We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Nuffield Health Newcastle-upon-Tyne Hospital Clayton Road, Newcastle Upon Tyne, NE2 1JP Tel: Date of Inspection: 06 November 2013 Date of Publication: November 2013 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Consent to care and treatment Care and welfare of people who use services Cleanliness and infection control Staffing Complaints Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Nuffield Health Mr. Graham Chapman Nuffield Health Newcastle Hospital is owned and operated by Nuffield Health. The hospital offers a number of inpatient and outpatient services which include a range of surgical procedures and diagnostic tests. The hospital is situated in a residential suburb near to the city centre. Acute services with overnight beds Diagnostic and screening procedures Family planning Surgical procedures Treatment of disease, disorder or injury Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Consent to care and treatment 8 Care and welfare of people who use services 9 Cleanliness and infection control 11 Staffing 13 Complaints 15 About CQC Inspections 16 How we define our judgements 17 Glossary of terms we use in this report 19 Contact us 21 Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 6 November 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service and talked with staff. We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. What people told us and what we found We spoke to ten patients. All of them were happy with the standard of service they had received. One patient told us; "The care has been fantastic." Another patient said;" All the nurses are lovely... everyone one of them." And;" All the nurses are very pleasant." Patients' views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One patient said;" All of the procedures to be undertaken were explained step-by-step and choices were given to me." Another patient said;" I was given written information that told me what could be achieved with treatment." Before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw consent forms were signed before any treatment took place. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One patient said;" I've been so impressed with the care, I'll come back for other treatment depending on the cost." Another said;" I knew how good the Nuffield was even before I was admitted, as people had told me." We saw effective infection prevention and control procedures were in place to reduce the risk of infections. Patients we spoke with said the hospital clinic was spotlessly clean. Patients were cared for, or supported by, suitably qualified, skilled and experienced staff. One patient said;" The staff are brilliant and easy to get hold of." Another patient said;" Nurses come straight away." Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

5 Systems were in place to ensure people's complaints were fully investigated and resolved, where possible, to their satisfaction. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

6 Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Reasons for our judgement Patients who used the service understood the care and treatment choices available to them. These choices were discussed with them at their first meeting with their consultant. They had another opportunity to discuss the treatment choices and their implications, as part of the 'pre-assessment' process meeting with qualified nursing staff. At this stage of their consultation, patients were given verbal and written information about their treatment options and were given the opportunity to ask any questions they might have. If people were due to be admitted for an operation they were sent booklets which gave specific information about the surgery that had been planned. This enabled them to read about the procedure in their own time and to consider their options. Patients were also given a 'named nurse' who would oversee their course of treatment, providing consistency, and giving the patient a focal point for information and further questions. Where necessary, they were able to speak again with their consultant, if they were still unclear about their treatment choices. Patients we spoke with confirmed they were involved. One person said;" The information I was given was personalised and comprehensive." Another said;" Everything is explained thoroughly." We talked with the manager and nursing staff on the pre-assessment unit and wards. They told us they encouraged patients to ask any questions they may have about their possible treatment courses, and often spoke with people by phone after their pre-assessment meeting to answer any further questions that patients might wish to ask. We looked at examples of the written information given to patients. These included descriptions of standard procedures such as anaesthesia, post-operative pain relief and after-care arrangements, and of the different treatments available for specific conditions. These documents were detailed and informative and gave patients the necessary information to aid them to make decisions or request further advice. Administrative and financial arrangements were also clearly set out. One patient said; "I have received all the information I need about costs." Another said;" I don't need to know about costs as my son-in-law is taking care of them." Another patient said; "I have a rough idea." This meant Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

7 that patients were given appropriate information and support regarding their care or treatment. We looked at a sample of patients' care records. We saw evidence that proposed surgical procedures were fully explained and discussed with patients, before any treatment was started. We spoke with three people who had recently undergone surgery and they said that they had been given enough information to help them make a decision about their treatment. One said; " The procedures undertaken have been explained step by step and I was kept informed and given choices." Another said; "I was told all about the operation and what to expect afterwards". This meant people expressed their views and were involved in making decisions about their care and treatment. We saw each patient had their own en-suite bedroom where care and support was provided. We saw that staff knocked on the door before entering and asked the patient whether they wanted the door to be open or closed when they left. We observed that a call bell was left within easy reach of people so that they could call for assistance if necessary. Staff told us part of the introduction when the patient was admitted to the ward was to ask how they wished to be addressed. The staff member who was 'dignity champion', also gave examples of how staff were encouraged to keep focussed on patients' privacy and dignity at all times. She said the hospital gowns provided for patients were now of a more suitable design, and better protected their privacy and dignity, especially when being transported to and from the theatres. This meant people's privacy and dignity was maintained. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

8 Consent to care and treatment Before people are given any examination, care, treatment or support, they should be asked if they agree to it Our judgement The provider was meeting this standard. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Reasons for our judgement We saw a 'guide to consent' document was displayed in the reception area of the hospital, and was posted to all potential patients, along with information about their admission details and pre-operative advice. We saw documentary evidence that the patient's consultant insisted on receiving patients' signed consent before starting any treatment. We also saw that patients' verbal consent for minor aspects of treatment such as taking swabs was recorded in their care record. The sister on the pre-assessment unit told us that patients were able to cancel their treatment by phone, even after having already signed their consent and that there was no financial penalty imposed for such cancellations. We asked staff how they responded to situations where a patient's capacity for making informed decisions about their treatment was in doubt. The provider may find it useful to note that staff told us they had received no specific training in the implications of the 2005 Mental Capacity Act (although the legislation was referred to in their safeguarding of vulnerable adults training). They also said they were not fully aware of the hospital policy and procedures regarding mental capacity. In practice, however, we were told that any concerns about capacity would be referred back to the consultant and anaesthetist, and that treatment would not be given to any patient who was not clearly able to discuss and agree their treatment. This meant before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Staff told us that any treatment involving children was only carried out after the full involvement of a consultant paediatrician, the written consent of the parent, and with the support of a paediatric nurse at all times. This meant where people did not have capacity to consent, the provider acted in accordance with legal requirements. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

9 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement Patients we spoke with told us they were happy with the care and treatment that they received. One commented the care was fantastic." Another said;" It's like a five star hotel." Other comments included;" Everyone is smashing and everything is explained thoroughly." Another said;" I know how good the Nuffield is, even before I came, other people told me." We were told following an initial appointment with their consultant, patients were taken through a comprehensive pre-assessment process in which they completed a detailed self-assessment of their medical history and answered key health questions. As part of this assessment, qualified staff carried out routine observations and tests to ensure patients were suitable for surgery. The results of tests and pathology reports were included in the care record. Where any conditions indicated the person was not suitable for the proposed course of treatment at the pre-assessment stage of the consultation, and it was deemed unsafe their treatment would not be provided. We saw evidence that patients with disabilities were given extra time for their consultations and assessments. Where patients had to travel long distances for their treatment this was taken into account when planning their care. For example, arrangements had been made with hospitals local to the patient for routine tests such as taking swabs. This meant people's needs were assessed and care and treatment was planned before any treatment was started. We looked at the care records for day care and long stay surgery for six patients and saw that each of them contained a comprehensive care plan. Risk assessments formed an integral part of the patient's care record, with the management of any identified risks fully recorded. There were risk assessments for deep venous thrombosis, manual handling, pressure sores, wound healing and falls. We saw there was a record of the care and treatment given and each entry was signed and dated. Surgeons had described the details of the operation performed and anaesthetists had recorded the drugs given and the person's response to them. We saw there was a detailed record of the post-operative care and observations charts included a clinical early warning system. This helped staff to identify when someone's condition was at risk of deteriorating. This meant that care and treatment was planned and delivered in a way that ensured patient's safety and welfare. We were told an individual personal discharge plan was drawn up to ensure patients' on- Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

10 going safety and welfare was supported by means of, for example, hospital discharge letters to relevant professionals. Patients confirmed their pre-operative assessment included discharge arrangements. One patient said;" Social Services have already been contacted about my discharge as a shower seat and lavatory seat were delivered before I came into hospital." We saw detailed information was provided to each patient about their aftercare. This included information about the procedures which had been undertaken as well as a contact phone number for people to ring for help and advice. This helped to maintain people's health and wellbeing. We saw follow up appointments were arranged so the consultants and nursing staff could assess the effectiveness of the treatment that had been undertaken. This meant patient's felt supported. One patient said;" I have been given a post discharge appointment and physiotherapist appointment." We saw the hospital had disabled access, passenger lifts, and a specially adapted disabled bedroom. Leaflets showed interpreters were available for patients for whom English was not their first language, and we were told written information was made available at short notice in other languages. We were told if a person arrived unexpectedly and there was a language barrier, an interpreter would be accessed and their skills would be provided on the next visit. Chaperones were also made available on request. Patients were asked if they had any special dietary wishes and needs as part of their pre-treatment assessment. This meant that patients' care and treatment was planned and delivered in a way that protected them from unlawful discrimination. We were told that all staff, including non-clinical staff, had received basic life support training. This training was repeated annually for clinical staff, who also received intermediate life support training. In addition, arrangements were in place to ensure that there was always at least one person qualified to the advanced life support level on duty at all times. Staff described the systems in place for checking, on a daily basis, that emergency equipment was available and in working order on each floor of the hospital. Staff told us there were regular, unannounced, emergency scenarios arranged by senior staff, which were followed by debriefings to learn any lessons from the exercises. This meant there were arrangements in place to deal with foreseeable emergencies Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

11 Cleanliness and infection control People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was meeting this standard. People were protected from the risk of infection because appropriate guidance had been followed. Reasons for our judgement We saw the environment was clean and tidy which made it pleasant for people as well as reducing the risk of infections. People we spoke with were happy with the cleanliness of the environment. One person told us;" The hospital is very clean and stops me worrying about infection.'' We were told about the screening procedures for patients being admitted. We saw evidence that this took place consistently. We were informed that the hospital had no reported cases of MRSA (Methicillin-resistant Staphylococcus Aureus) or reported cases of Clostridium Difficile. We saw extensive and comprehensive infection control policies in place and cleaning audits which were all up to date. We were told cleaning schedules were followed with individual patient rooms being clean thoroughly between each patient. An evening domestic team was in place to clean all public areas and outpatients. An overnight domestic team was also in place to clean the operating theatres with minimal disruption to staff and people using the service during the day time. The provider may find it useful to note at the time of inspection we observed the doorplates to the doors around the hospital had a build-up of finger marks. We saw evidence of infection control link workers across departments in the hospital. These link workers were responsible for local auditing and education within their department. We were told the lead infection control practitioner chaired the regular infection control meetings and each department in the hospital was represented at this meeting. We were also told a standing agenda item at the monthly staff meetings was infection control and prevention. One of the infection control link nurses told us the premises were cleaned daily by staff and monthly deep cleaning was carried out in treatment areas. We saw the completed monthly cleaning log sheets were signed by the person responsible for cleaning the clinics. This meant patients were cared for in a clean, hygienic environment. The provider may find it useful to note a recent infection control audit showed due to the damage to walls and doorways from trollies and wheelchairs there was a lower score in this area. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

12 We saw systems were in place to reduce the risk of infections spreading such as the availability of alcohol hand rubs and aprons. We were told by patients staff wore personal protective equipment (PPE). We also saw signage above hand wash sinks to promote effective hand washing together with soap dispensers and paper towels. This ensured a good standard of hygiene was maintained. We were told by staff single use devices were used whenever possible, for undertaking treatment. There was a dating and labelling system for cleaning large instruments such as scopes and other theatre equipment to identify when equipment was cleaned and when it was due to be deep cleaned off site. Other equipment used in patient observations for daily use were cleaned after use. This meant very few decontamination or sterilising processes took place at the location which helped to reduce the risk of cross infection. A system of auditing was in place to ensure there were sufficient devices for the number of people receiving treatment. This included checks for the safe disposal of single use devices after their use to reduce any risk of them being used again. This meant there were effective systems in place to reduce the risk and spread of infection. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

13 Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement We were told the staffing of wards and departments varied according to the number of people present and the complexity of their conditions. We talked to three ward sisters who drew up the duty rotas. They were able to demonstrate the care and deliberation that was used to ensure that sufficient staff, with appropriate skills, were available to care for people using the service. Staff rotas were planned in advance to enable management to have a clear understanding of which staff were working and whether any additional staff would be required. Staff we spoke with on the pre-assessment unit felt there were enough qualified and unqualified staff to meet the needs of the patients. They told us staffing was organised on a monthly basis to meet the planned number of appointments given to patients, with a normal complement of two qualified staff and one healthcare assistant. We were told that, if there were insufficient staff to adequately meet patients' needs, referrals would be refused or put back. They said there was consistency and good communication between shifts. Any sickness or other staff shortages would be covered by the existing staff team, with the manager working with patients, where necessary. Due to the specialised nature of the nursing, agency staff were rarely used. We spoke to staff on one ward who told us there were three qualified staff members and two health care workers on duty to look after 15 patients. On another ward we were told there was one qualified staff member and one health care worker to look after six patients. We spoke to theatre staff who told us on a routine day there were 23 staff members available to support three operating theatres. This meant there were sufficient, appropriately trained staff to meet the needs of the people. The provider may find it useful to note that we were made aware that, due to the change in the National Health Service (NHS) contracts for surgeons, they did not usually start clinics or operating theatre lists until 5:00pm. We were informed as theatre lists were scheduled until 9:00pm sometimes people who had been booked as day patients had to remain overnight after surgery took place as they could not be discharged home so late. This meant people would remain in hospital unexpectedly and the ward was not always staffed to meet this sudden extra need overnight. For example the previous night the ward had 18 patients and only two qualified staff members working overnight with the on call medical officer on site. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

14 The patients we spoke with told us they were happy with the staff who looked after them. One said;" All the nurses are lovely, every one of them is great." Another person said;" The nurses are very pleasant, and make time to chat, even when they are busy." All said the staff were approachable and provided help. One patient said the staff were;" Brilliant and easy to get hold of." This meant staff were available to provide care and treatment to patients. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

15 Complaints People should have their complaints listened to and acted on properly Our judgement The provider was meeting this standard. There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Reasons for our judgement We saw evidence that the complaints process was publicised throughout the hospital and leaflets were also available. Each patient was given a complaints procedure as part of the hospital information pack before they were admitted for treatment. One patient said;'' I have no concerns or complaints although I remember a complaints form was in the admission pack." All patients we spoke with said they knew how to complain although they had no reason to because of the outcome of their treatment. The hospital's policy and procedure provided guidance for staff about how to deal with complaints. This meant patients were able to raise their concerns through the provider's complaints process and staff knew how to respond to patients' complaints. We saw the provider kept a record of compliments received. Several were displayed around the hospital. We asked for and saw a summary of complaints people had made and the provider's response. We saw two complaints had been received since February We looked at one complaint and found it had been fully investigated and the outcome recorded. We found the provider had followed its own policy and had dealt with the complaint appropriately. We saw an audit of the complaints log was carried out as part of the hospital's quality assurance process. This meant patients' complaints were fully investigated and resolved where possible to their satisfaction. We also saw evidence that complaints were discussed at department meetings. The outcome of each complaint and any lessons learnt were also discussed. This helped with quality assurance processes. All patients were asked to complete a customer experience questionnaire after their treatment. All patients we spoke with confirmed this. One patient said;" I'm taking it home and will complete it from there." This meant patients, their representatives and staff were asked for their views about their care and treatment and they were acted on. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

16 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

17 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

18 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

19 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

20 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November

21 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report Nuffield Health Newcastle-upon-Tyne Hospital November