During our inspection of Guildford Nuffield Hospital we spoke with seven staff, including doctors, nurses, reception staff and housekeeping staff. We also spoke with patients who had undergone or were about to undergo surgical procedures.

The discussions we had with patients indicated a high level of satisfaction with the service they received at the hospital. Patients commented that they were treated with dignity and respect and that they felt involved in their treatment and that the care they received at the hospital was good. One patient commented “I am always given information and choices regarding my care” A second patient commented “Always satisfied with the service and treatment.” A third patient commented “The advice and guidance and care I have always received has been excellent.”

The hospital had policies and procedures regarding safeguarding children and adults. We found that staff were aware of these procedures. Patients commented they always felt safe with the staff at the hospital. One person commented “No, I have never at any time felt unsafe or had any concerns.”

We found that the hospital had good processes in place to manage infection control. Patients commented that the hospital was clean. One patient commented “It is a comfortable clean environment.” Another person commented “Excellent the hospital is always clean and tidy.”

Patients were protected by the arrangements in place for managing medicines. There were procedures in place regarding complaints management and patients felt their complaints were dealt with appropriately and in a timely manner. One patient commented “If I had to complain I am sure it would be responded to very quickly.” Another patient commented “No, I have been in the hospital for some time now and never had to complain an excellent service.”

During the inspection we spoke with more than twelve patients on the wards and three people in the outpatients department.

The majority of patients we spoke with said they were extremely well looked after and treated with care. They said that staff were polite and courteous but one patient told us that one staff member had not spoken to them politely. This was raised with the registered manager during the inspection.

One patient told us they could find no fault with the nursing care although they missed having the little extras for example pencils, paper and envelopes which used to be provided.

Two people visiting the hospital told us they felt strongly that there should be single sex toilets available throughout the hospital. They said that there was no signage on the toilet doors of a man and a woman side by side on shared/unisex toilets.

The provider had informed CQC that a previous manager had left but they had not deregistered with CQC. Therefore their name still remains on this report. The CQC has received the required information to deregister the previous manager. This application is currently being processed and following completion the previous manager’s name will not appear on any subsequent reports.

Patients who spoke with us indicated that they were very satisfied with the services provided at the hospital. They felt that they had been fully informed about their treatment and care needs, had been involved at all stages of their care, and made aware of their progress.

Staff were said to be very professional in their duties and respected the dignity and rights of each person. Preferences and choices had been taken into account when planning individual care.

Nuffield Health Guildford Hospital is operated by Nuffield Health. It is an independent hospital and has 49 beds. The hospital has 4 operating theatres, diagnostic imaging and outpatient services

The hospital provides surgery, services for children and young people, and outpatients and diagnostic imaging. We inspected surgery (including endoscopy), services for children and young people and outpatients and diagnostic imaging. We did not inspect oncology services, but will inspect this service within six months, as the service had recently moved to a refurbished ward.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 to18 November 2016 and an unannounced visit on 1 December 2016.

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.

We rated this hospital as good overall because:

• Staff confidently escalated any risks that could affect patient safety and we saw effective systems for reporting, investigating and learning from incidents.

• There were sufficient staff with the right skills to care for patients and staff had been provided with induction, mandatory and additional training for their roles. Completion rates for mandatory training including key topics such as safeguarding was better than the target set by the Nuffield Group.

• The hospital was visibly clean and there were appropriate systems to prevent and control healthcare associated infections. We saw that rooms were equipped with sufficient equipment and consumable items for their intended purpose. The waiting areas were spacious and well-appointed with amenities for refreshments and comfortable seating, including a variety of seat heights available to assist those recovering from surgery.

• Medicines were managed safely in accordance with legal requirements and checks on emergency resuscitation equipment were performed routinely.

• Staff responded compassionately when people needed help and support to meet their basic personal needs. Staff also respected people’s privacy and confidentiality at all times. Patients’ feedback through interviews and comment cards was positive.

• People were always made aware of waiting times and meals were offered to those delayed or in clinic over meal times. Any concerns or complaints were listened and responded to and feedback was used to improve the quality of care.

• We saw strong leadership at the location with an open and transparent culture. The hospital director used the Heads of Departments forum as a governance and performance management tool to maintain and improve the quality of the service. There was a clear vision and focused strategy to deliver good quality care.

• The governance framework ensured staff responsibilities were clear and that quality, performance and risks were all understood and managed. Services continuously sought to improve and develop novel approaches to enhancing care, such as exercise courses offered to the public.

• Staff were overwhelmingly positive about their experience of working at the hospital and showed commitment to achieving the provider's strategic aims and demonstrating their stated values. Staff told us they were supported by the hospital director and the new matron, both of whom were visible and approachable.

• We found evidence of multidisciplinary team (MDT) working across all of the areas we visited and we saw good collaborative working and communication amongst all staff in and outside the department. Staff frequently reported they worked well as a team and liked the “family” feel of the organisation.

• There were no delays in accessing surgical intervention once the patient was identified and had accessed the hospital’s booking systems. The hospital offered rapid access to diagnostic imaging and physiotherapy services, usually within a week. The hospital was above the 90% national referral to treatment (RTT) waiting time target for the majority of the year.

However, we also found the following issues that the service provider needs to improve:

• The provider must improve the way it manages records in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided’.

• Staff should ensure all entries in the theatres CD register are legible and in line with Nursing and midwifery council (NMC) Standards for medicine management.

• The provider should ensure that they are assured at all times that staff are complying with the bare beneath the elbows policy.

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, to help the service improve. Details are at the end of the report.

Name of signatory

Professor Edward Baker

Deputy Chief Inspector of Hospitals (London and the South)