You are here

Provider: Kent and Medway NHS and Social Care Partnership Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 1 March 2019

  • The team bases were safe for use by patients and staff.
  • Patients who were prescribed anti-psychotic medicine received regular monitoring of their physical health.
  • The service employed enough staff to meet the needs of the service. Staff felt supported by the trust, completed mandatory training, received supervision and had access to training opportunities.
  • Staff had manageable caseloads that were reviewed regularly. They completed detailed risk assessments and had support from the multidisciplinary team when their patients presented as high risk.
  • Staff had a good understanding of how to safeguard patients from abuse. They knew how to report incidents and were supported to gain learning from them.
  • Staff had access to a secure system where they could access and record information regarding patients’ care and treatment. Staff could to access this system remotely to record important updates and support their time management.
  • Staff carried out comprehensive assessments of patients’ needs and completed detailed care plans that addressed these identified needs.
  • The service employed clinical psychologists and occupational therapists who provided a range of interventions to improve treatment outcomes and promote independence.
  • The service had good links with internal and external agencies where patients, and their carers, could get support with social, dietary and physiological needs.
  • The service carried out a programme of audits around clinical documentation and physical health monitoring of patients on anti-psychotic medicine.
  • Patients, and their carers, were universally positive about the care and treatment they received. Staff knew their patients and treated them with compassion and respect.
  • Patients, and their carers were fully involved in decisions about their care and treatment. The service offered them exceptional support in the early stages of their diagnosis.
  • Admiral nurses supported families with all aspects of living with dementia. Healthcare assistants instilled hope in families by introducing them to emotional and practical support.
  • The service actively collected feedback, from patients and their carers, about their experiences of the service. Responses received were extremely positive.
  • The service was proactive in ensuring referrals were appropriately triaged and patients were seen and treated in a timely manner. All teams provided a duty service that could respond to emergencies.
  • The service responded to patients’ individual needs. Patients had a choice in what services they received support from. It was proactive in engaging patients and provided satellite sites to support patients from rural areas.
  • The service promoted dementia friendly communities and supported the concept of patients supporting each other. The service used feedback from complaints and compliments as learning opportunities.
  • The service had experienced senior managers and team leaders who staff felt were supportive and approachable. Staff enjoyed their jobs and felt supported by their colleagues.
  • The service maintained operational oversight through a well-structured schedule of meetings. Staff had access to an informative intranet site and the general public similarly had access to a user-friendly internet site.
  • All teams were accredited, or in the process of applying for accreditation, to the memory service national accreditation programme. The service involved themselves in many innovative projects to improve patient experience.

However:

  • Staff reported the current risk assessment template on the trust’s electronic care record system did not cover all risk areas common to older people with mental health issues. They also told us this same system could be hard to access, or respond slowly, during busy times.
  • The service did not have a consistent approach to some areas of clinical practice, such as recording supervision; measuring outcomes for patients who attended groups; and recording patients’ capacity or consent to treatment.
  • Due to commissioning arrangements, most areas of the trust were unable to provide a crisis service for patients with a diagnosis of dementia. Some teams were experiencing excessive waiting times for neuropsychology assessments.
  • Some interview rooms did not provide adequate soundproofing to maintain patients’ privacy and confidentiality. The service did not always have appropriate dementia friendly signage and features and some sites did not provide enough parking for people with disabilities.

Inspection areas

Safe

Good

Updated 1 March 2019

  • The service provided interview rooms and clinic rooms that were clean and tidy. Systems and environmental checks were in place to ensure patients’ and staffs’ safety was maintained at all times.
  • The service employed enough staff to meet the needs of the service. All vacancies were being interviewed for and bank and agency staff were being used appropriately in the interim.
  • Staff had manageable caseloads that were proportionate to the hours they worked. Team leaders offered regular caseload reviews to ensure staff were managing patient risks safely whilst maintaining their own well-being.
  • The service had sufficient medical input that was routinely available to support the medical needs of patients. Medical staff felt supported by the trust, received supervision and had access to training opportunities.

  • Teams consisted of staff from all disciplines of healthcare with high completion rates of the trust’s mandatory training courses.
  • Staff completed appropriate risk assessments and corresponding management plans for patients. They had systems in place, such as regular risk handovers, to ensure all high-risk patients had appropriate input and response from the multi-disciplinary team.
  • Staff had a good understanding of how to safeguard patients from abuse. Teams kept a record of all open safeguarding referrals and involved agencies that supported people at risk of abuse.
  • Staff had access to a secure system where they could access and record information regarding patients’ care and treatment. Staff could access this system remotely to record important updates and support their time management.
  • The service followed national guidance on prescribing anti-psychotic medicines in older people. All patients who used these medicines had their physical health monitored regularly.
  • Staff knew how to report incidents. The service had a good approach to learning lessons from incidents. Teams had regular opportunities to discuss incidents and were provided with debriefs when required.

However:

  • Staff felt the current risk assessment template being used by the trust did not appropriately cover all risk areas common to older people with mental health issues.
  • Staff told us that the electronic care record system could be hard to access, or respond slowly, during busy times.

Effective

Good

Updated 1 March 2019

  • Staff carried out comprehensive assessments of patients’ needs. Patients with suspected cognitive impairment were clearly explained the purpose of the assessment and carers were encouraged to be present.
  • Staff completed care plans that addressed patients’ identified needs. Staff adhered to the trust’s policy around care plans and this ensured that patients with more complex needs received effective care and treatment.
  • The service employed clinical psychologists who provided a range of psychological interventions to individual patients or within a group.
  • The service employed occupational therapists who provided a range of intervention to support patients’ independence in the community.
  • The service had good links with local agencies where patients, and their carers, could get support with social needs such as housing, benefits, transport and volunteering opportunities.
  • The service carried out a programme of audits around clinical documentation and physical health monitoring of patients on anti-psychoticmedication.
  • Staff received regular individual supervision that addressed their clinical practice and well-being. They could also access group supervision and reflective practice sessions. Most staff had received an annual appraisal in the last year.
  • Teams consisted of skilled staff who were encouraged and supported to enhance their knowledge and career progression through additional training and development days. In particular, healthcare assistants were of a high standard and were valued by the service.
  • The service had good links with internal teams and external agencies where patients could access input from professionals such as dieticians and physiotherapists.
  • The majority of staff had a sound understanding of the Mental Health Act and Mental Capacity Act.

However;

  • The service did not have a consistent approach to measuring outcomes for patients who attended groups. This meant they were not monitoring the effectiveness of groups.
  • Teams did not have a consistent approach to recording patients’ capacity or consent to treatment.

Caring

Outstanding

Updated 1 March 2019

  • Patients, and their carers, were universally positive about the care and treatment they received. Staff went the extra mile to ensure patients received person-centred care.
  • Staff were respectful and compassionate whilst engaging with patients and carers. They knew their patients well and discussed their needs and risks to other members of staff in a positive, non-judgement manner.
  • Patients, and their carers were true fully involved in decisions about their care and treatment. Care plans were collaborative and identified patients’ strengths to promote prolonged independence.
  • The service offered exceptional support to patients, and their carers, in the early stages of their diagnosis. Healthcare assistants instilled hope in families by introducing them to emotional and practical support.
  • The service had a good provision of admiral nurses who supported families with all aspects of living with dementia. They provided families with education courses and worked flexibility around the needs of carers.
  • The service actively collected feedback, from patients and their carers, about their experiences of the service. Responses received were extremely positive.

Responsive

Good

Updated 1 March 2019

  • The service used initiatives, such as weekend clinics, appointments at short notice and pre-requesting scans, to ensure patients were seen and treated in a timely manner.
  • All teams operated a duty service that could respond to emergencies and provide daily urgent assessments.
  • Teams took a multi-disciplinary approach to triaging referrals. This ensured urgent referrals were identified and offered assessments in a timely manner.
  • The service responded to patients’ individual needs. Patients with functional conditions could be referred to community mental health teams for working age adults. Likewise, patients under 65 would be supported by the service in cases such as early onset dementia.
  • Staff were proactive in engaging patients who were reluctant to use the service. The service operated out of satellite sites to support patients from rural areas.
  • Many areas of Kent were dementia friendly communities and provided many opportunities for patients, and their carers, to engage with the wider community. The service supported the concept of patients supporting each other.
  • The service used feedback from complaints and compliments as learning opportunities. Patients and carers were aware of how to complain and were supported by the service to do so.

However;

  • Some interview rooms used by the Maidstone team did not provide adequate soundproofing to ensure patients privacy and confidentiality was maintained.
  • Areas that were accessed by patients did not always have appropriate dementia friendly signage and features. Some sites did not provide adequate parking for people with disabilities.
  • Due to commissioning arrangements, most areas of the trust were unable to provide a crisis service for patients with a diagnosis of dementia.
  • In some teams, patients were experiencing excessive waiting times for neuropsychology assessments.

Well-led

Good

Updated 1 March 2019

  • The service had experienced senior managers and team leaders who staff felt were supportive and approachable. They supported staff to following their clinical interests and achieve career progression.
  • Staff enjoyed their jobs and felt supported by their colleagues. We observed hard working staff throughout the service working in friendly environments. The service had sickness rates and staff turnover rates lower than the trust average.
  • The service maintained operational oversight through a well-structured schedule of meetings that communicated relevant information from the board down to front staff and vice versa.
  • Staff had access to an informative and user-friendly intranet site where they could access relevant information such as policies or trust bulletins. The general public similarly had access to a user-friendly internet site.
  • All teams were accredited, or in the process of applying for accreditation, to the memory service national accreditation programme.
  • The service involved themselves in projects to improve patient experience, such as improving dementia care in primary care and supporting GPs to make appropriate referrals

However;

  • Team managers were not consistently recording supervision on the trust’s database. This meant the board did not have accurate oversight of this area of clinical practice.

Checks on specific services

Services for people with acquired brain injury

Updated 30 July 2015

We rated the Knole Centre neurological rehabilitation ward for adults who require rehabilitation following an acquired brain injury or non-progressive neurological illness by Kent and Medway NHS and Social Care Partnership Trust (KMPT) as good because:

  • Staff received training that was specific to the needs of their patients to assist them deliver good care and treatment.

  • The ward had a system of governance in place to identify and monitored risks for patients. Staff learnt from incidents to ensure patient safety.

  • Patients could access psychological therapies as part of their treatment. The ward had a wide range of staff that came from professional backgrounds to support patients. The ward used appropriate clinical outcome scores to show patients progress was monitored by quantifiable measures. Staff produced a yearly outcome report for the trust.

  • Care plans were in place that addressed patients’ assessed needs and they were reviewed weekly by the staff team at the multi-disciplinary team meetings.

  • Staff received training in the use of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

  • Patients were treated with compassion, respect and dignity. They were positive about the way staff treated them. They were involved in the planning of their care. Their wishes and needs were integrated into their care plans.

  • Patient were admitted based on their clinical need and beds could usually be available quickly. Patient usually stayed for a twelve week period and could have week end stays at home.

  • There was a range of therapeutic activities available, on both an individual and a group basis. These included bespoke therapies like hydro therapy, exercise groups and walking practice.

  • Ward managers provided good leadership and were visible and accessible to both patients and staff.

  • The ward did not separate facilities for men and women, according to paragraph 16.9 of the Mental Health Act Code of Practice, and national guidance regarding the provision of same sex accommodation

  • Staff members did not have access to all parts of the ward. Staff members did not have keys to all the doors and used adapted objects such as coins to turn the locks. This presented as a potential risk to patients and staff in the event of a fire.

  • There were incidents where staff had not signed medication records to show that prescribed medication like thickening agents for patient’s food had been given to patients.

Community-based mental health services for older people

Good

Updated 1 March 2019

  • The team bases were safe for use by patients and staff.
  • Patients who were prescribed anti-psychotic medicine received regular monitoring of their physical health.
  • The service employed enough staff to meet the needs of the service. Staff felt supported by the trust, completed mandatory training, received supervision and had access to training opportunities.
  • Staff had manageable caseloads that were reviewed regularly. They completed detailed risk assessments and had support from the multidisciplinary team when their patients presented as high risk.
  • Staff had a good understanding of how to safeguard patients from abuse. They knew how to report incidents and were supported to gain learning from them.
  • Staff had access to a secure system where they could access and record information regarding patients’ care and treatment. Staff could to access this system remotely to record important updates and support their time management.
  • Staff carried out comprehensive assessments of patients’ needs and completed detailed care plans that addressed these identified needs.
  • The service employed clinical psychologists and occupational therapists who provided a range of interventions to improve treatment outcomes and promote independence.
  • The service had good links with internal and external agencies where patients, and their carers, could get support with social, dietary and physiological needs.
  • The service carried out a programme of audits around clinical documentation and physical health monitoring of patients on anti-psychotic medicine.
  • Patients, and their carers, were universally positive about the care and treatment they received. Staff knew their patients and treated them with compassion and respect.
  • Patients, and their carers were fully involved in decisions about their care and treatment. The service offered them exceptional support in the early stages of their diagnosis.
  • Admiral nurses supported families with all aspects of living with dementia. Healthcare assistants instilled hope in families by introducing them to emotional and practical support.
  • The service actively collected feedback, from patients and their carers, about their experiences of the service. Responses received were extremely positive.
  • The service was proactive in ensuring referrals were appropriately triaged and patients were seen and treated in a timely manner. All teams provided a duty service that could respond to emergencies.
  • The service responded to patients’ individual needs. Patients had a choice in what services they received support from. It was proactive in engaging patients and provided satellite sites to support patients from rural areas.
  • The service promoted dementia friendly communities and supported the concept of patients supporting each other. The service used feedback from complaints and compliments as learning opportunities.
  • The service had experienced senior managers and team leaders who staff felt were supportive and approachable. Staff enjoyed their jobs and felt supported by their colleagues.
  • The service maintained operational oversight through a well-structured schedule of meetings. Staff had access to an informative intranet site and the general public similarly had access to a user-friendly internet site.
  • All teams were accredited, or in the process of applying for accreditation, to the memory service national accreditation programme. The service involved themselves in many innovative projects to improve patient experience.

However:

  • Staff reported the current risk assessment template on the trust’s electronic care record system did not cover all risk areas common to older people with mental health issues. They also told us this same system could be hard to access, or respond slowly, during busy times.
  • The service did not have a consistent approach to some areas of clinical practice, such as recording supervision; measuring outcomes for patients who attended groups; and recording patients’ capacity or consent to treatment.
  • Due to commissioning arrangements, most areas of the trust were unable to provide a crisis service for patients with a diagnosis of dementia. Some teams were experiencing excessive waiting times for neuropsychology assessments.
  • Some interview rooms did not provide adequate soundproofing to maintain patients’ privacy and confidentiality. The service did not always have appropriate dementia friendly signage and features and some sites did not provide enough parking for people with disabilities.

Mental health crisis services and health-based places of safety

Good

Updated 1 March 2019

  • Teams were comprised a multi-disciplinary team of mental health professionals including psychiatrists, nurses, support workers, support, time and recovery workers, and occupational therapists. All services had access to a Mental Health Act Administrator.
  • The teams felt fully supported and spoke consistently of an open, caring culture. There was a clear management structure in place. Teams had direct management from an operational and clinical lead, who were supported by senior leaders in the trust, and all sites had access to a consultant psychiatrist when needed. The 136 suites had a dedicated clinical lead who supported the staff working there.
  • Overall, mandatory training was 95% compliant, well above the target of 85%.
  • Staff managed risk well and there were effective processes in place. All services had up to date risk registers and staff knew how to access this and add to it. All staff had received recent training in safeguarding and all staff that we talked with were aware of the safeguarding reporting process. Staff received appropriate debriefs following incidents.
  • All the teams had good medicines management practices, which were regularly audited. Each team had at least one medicines lead.
  • Managers undertook regular audits to ensure processes were effective. Meaningful learning was shared within and across teams to improve practice.
  • People told us staff involved them in their care and treatment, and we witnessed staff completing care plans with patients. We saw evidence that all patients had been offered a copy of their care plan. Patients were given an information pack on their first meeting with the crisis teams, informing them of treatment and support services, how to complain and how to access advocacy.
  • The teams were committed to equality and diversity and each team had an equality and diversity lead. All 136 suites were accessible for people with disability or mobility issues.
  • None of the crisis teams had waiting times which meant people were seen without delay.
  • Staff told us about the different ways they tried to provide personalised support, such as matching staff with similar hobbies to people who were unwilling to engage and scheduling visits around school hours for people with children.
  • The services had good working relationships with other organisations including the police, ambulance services and local authorities, with regular joint meetings and appropriate information sharing.
  • There were effective handovers and multi-disciplinary meetings to share information and issues constructively. These were also a forum for learning from complaints, compliments and incidents and sharing good practice.
  • Staff understood and were very positive about the values of the trust and could tell us how they incorporated the values into their work with patients.

However;

  • Though overall mandatory training compliance was above the trust’s target at 95%, some staff had not received mandatory training in all the key areas identified as essential to their role. Immediate Life Support training compliance was low at 66%, though the trust was taking action to improve this.
  • Although most of the risks from blind spots had been addressed since the last inspection, the bathroom at the Dartford health based place of safety still had a blind spot. This meant staff could not be assured of patient’s safety at all times in this area.
  • The S136 rights leaflet being given to patients detailed a maximum detention period of 72 hours and not 24 hours which did not reflect changes in legislation in 2017.

Community-based mental health services for adults of working age

Good

Updated 1 March 2019

  • During this inspection, we found that services had addressed many of the issues that caused us to rate it as requires improvement following the January 2017 inspection. And that the concerns raised in the warning notice, issued in February 2018, which remained after the follow-up inspection of May 2018 had been addressed. Staff were recording and reviewing patient risks and updating these if there had been a change in the patient’s circumstances. The duty service was provided by dedicated staff working solely on this function and that patients were no longer allocated to duty workers. The trust had embedded the buddy system which ensured that care co-ordinators had a named team colleague to cover supporting their caseload when they were absent.
  • Staff caseload sizes had reduced to around 40 patients per worker which meant that staff were able to adequately manage the needs of the patients they were supporting. Team leaders were regularly reviewing the caseloads with staff.
  • We reviewed 40 care records of patients in six teams and found that staff were completing a risk assessment upon initial assessment and regularly reviewing this and updating it after any patient incident. The teams had a duty system to respond to changes in risk or deterioration in the mental health of patients.
  • Staff could access a consultant psychiatrist for routine or urgent appointments and urgent medical advice.
  • Staff had completed safeguarding training and demonstrated a good awareness of safeguarding issues. Despite the changes in the role of social care staff, the pathway to register and investigate safeguarding concerns remained straightforward.
  • All staff knew how to report an incident on the trust’s reporting system. We saw that the learning from serious incidents was shared and discussed in the team’s multi-disciplinary team meeting.
  • The patient records that we reviewed contained comprehensive needs assessments. These were person-centred, holistic and recovery focused. Care plans reflected patient’s assessed needs and recorded risks.
  • Staff monitored the effects of medicine on the physical health of patients and reviewed this regularly in physical health clinics. Staff were using recognised scales to rate the severity of symptoms and monitor patient outcomes.. Staff offered a variety of treatment options to people including National Institute for Health and Care Excellence approved interventions such as access to cognitive behavioural therapy, and physical health monitoring for patients prescribed high dose anti-psychotic medicines.
  • All teams were multidisciplinary and had good relationships with other teams within the trust. We saw evidence of regular communication and joined up working between the inpatient and community mental health services. This ensured that patients had a smooth transition between services.
  • We saw evidence in patient notes of the involvement of people in their care planning. Care records showed that staff discussed care plans with patients and offered them a copy of their care plans.
  • Patients told us that staff helped them understand their conditions so that they could learn ways of managing these more effectively. Staff were encouraging and optimistic with patients and supported them with positive choices such as smoking cessation.
  • Staff provided patients with information about how to make a complaint and patients told us that they knew the process, and were confident raising concerns and complaints.
  • All services had a range of rooms to see patients, including clinic rooms. These were adequately sound-proofed to ensure confidentiality. Waiting areas had a range of information on local community groups, advocacy, and leaflets on mental health conditions and treatments.
  • There were clearly defined roles for team leaders and service managers within the six teams we inspected. Team leaders were receiving regular information about the team’s performance. The team leaders displayed a good understanding of the service they were providing and where it connected with the wider mental health pathway.
  • The trust had developed a clear operational identity for the community teams. A Day in the Life of a Community Mental Health Team provided clear guidance to staff in how to deliver community mental health team processes to agreed standards.
  • Staff we spoke with said that the services had improved. Staff could raise concerns and felt positive about their teams despite the pressure of recent changes regarding the integration of social care colleagues. Staff felt well supported by their team managers and colleagues.

However;

  • There were issues with the recording of fridge temperatures at the Canterbury and Coastal team and the clinic room at Dartford, Gravesend and Swanley was very hot in summer months.
  • Patients at the Dartford, Gravesend and Swanley team sometimes faced excessive waiting times when trying to contact the team by telephone.
  • Trust data showed that staff were not receiving supervision at the frequency of the trust’s supervision policy which was every six weeks. Several teams’ recent supervision rates were 60% or lower. The trust acknowledged that supervisions had been missed as a high number of team leaders had been absent and the trust had implemented a series of actions for managers to improve the supervision rates and monitor the delivery of supervision.
  • Not all the teams were meeting the trust target time of 28 days to initial assessment for newly referred patients. The total service reported seeing 73% of patients referred within 28 days. Performance had dropped as low as 46% in the Thanet team.
  • Patients were waiting a long time for access to psychological therapies in some teams. There were 30 patients at Thanet and 39 patients at Dartford, Gravesend and Swanley teams who were waiting over 30 weeks for treatment to start. The patients on the waiting list were not routinely reviewed by psychological therapy staff.

Forensic inpatient or secure wards

Outstanding

Updated 1 March 2019

  • We rated the service good for safe, effective and responsive care. We rated caring and well led as outstanding.
  • The psychology team led a restorative justice programme within the service, which had become embedded within the culture of the wards. The psychology team trained staff in the application of restorative justice and wards had a nominated restorative justice champion. The focus of the first year of the programme had been to assist staff to resolve issues between patients.

  • The Allington Centre was in the process of applying for a quality mark accreditation with the restorative justice council. The psychology team worked jointly with National Health Service and international partners for the ongoing development of the programme and to collectively apply for an international research grant.

  • All wards in this core service were engaged with the quality network for forensic mental health services, operated by the Royal College of Psychiatrists. They gained accreditation by demonstrating that they met a certain standard of best practice in their area.

  • There was a strong culture of respect, in which staff demonstrated their “patients first” ethos. Staff adopted a person-centred approach to care delivery and had worked to promote equality and diversity to patients. Patients spoke very positively about the way staff treated them. We observed caring, respectful and supportive interactions between staff and patients.

  • Staff were knowledgeable about their patients and worked hard to develop good relationships with them. Patients told us they enjoyed regular ward events, including those where patients and staff jointly prepared and ate a meal together.

  • The service had an experienced, supportive and approachable management team. Staff felt highly engaged and valued. They spoke with pride and passion about their work. Managers utilised the skills and interests of staff to enhance the experience of patients and staff alike. Some staff had been given ‘champion’ roles within their team, leading in an area such as healthy eating or exercise.

  • Patients were actively involved in care planning and in making decisions about their care. Patient experience surveys were used with the aim of improving services for patients. There were regular community meetings on every ward and a patient council.

  • Patients moved between the medium secure wards and the low secure ward when clinically indicated. Staff supported patients when they were moving to another ward or preparing for discharge from the hospital. Multidisciplinary and management team members from both hospital sites met once a week at a referrals meeting, to discuss planned and potential patient admissions, discharges and moves within the service.

  • All families and carers were offered an initial engagement meeting with the patient’s consent. Patients led the production of a quarterly report about their progress, to be shared with relatives and carers of their choosing. The trust had a family and engagement lead, who worked to ensure families and carers were included where the patient wanted them to be. There were regular engagement events and an annual survey.

  • Some patients held voluntary jobs within the local community, including at the Lakeside Lounge Café on the Trevor Gibbens Unit campus. Patients could access educational courses during their time as an inpatient. Patients had access to agricultural activities on both the Trevor Gibbens Unit and Allington Centre sites.

  • Patients had good access to physical healthcare and a range of psychological therapies. The psychology team individually assessed each patient and formulated their personalised therapeutic plan. They provided sessions in trauma work, relapse prevention and substance misuse. The offenders group programme had three strands, namely: violence, fire setting and sexual offending.

  • Staff completed mandatory training necessary to do their jobs. Staff teams met regularly, to share information and learning from incidents. Staff were debriefed after incidents and received support from managers and members of the psychology team. Staff used specialist risk assessment tools to assess the risks posed by each patient and used seclusion and restraint only as a last resort. Patient care plans we looked at were consistently up to date, personalised, holistic and recovery oriented, incorporating patients’ strengths and goals.

However;

  • There were problems with the heating system on Walmer-Bedgebury and Emmetts-Bedgebury wards. On Walmer-Bedgebury ward (particularly the large communal area) could become uncomfortably cold at night, during winter months. Some areas of Emmetts-Bedgebury ward were cold. We reported these concerns to the service management team who took urgent action to begin addressing the issue.

  • The patient control for bedroom door viewing panels was not working in most bedrooms on the wards at the Trevor Gibbens Unit.

  • The lounge area on Emmetts-Bedgebury ward was located down several steps, adjacent to the ward’s central dining area. This meant that anyone with restricted mobility would find it difficult to move between the two portions of the room. The trust informed us that they planned to resolve this issue, in likelihood by installing a ramp between the lounge and dining areas.

  • The service did not meet the trust’s targets for completion of staff appraisals and clinical supervision with some wards significantly below the trust target.

  • The female portion of Bedgebury unit had only a small concrete yard allocated to it. The trust had a plan to develop a more inviting garden space for the unit.

  • Some patients at the Trevor Gibbens Unit expressed dissatisfaction with their food, for example at the size of portions. The trust had recently agreed a contract with a new food provider who was due to start supplying the wards in November 2018.

Wards for older people with mental health problems

Updated 12 July 2018

We carried out a focused inspection of Jasmine ward on 17 April 2018, following concerns we had received through intelligence monitoring, a Mental Health Act review visit and from carers and relatives of patients. Concerns included poor monitoring of the physical health of patients and of their state of nutrition and hydration and staff’s response to patients whose physical health was deterioration of, poor risk management, the safety of the ward environment and lack of family and carer involvement. The ward was last inspected in January 2017 as part of a comprehensive inspection. At the comprehensive inspection, we rated the wards for older people with mental health problems as ‘good’ in all key lines of enquiry of safe, effective, caring, responsive and well led.

During this inspection, we found the following areas of good practice:

  • The ward had implemented a safe transfer to A&E protocol which was a collaboratively designed by both staff on Jasmine ward and the general hospital. This meant patients were not left waiting in unfamiliar surroundings which could add to their distress. Staff on Jasmine ward had developed strong links with specialist services.

  • For patients with functional mental illness, staff were in the process of developing a tool and pilot to the use of ‘one-page profile’ was due to commence. The trust had a drive for a person-centred culture and to help reduce stigma, staff were also completing their own ‘one-page profile’.

  • Risk assessments and risk management plans were fully completed and detailed. Staff carried out risk assessments with patients, who had mental capacity to engage with this, within 72 hours of admission to the ward and regularly throughout their care and treatment.

  • The trust had undertaken work to the ward environment to enable patients living with dementia. Toilets had red seats to contrast with the wall and floor. The use of clear colour contrasts on the ward helped define important aspects of the environment.

  • Staff were aware of safeguarding procedures and protecting patients from abuse. Improvements to safety, mitigation of future risk and learning from incidents was evident. We saw evidence of changes made because of incidents.

  • Staff carried out a range of assessments with patients on admission to the ward and throughout their care and treatment. Patients were involved in their care and had individualised care plans to support all areas of their recovery. All patients had a comprehensive physical health assessment. Physical healthcare needs were incorporated into care plans and were comprehensive and detailed.

  • The multidisciplinary team had regular handovers and clinical meetings to ensure they were providing consistent evidence based care to patients. They delivered patient-centred care that was open, transparent, and inclusive of the individual.

  • Staff were supportive and respectful towards patients and displayed a genuine interest in their recovery.

  • Compliments and complaints were uploaded to datix and analysed by the trust complaints team.

However, we also found the following areas for improvement:

  • The door to main entrance of the ward was a known concern to staff and the trust. The door did not close securely and staff had to ensure they checked when entering or exiting the ward that it was secured. However, proposed building works were in the planning stages.

  • There was no de-escalation room on the ward. This meant that when patients were displaying signs of distress, agitation or unsettled behaviour, there was no designated space available to offer a calming, safe and low stimulus environment.

  • The ward had some ligature risks present in the communal areas and patients’ bedrooms. Although these were identified on the ligature audit, they were assessed as no risk present and because of this no action was taken or considered to mitigate risk. We brought this to the attention of the ward manager and immediate action was taken by the trust.

  • There was no direct provision of physiotherapy for patients on the ward, unlike some of the trusts other older persons inpatient wards. However, patients could be referred to physiotherapy at the local hospital.

Wards for people with a learning disability or autism

Outstanding

Updated 12 April 2017

We rated wards for people with learning disabilities or autism as outstanding overall because:

  • At this inspection, we found the trust had made improvements to the quality and safety of the service and care and treatment given to patients. We have rated each domain as outstanding.

  • There was a truly holistic approach to assessing, planning and delivering care and treatment to patients. Care plans were comprehensive, personalised and recovery oriented with clear goals set to support patients through their care and treatment pathway.

  • A proactive approach to anticipating and managing risks to patients was embedded, recognised, and owned by all staff. Patients and their carers were actively involved in managing their own risks through the use of risk assessment tools and worked collaboratively with staff.

  • All patients had a detailed positive behaviour support plan in place. Staff applied effective proactive strategies to de-escalate or prevent patients challenging behaviour and applied reactive strategies when needed as per patients positive behavioural support plans.

  • Staff were focused on the use of preventative approaches and de-escalation with minimal use of all restrictive interventions. Staff used de-escalation or positive behaviour support proactively. Between 1 April 2016 and 30 September 2016, there had been no episodes of restraint or rapid tranquilisation across the service.

  • All patients had a comprehensive physical health assessment. The service had fully implemented the use of ‘The Lester Adaptation Tool’. Physical healthcare needs were incorporated into patients’ care plans and were comprehensive and detailed.

  • There was a continued drive by the clinical team tried to reduce the use of medications. Patients from wards for people with learning disabilities or autism were not on any high dose antipsychotic medication or multiple medications for psychosis.

  • Occupational therapists worked with patients to formulate intervention and treatment plans. All patients had access to an extensive activities programme that was individual and therapeutic. Each patient’s treatment programme was tailored to their individual needs.

  • Patients had access to a wide range of evidenced based psychological therapies as recommended by the National Institute for Care and Excellence as part of their care and treatment delivered on a one to one or group basis.

  • The service was discharge oriented and committed to achieving a sustained reduction in the number of patients admitted to the wards. Staff undertook thorough pre-admission assessments, to ensure only patients who could not be managed in the community were admitted to the wards. Pro-active discharge planning took place from the point of admission. The service worked in conjunction with the patient and partner agencies to facilitate discharge as soon as was safely possible.

  • Staff were encouraged to review practice and actively engaged in activities to monitor and improve patient outcomes.

  • Patients spoke very highly of the staff and the quality of care they received. They told us that staff were caring and supportive and they felt empowered as partners in their care. The service ran a number of projects to engage and support relatives, friends and carers.

  • Staff were open and transparent, and fully committed to reporting all incidents and near misses. All staff were engaged in reviewing and improving safeguarding systems across the service to ensure improvements in safety and a continuous reduction in harm and abuse. Learning was based on thorough analysis and investigation.

  • Staff were passionate about their work and were clearly very proud about the wards they worked on. Staff felt valued by the trust and there was high staff morale across the service.

  • Staff from the multidisciplinary team worked in equal partnership and clearly respected and values each other’s decisions. Staff continuously demonstrated they were motivated and dedicated to deliver the best care and treatment they could for patients.

Long stay or rehabilitation mental health wards for working age adults

Outstanding

Updated 12 April 2017

We rated the long stay/rehabilitation mental health wards for working age adults as outstanding because:

  • All six of the rehabilitation units were clean, well maintained, and without exception patients told us that they felt safe.

  • The service model optimised patients’ recovery, comfort and dignity. The patients’ care plans were robust, recovery focussed and person centred. There was a clear care pathway through the service with associated treatment and therapy options. The recovery star approach was firmly embedded and used in all of the rehabilitation units. Some units used this as the basis for planning care needs. There was a varied, strong and recovery-orientated programme of therapeutic activities available every week in each of the units. Patients had an excellent level of access to a wide variety of psychological therapies either on a one to one basis or in a group setting. All patients and staff told us that the ability to self-cater enabled them to gain vital knowledge and skills in preparation for their discharge and more independent living.

  • There were enough suitably qualified and trained staff to provide care to a very good standard. Staff had the skills to deliver high quality care and treatment. Throughout the rehabilitation units the multidisciplinary teams were consistently and pro-actively involved in patient care and everyone’s contribution was considered of equal value.

  • Staff managed risk well. They made and recorded robust risk assessments. Staff were confident in how to report incidents. They told us about changes they had made to service delivery as a result of feedback following incidents. Lessons learnt were shared across all of the rehabilitation service.

  • There was evidence of best practice in the application of the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). All staff we spoke with had a good understanding of the MHA, the MCA, Deprivation of Liberty Safeguards (DoLS) and the associated Codes of Practice. The majority of the units cared for people detained under the MHA, where units had no patients currently detained, we looked at records retrospectively.

  • The staff were kind, caring, passionate about their work and involved patients fully in decisions about their care. We saw good, professional and respectful interactions between staff and patients during our inspection. Staff showed patience and gave encouragement when supporting patients. We observed this consistently throughout the inspection. Patients told us that they were the priority for staff and that their safety was always considered. The atmosphere throughout the units was very calm and relaxed. Staff were particularly patient focussed and not rushed in their work so their time with patients was meaningful. Staff were able to spend time individually with patients, talking and listening to them. We did not hear any staff ask a patient to wait for anything, after approaching staff. We saw evidence of initiatives implemented to involve patients in their care and treatment. Patients told us that the staff across the rehabilitation service consistently asked them for feedback about the service and how improvements could be made. The service was particularly responsive to listening to concerns or ideas made by patients and their relatives to improve services. We saw that staff took these ideas into account and used them when they could.

  • All staff had good morale and they felt well supported and engaged with a visible and strong leadership team, which included both clinicians and managers. Staff were motivated to ensure the objectives of the trust and the service were achieved.

  • Governance structures were clear, well documented, followed and reported accurately. There were controls for managers to assure themselves that the service was effective and being provided to a good standard. Managers and their teams were fully committed to making positive changes. We saw that changes had been made to maintain improvements in quality through the use of audits. The service had clear mechanisms for reporting incidents of harm or risk of harm and we saw evidence that the service learnt from when things had gone wrong.

  • We inspected these services previously in March 2015 and not all the essential standards were met. The rehabilitation wards were rated as inadequate in the safe domain. During this inspection visit we found that considerable improvements had been made in these areas and the essential standards had now been met.

However:

  • The provider should consider the skill mix of qualified and non- qualified posts as staff commented that there is little career progression opportunity from Band 5 to Band 6 nurses and from Band 3 to Band 4 support workers.

  • The provider should consider whether all staff should wear personal alarms at all times on the wards.

  • The provider should review which team is responsible for up-loading care programme approach review meeting minutes on to the electronic care record system. Currently the community mental health teams are responsible and the compliance % is under target. The staff at the rehabilitation units have expressed an interest in taking this task over to ensure the target is met.

Community mental health services with learning disabilities or autism

Good

Updated 12 April 2017

We rated community-based mental health services for people with learning disabilities as good because:

  • We looked at ten care records for people who used the service. All of these included a risk assessment and all records had been reviewed recently. The trust, in collaboration with partners, had developed the complex care response procedure across the teams which meant people who used services could receive a same day assessment of risk to reassess needs in order to prevent any further deterioration of mental state, which may have resulted in a hospital admission. Comprehensive assessments were documented in each of the care records we reviewed and were carried out at the person’s first appointment. All of the care records we reviewed had care plans. People’s needs were assessed and care was delivered in line with their individual care plans. Assessments were completed in a timely manner and the care plans were detailed, personalised, focused on maximising independence and holistic. All of the records we looked at had a health action plan included.

  • The teams were situated in buildings that were clean and well-maintained. There were clear protocols available to guide staff on how to respond should an alarm be activated on site and staff we spoke with were able to describe the response guidance.

  • There were sufficient staff to deliver care to a good standard and the staffing rotas indicated that there were sufficient staff in each of the teams. Staff we spoke to understood the vision and direction of the organisation. Staff felt part of the service and were able to discuss the philosophy of the service confidently All of the staff we spoke with were highly satisfied working in the service. The senior management team held monthly leadership forums where senior clinicians and managers came together from the service line and discussed, for example, the quality of service provision and service developments.

  • People who used services told us they were supported well to live safely in the community and that their needs were met, including if they needed additional support. The teams offered a treatment model based on individual care and treatment pathways. People were supported through transitions between services, for example from children’s services to adult or from inpatient services to the community. People were involved in drawing up information to accompany them in their move. We observed interagency working taking place. Staff created strong links with primary care, the learning disability community teams, mental health acute inpatient services, social services and residential care homes being particularly positive examples.

  • All of the people we spoke with and their relatives and carers complimented staff providing the service across the teams. People who used the service told us that they were treated with compassion, dignity and respect and that they were supported to make their own choices in their daily life. Staff we spoke with showed they knew the people who used services well. Staff told us confidently about their approach to people who used services and the model and philosophy of care practiced across all of the teams. They spoke about the emphasis they put on ensuring any treatment or support interventions were individualised and centred on the person and co-produced with them and their family or carer. Staffs’ approach was person centred, highly individualised and recovery orientated. People or their representatives told us they were fully involved with every aspect of their treatment and care planning.

  • Key performance indicators and performance data was available to staff relating to waiting times from referral to assessment and onto treatment. Information on performance in key areas was collated and summarised by senior managers and published monthly. Staff participated in clinical audits to monitor the effectiveness of services provided. They evaluated the effectiveness of their interventions. The teams carried out audits against the National Institute for Health and Care Excellence (NICE) guidelines on promoting good health and preventing and treating ill health for people with learning disabilities and autism. Staff told us that they received feedback from incident investigations in regular team meetings and that they learnt key themes and lessons and developed action plans if they needed to make changes.

  • People who used services and their families we spoke with all knew how to make a complaint, should they wish to do so. This included how to contact the Care Quality Commission. Staff confidently described the complaints process and how they would handle any complaints.

However:

  • All relevant documentation about care planning was not filed in the care planning section of the electronic care records which made it difficult to locate information in a timely manner.

  • There were 15 people waiting up to a year for psychology. We had concerns about psychology waiting lists during our inspection in 2015 and on this inspection we found improvements had been made however some people assessed as low risk were having to wait up to a year. These people were being supported by other community services and told to contact the mental health team should there be any concerns.

Acute wards for adults of working age and psychiatric intensive care units

Requires improvement

Updated 12 April 2017

We rated acute wards for adults of working age and psychiatric intensive care units as requires improvement because:

  • Cherrywood ward at Littlebrook Hospital was not complying with guidance on same-sex accommodation.

  • Patients’ bedrooms on the psychiatric intensive care unit, Willow Suite, contained multiple ligature risks.

  • Some areas of the service had excessive vacancies and relied heavily on bank and agency staff. Some staff did not meet the trust’s target for completion of mandatory training or have access to regular supervision.

  • Patients’ risk assessments were not always reviewed or updated following risk related incidents. Episodes of patient being secluded were not always recorded in line with the trust’s seclusion policy.

  • Patients’ care plans did not always address a full range of needs; were not always recovery focussed and patient involvement was not always recorded. Psychological assessments or treatment was not available to patients on the psychiatric intensive care unit, Willow Suite.

  • Staff did not always have sufficient knowledge of the Mental Health Act Code of Practice and the Mental Capacity Act. Documentation was not always completed in line with these Acts.

  • Staff were not always using systems in place to document and monitor when patients were taking Section 17 leave.

  • The trust’s no smoking policy was presenting issues for patients and staff. These included episodes of physical aggression, inconsistencies in following the policy, and increased risks of patients smoking in bedrooms. Patients’ outside areas were not always accessible or therapeutic.

  • Some managerial decisions had been counter-productive. These included salary incentives that excluded some staff; lack of clarity on wards providing same-sex guidance; and inconsistencies in following the no smoking policy.

However:

  • All wards had clinic rooms and emergency medical equipment for staff to respond to medical emergencies. Seclusion rooms were equipped in accordance with the Mental Health Act Code of Practice.

  • All ward environments were clean and well-maintained with systems in place that ensured environmental issues were identified promptly. Patients and staff had access to alarm systems to ensure they could summon support if they felt at risk.

  • Staff had good observation systems in place to ensure that patients were kept safe. Staff were able to manage distressed patients safely. They had access to calming rooms and only used restraint as a last resort. Staff received restraint training that eliminated the need to restrain patients in a face down position.

  • Staff had a good understanding of the processes of incident reporting and raising safeguarding issues. The service regularly discussed incidents and learnt from them.

  • Patients received ongoing monitoring of their physical health needs from registered general nurses who were trained in recognising physical health concerns. The service received support from pharmacists to ensure that medicines were managed effectively.

  • The service had recently introduced therapeutic staffing. This model integrated occupational therapists and psychologists into staff teams and provided patients with a wider range of structured activities seven days a week.

  • Staff had regular meetings and handovers where they discussed patients’ care needs in detail.

  • Staff treated patients with dignity and respect. Staff had a good understanding of patients’ needs and listened to their views. Patients had access to recovery groups that encouraged them to maintain their independence. The service was committed to involving families and carers.

  • The service employed discharge facilitators to address issues preventing discharge. In the last six months the service had significantly reduced its use of private beds. They also employed dedicated staff to improve patients’ access into the trust’s psychiatric intensive care unit.

  • Patients had access to a wide range of therapy rooms and activities which were available seven days a week. Patients were able to access their bedrooms during the day and had access to mobile phones and rooms to see visitors in private.

  • All wards displayed a wide range of patient information including how to complain. Patients knew how to complain and staff knew how to manage complaints. Patients could access interpreters and chaplains and were provided with information on local services.

  • Staff knew the trust’s vision and values and agreed with them. They enjoyed their roles and morale was generally high. Staff felt supported by managers and colleagues and had opportunities for career progression.
  • Ward managers had effective governance systems to enable them to monitor training, supervision and staffing levels. Staff had the use of effective systems to record incidents and safeguarding issues.

Substance misuse services

Outstanding

Updated 12 April 2017

We rated substance misuse services in Kent and Medway NHS and Social Care Partnership Trust as outstanding because:

  • Bridge House was exceptionally clean and well maintained and without exception, patients told us that they felt safe. The ward was well equipped and fixtures and fittings were provided to a high standard.

  • There were enough suitably qualified and trained staff to provide care to a very good standard. The provider employed some staff with lived experience of addiction which further enhanced the skill mix and diversity of staff available. Skilled staff delivered care and treatment. Throughout the ward the multidisciplinary team was consistently and pro-actively involved in patient care and everyone’s contribution was considered of equal value.

  • We found that patients’ risk assessments and care plans were robust, recovery focussed and person centred. The assessment of patients’ needs and the planning of their care was thorough, individualised and recovery focused. Staff considered and met the needs of patients at all times.

  • Staff were confident in how to report incidents and they told us about changes they had made to service delivery as a result of feedback following incidents.

  • All patients received a thorough physical health assessment by both the consultant and a nurse on admission to the ward and staff identified and managed risks to physical health. Patients had an excellent level of access to a good variety of psychological therapies either on a one to one basis or in a group setting. The service model optimised patients’ recovery, comfort and dignity. There was a clear care pathway through the service with associated treatment and therapy options. The patient successful completion rate for the detoxification programme was over 96% during the preceding year. There was a varied, strong and recovery-orientated programme of therapeutic activities available every week. Aftercare for all patients was arranged before admission to Bridge House. This included aftercare in the community with specialist teams or longer term residential rehabilitation. The ward offered ex-patients and their families and friends the opportunity to contact staff for support and/or information after discharge

  • Staff interacted with patients and their approach was kind, respectful and professional at all times. Staff continually interacted in a positive and proactive way. The atmosphere was really welcoming, friendly and warm. Staff were particularly enthusiastic, dedicated and motivated by their work. Staff spoke respectfully about their patients at all times and demonstrated an excellent understanding of their issues with a non-judgemental approach.

  • The trust carried out a monthly friends and family test, asking how likely a patient would be to recommend the services to family or friends if they needed similar care or treatment. All patients asked in December 2016 said they were extremely likely to recommend the service.

  • All patients and staff told us that the quality and range of food offered was of a high standard.

  • All staff had good morale and told us that they felt well supported and engaged with a visible and strong leadership team, which included both clinicians and managers. Staff were motivated to ensure the objectives of the organisation and of the service were achieved.

  • Governance structures were clear, well documented, followed and reported accurately. These are controls for managers to assure themselves that the service was effective and being provided to a good standard. Managers and their team were fully committed to making positive changes. Changes were carried out to ensure that quality improvements were made, for example through the use of audits. The service had clear mechanisms for reporting incidents of harm or risk of harm and we saw evidence that the service learnt from when things had gone wrong.

However:

  • Staff could not be sure that patients were able to securely store all of their possessions in their bedrooms as there were no locks on the doors.Although no patients or staff raised any issues or concerns about bedrooms doors not being lockable, we did consider that the security of patients’ belongings could be compromised.

Reference: not found

Updated 1 March 2019