Regulator takes action as Kent NHS trust downgraded following inspection

The Care Quality Commission (CQC) has taken action to protect people at Kent and Medway NHS and Social Care Partnership Trust following an inspection in May.

The CQC inspected the acute wards for adults of working age and psychiatric intensive care units (PICU) at Littlebrook Hospital, in Dartford, Priority House, in Maidstone, and St Martins Hospital, in Canterbury, and found a decline in the quality of care being provided.

Following this, the organisation carried out the inspection at hospitals in response to a number of concerns raised about the safety of the service.

After the inspection, the trust was issued with a warning notice regarding rapid tranquilisation. This was to make sure significant improvements took place so that all staff followed local and national recommendations to monitor and record a person’s physical health after rapid tranquilisation (sedation) had been administered. There was a concern that staff weren’t always aware of the potential impact these medications had on people’s health.

In addition, the rating for the acute wards for adults of working age and PICU has declined from good to requires improvement, as has the rating for leadership. The rating for safe has dropped from requires improvement to inadequate.

Serena Coleman, the CQC’s deputy director of operations in the South, said: ‘During this inspection of Kent and Medway NHS and Social Care Partnership Trust, we saw staff working hard to meet people’s needs. However, we also found some staff weren’t always using the least restrictive options to make sure that people’s behaviour wasn’t controlled by an excessive use of medicines.

‘As required medication, such as lorazepam and promethazine, was being used quite frequently but we couldn’t always find records to explain why these medications were necessary. There were examples where reviews hadn’t happened for long periods, meaning staff couldn’t be sure it was still appropriate to administer to people.

‘We also found that staff didn’t always follow the trust’s guidelines on documenting the monitoring of people’s physical health after administering medicines for rapid tranquilisation. This made it difficult for the trust to review these and ensure they were appropriate.

‘In some of the sites we inspected, we also found restrictive practice or blanket restrictions such as people not having independent access to drinking water, gardens and certain rooms on the wards. For example, at Littlebrook Hospital and Priority House there were designated areas where people could have access to hot and cold drinks.

‘We have given the trust a warning notice which will direct focus on the improvements we want to see regarding rapid tranquilisation implemented and embedded. If not, then we won’t hesitate to take further action to ensure people are safe.’

Inspectors found the following problems during the inspection:

• Some people’s care plans didn’t include guidance to help staff support people and manage their medical conditions
• At Littlebrook Hospital and Priority House there were inconsistencies in how staff put in place measures to manage environmental risks or audit ligature risks
• At St Martin’s Hospital people had limited access to showers on the wards. On one ward there were four showers, but only two could be used for 18 people. There wasn’t a good reason for why this was
• Some staff were unable to access the online incident reporting system that the trust had recently introduced, meaning staff could not report incidents in a timely manner
• Some managers said that at times they had to wait for a long time for maintenance works to be completed and they found this frustrating
• A manager at Littlebrook Hospital said they rely on staff to inform them whether any repairs had actually been completed. This meant that the CQC was not assured that any potential environmental risks were always correctly identified or managed

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