Edinburgh Royal Infirmary has been ordered to take action to improve care of elderly patients after concerns identified by inspectors.
Last year the hospital was criticised after an inspection by Healthcare Improvement Scotland (HIS) flagged up a number of failures in the care provided to older patients.
A new inspection has now found while improvements have been made, the hospital is still failing to properly screen patients to assess their needs or take action to improve ward environments.
The Royal College of Nursing (RCN) said staff cuts meant nurses were “rushed off their feet” and further action was needed to address staffing levels.
HIS inspectors said they observed staff treating patients with dignity and respect, with “dementia champions” at work throughout the hospital.
Inspectors said that although the wards were busy, they were “managed in a calm and organised manner” which contributed towards the care being dignified, compassionate and respectful.
One area of concern noted by inspectors included patients dressed in hospital gowns “that did not maintain their dignity”.
The report said that handsets used by patients to call staff were not always placed where they could reach them.
In interviews with patients, 89 per cent said the quality of care they received was good.
But some noted concerns, including a buzzer being ignored and problems getting help with meals such as opening a packet of sandwiches.
One patient said: “Other days food required to be cut up. One nurse said ‘surely you can do it!’ I could go on and on, the nurses don’t have enough time to help patients.”
The report said on six occasions they saw patient health records being left open and unattended and in some cases computer screens displaying patient records left unlocked.
The inspectors also raised concerns that routine screening for dementia and cognitive impairment, which should be carried out on admission, was inconsistent.
In the 33 patient records they reviewed, screening on admission had only taken place in 11 cases. Screening for malnutrition and the risk of bed sores was also patchy.
The report said that patients with dementia could benefit from environments adapted to limit potential confusion or distress.
But it said in the wards inspected, little had changed since the last inspection meaning “the wards are not suitable for people with dementia”.
It went on: “During the August 2012 inspection, a lack of stimulation and activity for patients was noted. This was also observed during this inspection.
“There appeared to be limited stimulation or activity for patients other than individual TV equipment and interactions with staff and visitors.”
RCN Scotland Associate Director Norman Provan said despite efforts by NHS Lothian to address the “serious issues” highlighted by HIS, on the ground they still had concerns about the number of staff on wards and the number of available beds.
“NHS Lothian, following significant cuts to staff, are now acknowledging that they cut too deeply and are recruiting staff,” he said.
“This is welcome, as it the fact that senior charge nurses on the wards are being freed up to oversee their teams and provide effective clinical leadership.
“But nurses are rushed off their feet and, in these circumstances, may not always be able to provide the level of care they wish to.”
Melanie Hornett, nurse director at NHS Lothian, said despite the improvements made, they acknowledged there was more to do.
“We are rolling out a programme of environmental improvements making wards more dementia friendly and are currently improving the facilities for patients with dementia including improving colour schemes within wards to make it easier for patients to identify locations and facilities like bathrooms,” she said.
“We have invested considerably in dementia training for large numbers of our staff and we are also reviewing the excellent work our many dedicated volunteers can play in the care of patients with dementia.”