A mental health trust in Kent has been issued with two warning notices after inspectors found care on a ward for elderly dementia patients was “inadequate and unsafe”.
Kent and Medway NHS and Social Care Partnership Trust was told to make urgent improvements by the Care Quality Commission after an inspection visit in March this year.
“The managers of the trust should have taken more decisive action sooner to tackle the problems”
In particular, inspectors raised concerns about standards at Littlestone Lodge in Dartford, a 16-bed continuing care unit for older people with dementia.
“We had serious concerns about the quality of care at Littlestone Lodge,” said their report. “We identified poor practice including staff not meeting the needs of patients and observed unsafe care.
“For example, we found patient’s pain was not being managed; all patients were wearing incontinence pads without their needs being assessed and medicines were being administered covertly without rationale,” said the inspectors.
They found the acting manager of the facility – a band 6 nurse who had temporarily been promoted to the role in December – had tried to make improvements but been hampered by lack of support.
This included the fact senior managers had failed to “provide additional experienced nurses to support the day to day delivery of care”.
“We believe that the managers of the trust should have taken more decisive action sooner to tackle the problems,” said Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health.
However, the CQC noted that when inspectors returned to check on progress they found the service had made “many improvements” and that the trust had met the requirements of the warning notices.
Overall the trust was rated “requires improvement” by inspectors who visited 37 of the trust’s hospital wards and several of its community services, reporting wide variation in quality.
A lack of registered nurses – especially during day shifts – was found to be a key issue despite the fact the trust had successfully brought down overall vacancy rates from 17.4% to 9.7%.
Thirty-one of the trust’s sites were said to have a vacancy rate of 50% or more, with bank and agency staff used to fill over 100 shifts in the three months up to October 2014.
“Staffing levels were having an impact on the ability of staff to deliver care,” said the inspection report.
It said this was the case across the trust’s community mental health services for older people.
“The high number of caseloads in community mental health teams meant that staff could not ensure that all patients were being appropriately monitored to ensure they were not at risk,” the report added.
Inspectors also found examples of staff working very long hours, with one employee in the rehabilitation service working 13 shifts in 14 days.
“In very many areas we are ‘good’ and ‘outstanding’, so we have the skillsets”
Nevertheless, they rated the trust “good” overall for staff being caring while its forensic service and wards for people with learning disabilities were judged “outstanding” for caring.
Trust chief executive Angela McNab said the organisation had already identified many of the areas flagged up for improvement by the CQC.
“Staff were found to be overwhelmingly compassionate, kind and motivated to involve patients in their care,” she said. “Patient and carers were positive about their experience and the processes for patient and carer engagement and feedback were recognised as being good.
“It was also recognised that the trust has an excellent strategy based on driving improvement in clinical practice and that staff know the strategy and understand it,” said Ms McNab.
“Nevertheless, safety, dignity and nothing less than excellent patient care is what motivates us,” she said. “As the CQC recognised, in very many areas we are ‘good’ and ‘outstanding’, so we have the skillsets.
“This report is important in making sure we apply those standards across the board. That is why we have either already addressed or are in the process of addressing with our partners the issues raised,” she added.