The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: Kent House Hospital

Overall: Requires improvement read more about inspection ratings

Crockenhill Road, St Mary Cray, Orpington, Kent, BR5 4EP (01689) 883180

Provided and run by:
Partnerships in Care Limited

Important: The provider of this service changed. See old profile

All Inspections

19 & 21 January 2022

During a routine inspection

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.

15-16 July 2019

During a routine inspection

We rated Kent House Hospital as good because:

  • Ward environments were safe and clean. Staff assessed and managed the risks of the young people receiving care at the service. They ensured that the level of restrictive practice was proportionate to the risk of harm, managed medicines safely and followed good practice with respect to safeguarding young people.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the young people and in line with national guidance about best practice. All young people had detailed positive behavioural support plans in place, which staff consistently followed.
  • The ward teams included or had access to the full range of specialists required to meet the needs of young people on the wards. The ward staff worked well together as a multidisciplinary team and with education staff. Parents and carers were complimentary about the multidisciplinary team and how well they worked together.
  • Staff carried out their duties in line with the Mental Health Act 1983 and Mental Capacity Act 2005. Young people had access to an independent mental health advocate (IMHA).
  • Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service was well led, and senior managers ensured that governance processes were in place to have oversight of the service.

However,

  • Staff did not always record the monitoring of restricted toiletries on the unit to keep young people safe. This was of concern due to some previous incidents of young people swallowing items, such as a toothbrush.
  • The service had high staff vacancies, which it covered with regular agency staff. It was actively trying to recruit permanent staff.
  • Some parts of the hospital environment hospital were not therapeutic for young people, such as an outside courtyard space which was bare with no plants or flowers. There were plans to improve this.
  • Young people told us that a small number of staff did not always treat them with kindness and respect as they were rude in their manner. Parents/carers also told us that communication could be improved with ward staff.

4th - 8th May 2017

During a routine inspection

We rated Kent House Hospital as good because:

  • The hospital had addressed the issues that had caused us to rate safe as requires improvement following the October 2015 inspection.
  • At the previous inspection in October 2015, we found that staff had not carried out physical health checks on young people after they had been given medicines for rapid tranquilisation. At the current inspection, we found there was an improvement and physical health checks were being carried out after rapid tranquilisation had taken place
  • At the previous inspection in October 2015, we found that staff had not recorded the details of each patient restraint accurately and consistently. The service could monitor the use of restraint and ensure that it was being done as safely as possible. At the current inspection we found there was an improvement in the recording of incidents of restraint. Records were completed accurately and consistently and senior managers had good oversight of restraints.
  • At the previous inspection in October 2015, we found that patients and staff were not protected from the risk of infection. The kitchen was not clean and food items were not stored safely or used when fresh. At the current inspection we found that the kitchen and serving area were visibly clean; food was stored appropriately and was in date.
  • At the previous inspection in October 2015, we found that the provider was not ensuring that checks with the disclosure and barring service were being completed on new staff before they started working in a clinical area. At the current inspection we found that checks with the disclosure and barring service were being carried out for prospective staff before they began work at the service.
  • Care records were up to date, personalised and holistic. Each patient had a number of different care plans, which covered different areas of need, such as: communication, mental health and medication. Clinical assessments were carried out on the day of admission and further assessments of risk and physical health were done shortly after admission.
  • All patients had very detailed positive behaviour support plans. These were person centred with evidence that the young person had been involved.

  • Patients and carers told us that staff were friendly, approachable and kind. The independent advocate reported that staff were very focused on the needs of the young people and cared about them.
  • Families could stay in the purpose built family bungalow whilst visiting their family member.
  • The multi-disciplinary team consisted of a range of experienced professionals. Staff were positive about the multi-disciplinary team and how they worked together. Hospital staff worked closely with the hospital school. The service supported the young people to continue with their education, achieving positive results. School staff knew about the health needs of the young people and were part of the multi-disciplinary team.
  • The senior management team ensured that leadership, governance and culture were used to drive and improve the delivery of high quality person-centred care. They ensured that there was a culture of continuous improvement within the service. Staff demonstrated excellent commitment to quality improvement that would improve patient care.
  • The leadership team within the service promoted and prioritised safe, high quality, compassionate care. Staff felt supported to do their job and described staff morale as good despite being a challenging place to work. The culture on the wards was open and encouraged staff to bring forward ideas for improving care.
  • The service had developed an innovative psychotherapy treatment programme for young people with autism and mental health needs. This pathway aimed for young people to be able to understand their autism, how it affected them and other areas of their mental health. It assisted in supporting them to learn to manage their difficulties and prepare them for their future. The therapy team had recently won an award for this programme at a medical psychotherapy conference.

However:

  • Emergency medication and equipment that was available in the grab bags did not match the current policy of the provider. This was due to a new provider recently taking over. The senior management team were aware of this and were in the process of changing the pharmacy provision to ensure that the contents of the bags matched the policy.

27-29 October 2015

During a routine inspection

We rated Kent House Hospital as good because:

  • There were enough skilled staff to take care of the young people using the service safely.
  • Staff assessed the risks affecting the young people regularly and updated their risk management plans.
  • Staff understood safeguarding children procedures and knew when and how to make a referral to the local authority safeguarding team.
  • Patient care plans were detailed, person centred, individualised, age appropriate and recovery oriented.
  • Staff offered evidence based interventions and therapies and used recognised scales to measure the progress of the young people.
  • There was good multi-disciplinary working and the team had good relationships with local mental health teams and care co-ordinators, which helped promote the continuity of care.
  • The young people had positive opinions about the staff. They were involved in the development of their care plans and treatment decisions. Young people were also involved in the recruitment of new staff. They interviewed candidates and gave feedback to the manager on how they had performed.
  • The service was accessible to new patients and staff promptly assessed appropriate referrals. There was a wide range of facilities available to the young people and the service provided many different activities for them. There was a school on site with educational activities fully integrated into the service.
  • There were clear governance structures in place and managers received information on performance that supported the development of the service. Managers reviewed complaints and incidents in order to learn from them and prevent them happening again. Lessons learned were shared with staff. Staff felt able to raise concerns and were confident they would be listened to by managers. Staff apologised to people when things went wrong.

However,

  • Staff did not always carry out physical health checks on young people after they had given them medicines for rapid tranquilisation. This was contrary to local and national guidance.
  • The kitchen was unhygienic and dirty. Some food items were stored unsafely or past their use by date.
  • Staff did not record the details of each use of restraint consistently. This meant senior managers could not be sure staff were restraining young people as safely as possible, when this was needed.
  • Two staff had started work in a clinical area before appropriate checks with the disclosure and barring service had been completed. The hospital had conducted risk assessments and risk management plans were in place. However, it was not clear how closely these arrangements were being monitored.