

• The hospital’s strong commitment to staff engagement included direct links to the board through ‘KIMS Voice’ so they could directly communicate their views, ideas and concerns

We found areas of practice that require improvement in surgery:

• The exclusion and acceptance criteria for surgery did not give specific guidance to consultants, which meant the service could not be assured that consultants were consistent in determining a patient’s suitability for surgery at the hospital.

• Carpeted flooring in clinical areas should be replaced in line with the hospital’s replacement programme.

We found areas of practice that require improvement in outpatients:

• The safety gate installed at the doorway to the children’s waiting room was covered with hazard tape. This could lead to potential trips and/or falls.

• Not all treatment areas had flooring fit for purpose.

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.

Amanda Stanford

Deputy Chief Inspector of Hospitals (area of responsibility)