Archived: Kent House Hospital

Updated 4 April 2022

Kent House Hospital is in Orpington in Kent and is one of the hospitals of Partnerships in Care Limited. The hospital is registered to provide the following regulated activities:

• Assessment of medical treatment for persons detained under the Mental Health Act 1983.

• Treatment of disease, disorder or injury.

The service provides low secure services to female children and young people aged 12 to 18 with mental health issues. The unit admits young people who frequently have complex needs and exhibit a high level of self-harming behaviour. The unit has 17 beds split across two wings. Previously, one wing was a rehabilitation wing, and the other was an acute care wing. However, at the time of our inspection both wings were providing acute care.

At the time of our inspection, the hospital had voluntarily paused admissions due to concerns around some quality issues, identified by themselves and commissioners. These were due to the gaps in reporting safeguarding concerns in a timely way, staffing and lack of leadership.

The hospital had developed an action plan to address these issues. From April 2022, the hospital planned to start increasing the number of admissions gradually, to full capacity by October 2022.

We previously inspected this service during June 2019. We rated the service as good overall.

On the day of our inspection, there were 10 young people receiving care at the hospital across the two wings – Pacific and Atlantic. At the time of our inspection, eight young people were being cared for on Atlantic ward and two young people were being cared for on Pacific. On Pacific one young person was being nursed in long-term segregation and the other young person was in isolation after testing positive for COVID-19. All young people were detained under a section of the Mental Health Act 1983.

At the time of the inspection, there was no registered manager in place. The service had appointed an experienced interim hospital director who was applying to become the registered manager of the service.

What people who use the service say

We spoke with five young people and their families. We received mixed feedback from young people about the quality of care they received. Young people said staff treated them well and behaved kindly. Young people specifically praised the support of the occupational therapist.

Most of the negative feedback we received was about the issues with staffing and the night staff always changing, which could be unsettling. Young people felt there was no consistency with frequently changing staff in how rules were consistently applied.

Four young people said they were given a copy of their care plans. One young person said that they needed to ask staff for a copy of their care plan, it was not offered to you.

Young people liked the quality of the food.

After the inspection, we asked the provider to supply us with the young peoples’ most recent satisfaction survey results. However, they could not provide these results for us to analyse.

Updated 4 April 2022

Kent House Hospital is a low secure independent hospital in the London borough of Bromley. It provides care and treatment to female children and adolescents with severe mental illness and additional complex behaviour.

We rated each key question as follows: safe as inadequate, effective as requires improvement, caring as good, responsive as requires improvement and well led as requires improvement.

Our rating of this location went down. We rated it as requires improvement because:

• The service did not have enough staff who knew the young people. There were 10 vacancies for registered nurses and 12 vacancies for non-registered nurses. The ward manager often stepped in to cover shifts when they were short staffed. The service used a high number of bank and agency staff. Some incidents that involved violence and aggression identified use of bank and agency staff as a factor. Young people felt there was no consistency with frequently changing staff in how rules were consistently applied.
• Ongoing vacancies for a clinical psychologist, social worker, occupational therapist and hospital director meant that some of the required specialists needed to meet the needs of young people were locums and changed frequently, which impacted upon consistency of care.
• Staff did not keep up to date with basic training to keep people safe from avoidable harm. Overall, mandatory training compliance for registered nurses fell below the provider’s 85% target. For example, Infection control, fire safety and the Mental Health Act. Managers did not ensure staff received specialist training for their role. Nursing staff had not received training in working in child and adolescent mental health services.
• Staff did not consistently record physical health checks. Some staff were not familiar with the Paediatric Early Warning System (PEWS) used by the provider to monitor physical health. There was a risk that staff could not safely identify when a young persons’ physical health was deteriorating.
• The ward environment required improvement. The service’s physical examination room was not clean. Staff did not consistently record the temperatures of the fridge in the clinic room. Some environmental risk assessments were not up to date and some bedrooms were not fitted with alarms.
• Improvements were needed in the reviewing of medicines incidents and devising treatment plans in relation to some medicines.
• Managers did not share lessons learnt with the whole team. Staff did not meet to discuss feedback and look at improvements to young people’s care. Staff could not provide examples of where they had learnt lessons after an incident.
• Improvements were needed to ensure that appropriate reviews took place for one young person being nursed in long term segregation. The service did not meet the needs of all young people – including those with a protected characteristic. Staff needed to improve how they supported young people with their gender identity.
• Staff were not responsive to young people’s feedback. Young people complained that they were often bored at weekends and during the evenings. This had been raised in the community meetings and to us during the inspection. Whilst there were plans for additional staffing to address this need, they were not yet in place.
• Staff did not always feel respected, supported and valued. The provider did not promote equality and diversity in daily work or provide opportunities for development and career progression. Staff did not always feel they could raise any concerns without fear.
• Our findings from the other key questions demonstrated that governance processes needed strengthening and that performance and risk management needed further embedding across the hospital. Staff did not keep an up-to-date risk register and action plan to reflect all the risks of the service. Staff did not complete audits of good quality and address the improvements needed.

However:

• Whilst the inspection identified concerns about the safety and quality of care of young people, senior managers within the hospital were aware of these. Senior managers were working with local stakeholders to develop and implement action plans to improve the service and keep children and young people safe.
• The service had limited the number of young people they were caring for to ensure the service was safe whilst improvements were made.
• Care plans were personalised, holistic and recovery orientated. Staff used the positive behavioural support (PBS) model to understand young people behaviours which challenge. The multidisciplinary team and young people contributed to their PBS plans.
• Staff had made improvements to outside space for young people. The courtyard had a gym, basketball court and gardening area with plants and flowers.
• Most staff treated young people with dignity and respect. Young people said staff treated them well and behaved kindly. Young people specifically praised the support of the occupational therapist. Staff supported patients to understand and manage their own care treatment or condition. We observed staff interacting with patients in a thoughtful way.
• Staff made sure young people had access to high quality education throughout their time on the ward. The on-site school was registered with Ofsted and rated as ‘Outstanding’ at their last inspection in June 2021. Staff encouraged young people to attend school, and this was part of their recovery journey. The teaching staff were involved with young people’s care and treatment at the hospital.
• Staff helped patients to stay in contact with families and carers. The service had a purpose-built bungalow for parents and carers to use when visiting. The young person could also stay with their family in the bungalow if it was suitable for them to do so.
• Whilst there had been changes in the leadership of the service, staff and parents reported that improvements had been made since the interim hospital director had been in post. These improvements included communication and a reduction in incidents of violence and aggression from young people.

Following the inspection we issued the provider with a warning notice due to the serious nature of the concerns we found on inspection. We asked the provider to take immediate action. We issued the provider with a warning notice because we were concerned the service did not have enough staff who were adequately trained to keep young people safe. The service needs to address this by 11 May 2022.

Updated 4 April 2022