Archived: BMI Coombe Wing

Updated 27 February 2019

BMI Coombe Wing provides care for privately-funded patients and is operated by BMI Healthcare Limited. The service was provided by Kingston Hospital until 2009 when it was taken over by BMI Healthcare. The hospital primarily serves the population of Kingston Upon Thames. It also accepts patient referrals from outside this area. BMI Coombe Wing is a ward which can accommodate 22 adult male and female patients. Patients have private rooms with en-suite bathroom facilities.

The service had been inspected three times previously. We last inspected the service in October 2016. At the time of our inspection, the registered managers were John Hare, registered since January 2014, and Hannah Dyer, who had been registered with the CQC since November 2017.

Updated 27 February 2019

BMI Coombe Wing is operated by BMI Healthcare Limited. BMI Coombe Wing operates one ward, located within Kingston Hospital and provides beds for patients with medical conditions, following surgery or for mothers after delivery of their baby. The ward has 22 beds and four outpatient consulting rooms.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 4 and 5 October 2016. We did not carry out an unannounced visit because we had obtained all the evidence required to make judgements, during the announced visit.

We did not inspect any of the services that are provided under Service Level Agreements by Kingston Hospital as these are services from another provider. Kingston Hospital NHS Foundation Trust was inspected and rated separately, and the report was published in July 2016.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well led?

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 medicine. Where our findings on medicine – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the medicine core service section.

Services we rate

We rated this service as good overall. This deviated from the aggregation principles that we apply when rating services, however we were satisfied that prompt action had been taken by the provider to rectify the issues that were raised for the safe domain so this was considered when rating the service overall.

We rated the services for medicine and outpatients and diagnostic imaging and used these ratings to rate the service overall.

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

• The quality handover was an effective method of communicating information to staff and learning about incidents, complaints and changes of policy and practice.
• The service managed staffing well with a flexible approach that meant there were always enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.
• The service had a robust admission policy which meant that there were limited occasions when a patient was inappropriately admitted.
• All incidents were investigated and lessons shared with staff.
• We observed effective multidisciplinary team (MDT) working to provide holistic care for patients which was confirmed by feedback from different staff groups.
• Patients were positive about the way staff treated them
• There were good systems in place to manage patient flow. Admission and discharges were multidisciplinary focused to ensure all the needs of patients were met.
• Staff spoke positively of the leadership and this was reflected in the culture across the service. Clinical leads were visible, approachable and supportive.

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

• There were no clinical handwashing basins within any of the patient rooms or along the patient corridor and hand sanitiser gel was not always positioned ideally within a room. This meant that there was potential for hand hygiene not to be undertaken in a best practice manner. However the service did have a risk assessment with mitigation actions and had a plan for four new sinks and 11 additional hand sanitiser dispensers to be installed within a month of our inspection. Evidence was provided following the inspection to show that this was completed in October 2016.
• The corridor floor of the ward was lined with carpets. This was an infection control and prevention risk. However, permission had been obtained to have the carpets changed to vinyl and this was evidenced as completed by the provider in December 2016.
• There was a low compliance level in the monthly audits reported of venous thromboembolism assessment and treatment.
• Some visiting consultants working in the outpatients department did not comply with bare below the elbow guidance.

Services we do not rate

The surgical activities conducted by the provider consisted mainly of diagnostic scoping. Only 36% of the activities logged were in fact surgical cases (93 procedures in total).

Due to the small size of the maternity service and the nature of the surgical services conducted at BMI Coombe Wing, we did not have sufficient evidence to rate these services. However, we have highlighted good practice and issues that the provider needs to improve.

We found the following areas of good practice:

• All patients were followed up within 24 to 48 hours from discharge with a phonecall from a ward nurse.
• There was clear evidence of learning from incidents, including the review and update of a policy when required.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 2 May 2017

Medical services were the main service of the hospital. Where our findings on medicine also apply to other service, we do not repeat the information but cross-refer to the medicine section.

Most staffing, incident reporting and mandatory training were managed jointly with surgery, outpatient and maternity.

We rated this service as requires improvement because the areas of safe, and effective were rated as required improvement although the areas for caring, responsive and well led were rated as good.

Updated 2 May 2017

The maternity services accounted for a small proportion of the service business and were managed and run jointly with the medicine and surgery services. Where arrangements were the same we have reported the detail in medicine.

As there were very few women cared for annually in this service, we did not have enough evidence to rate it, but highlighted good practice and issues that provider needs to improve.

Updated 2 May 2017

The outpatients department was directly next to the ward. Leadership and some staffing was managed jointly with medicine. Where arrangements were the same, we have reported the detail within medicine. Diagnostic imaging was not provided by the ward but through an SLA with Kingston hospital.

We rated this service as good because it was safe, effective, caring, responsive and well led.

Updated 2 May 2017

Although surgery patients made up the majority of patients only pre-assessment and post-operative ward care was provided on the ward, as surgical procedures and all theatre services were all carried out under a service level agreement (SLA) with Kingston Hospital.

The majority of surgical activities conducted by the provider were diagnostic scoping. Only 36% of the activities logged were in fact surgical cases (93 procedures in total).

Where arrangements were the same, we have reported the detail within medicine. Due to the nature of this service, we did not have sufficient evidence to rate it, but have highlighted good practice and issues that the provider needs to improve.