At our last inspection in July 2013 we found some patients had not received safe, effective and appropriate care. We considered this had a major impact on patients and issued a warning notice. The provider sent us a detailed action plan and stated they would be compliant with the notice on 18 October 2013. We carried out this inspection to check the necessary improvements had been made. Prior to the inspection we received some concerning information about the paediatric area in the Emergency Department (ED). We therefore combined this inspection with a check of the emergency arrangements for children.

We arrived unannounced at the ED department at 6.45 am and left the Trust at 7.30 pm this enabled us to observe the operation of the service over a 12 hour period. During the inspection we spent time on ED, Medical Assessment Unit (MAU), Paediatric area of ED and five wards. Following the inspection, we spoke to nine patients and three parents of children over the telephone who had recently been discharged from the service.

We spoke to a number of patients who had been admitted to the hospital via the urgent pathway and parents using the paediatric area both before and during the inspection. The feedback we received from the majority of patients and parents was very positive and people in the main described good experiences and good outcomes from their stay or visit. Patients described the care and treatment they received as “very good”, “excellent” and “fine” and were complimentary about the staff team. However, one relative of a patient was not happy with the care received, due to poor communication.

We observed patients being assessed and treated in a timely manner in ED and in the paediatric area of ED. Staff were seen to be caring and sensitive to patients needs in all areas visited during the inspection. We found the Trust had improved the systems in place to manage patient flow throughout the hospital and patients reported good experiences of their transfer from MAU to a ward. All patient records and other associated documentation seen were complete and up to date.

After carefully considering our findings, we found no evidence to support the concerns raised about the paediatric area of ED and found the Trust had made the necessary improvements to comply with the warning notice. This meant, at the time of our inspection, patients were receiving safe and effective care.

Before the inspection we gave the Trust three weeks notice of the visit date and requested specific information about the service. We also sent an email to staff informing them of the visit. During the inspection we looked at the care and treatment received by patients using the Integrated Care Team based at St Peter's Centre, Burnley. We spoke with eight patients, six members of staff and four senior managers, including the Deputy Chief Executive. We also looked at four sets of records for people using the service.

Patients told us they were satisfied with the care and treatment provided, one patient told us "Everything is very good, the nurses are lovely and very helpful".

We found patients’ care was planned and delivered in accordance with their needs. We also noted there were systems in place to ensure care was well coordinated and staff worked closely with other organisations and professional staff in order to achieve good outcomes for patients.

Staff were given opportunities to update and extend their training in line with their roles. Staff had an annual appraisal of their work performance to monitor competencies and set learning objectives. All staff spoken with had a thorough understanding of safeguarding procedures for the protection of vulnerable adults.

There were established and effective systems in place to monitor the quality and safety of the service which included the analysis of patient and staff feedback.

We spoke with 14 patients and four visitors on wards B6 and B8 at the Royal Blackburn Hospital. We also spoke with staff and senior managers and looked at a sample of records and policies and procedures. Wards B6 and B8 provide care and treatment for older people.

Patients told us they were satisfied with the care and treatment they had received and they were involved in decisions about their care. One person said, “They have been really good, they’ve kept me up to date with everything”. Visitors spoken with also made positive comments about the quality of care.

Patients’ needs were assessed on admission to the hospital and care pathway plans were developed depending on what treatment or procedure they required. Multidisciplinary progress notes were maintained in order to keep the staff informed of up to date information about patients’ needs and circumstances.

Staff had a thorough understanding of safeguarding procedures for the protection of vulnerable adults. We saw evidence to demonstrate staff liaised with other agencies to ensure a coordinated response to safeguarding issues.

Staff were given opportunities to update and extend their training in line with their roles. Staff also had an annual appraisal of their work performance to monitor competencies and set learning objectives.

There were established and effective systems in place to monitor the quality and safety of the service which included the analysis of patient and staff feedback.

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

Our rating of services stayed the same. We rated it them as good because: