Sittingbourne Memorial Hospital

Updated 19 October 2022

Sittingbourne Memorial Hospital is one of four locations within the North Kent business unit under HCRG Care Services Limited, who are an independent healthcare provider with over 5,000 staff nationally working in partnership with the NHS and local authorities.

Sittingbourne Memorial Hospital provides community adults services across the Swale boroughs in Kent, which align with the local Health and Care Partnership. After more than 10 years as part of the Virgin Group, Virgin Care rebranded as HCRG Care Services Limited in 2021 and was acquired by Twenty20 Capital.

The service registered with the Care Quality Commission in 2016. They are registered to provide the following regulated activities:

• Treatment of disease, disorder or injury
• Nursing care

Sittingbourne Memorial Hospital provides the following core services:

• Community health services for adults
• Community inpatient service

The community health services for adults operated across the whole of Swale area. They provided care and treatment for patients in their own homes and in clinics.

The teams at Sittingbourne Memorial Hospital consist of:

• Community cardiology service based at Kent Science Park worked Mondays to Fridays 8.30am to 4.30pm, and held clinics at the Sittingbourne Memorial Hospital, Sheppey Community Hospital, Castle Connections (Charity) in Queensborough and King George’s Pavilion (Park Avenue) on different days of the week.
• Community Matrons services based at the Kent Science Park, worked Mondays to Fridays 9am to 5pm. The also provided out of hours cover from 5pm to 8pm seven days of the week.
• Community Nursing teams worked from 8am to 8pm seven days of the week and held daily handover meetings between 1.30 and 3pm.
• Multidisciplinary Coordinator Service worked Mondays to Fridays 9am to 5pm across sites.
• Tissue Viability Service (TVN) and Wound Medicine Centre (WMC) worked seven days of the week with clinics on weekdays between 9am and 5pm.
• Community Diabetes Service based in Kent Science Park held clinics in Sittingbourne Memorial Hospital on Wednesday afternoons and Diabetes Education on some evenings.
• Community Respiratory Service based at Kent Science Park held clinics at the Sittingbourne Memorial Hospital on Mondays.
• Phlebotomy Clinic at Sittingbourne Memorial Hospital operated from 8am to 2pm Mondays to Fridays.
• Podiatry service based at Sittingbourne Memorial Hospital worked Monday to Friday 8.30am to 2.30pm.
• Speech and Language Therapy (SALT) teams worked virtually or in the community and clinics were held on demand. The service was available from 8.30am to 4.30pm Mondays to Fridays.
• Continence Service based at Kent Science Park worked virtually and provided continence service from 8am to 4pm Monday to Friday.

The community inpatient service, Kestrel ward, is a 22-bed rehabilitation ward. At the time of the inspection the ward had 17 patients. The ward had beds for patients with progressive and non-progressive neurological conditions who need more rehabilitation following discharge from an acute hospital. This may be following a stroke.

Rehabilitation is also provided for patients who are medically stable but need support to improve their independence. The service provided therapy, education and support enabling patients and their carers to achieve the best possible quality of life.

Kestrel ward worked on improving mobility, strength, independence in personal and domestic care tasks, cognitive ability, communication and language.

At the time of this inspection the service did not have a registered manager but they had submitted an application.

We had not inspected this location before.

What people who use the service say

Community health services for adults:

Patients and carers were very positive about the service, staff and the care and support they received. Patients told us the staff were very knowledgeable and experienced and they felt the care they provided was safe. Patients reported that staff were very kind and respectful and always addressed them by their preferred name. Some patients reported that they felt the staff were going over and above in the way they cared for them. While a majority of patients reported that the care and treatment met their needs, one patient told us they did not feel their needs were being met as the physiotherapy sessions often left them in pains days later

Community inpatient service:

People who used the service were positive about the care they received and the staff. They told us that they felt safe, that they were being helped to get better, that they were always treated with dignity and respect and that they felt involved in their care. They told us that staff were very responsive and friendly and they appreciated staff taking the time to spend with them. They told us that the cleanliness level of the ward was always very high. However, they gave negative feedback around the quality and quantity of food they received on the ward.

Updated 19 October 2022

We rated this location as good because:

• Staff understood how to protect patients from abuse, and managed safety well. All patients that we spoke with told us that they felt safe.
• Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Managers and staff gave us examples of recent lessons learnt from incidents and changes that had been made to prevent this from happening in the future.
• Staff across the services controlled infection risk well.
• The teams used systems and processes to safely prescribe and store medicines.
• Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. The patients we spoke with were happy with their care; one patient described the service as “excellent”.
• The provider planned care to meet the needs of local people and took account of patients’ individual needs. Patients we spoke to told us they felt confident to raise concerns about the care received.
• Leaders ran services well and staff felt respected and supported. They were focused on the needs of patients receiving care and clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However;

• Staff did not always ensure they kept up to date with their mandatory training. Some teams such as the community nursing teams, and speech and language therapy teams were not keeping up to date with their basic life support and anaphylaxis training.
• Team leaders across the core services did not always record clinical supervisions with staff. Although all staff we spoke to said they met regularly with their clinical supervisors and training and development educators, and these met their needs. Staff from the inpatient services told us they received one-to-one meetings with their managers on an ad-hoc basis, and clinical supervision was being carried out. We saw that one staff member had not received clinical supervision for over a year.
• Not all staff were fully compliant with the essential safety modules of fire safety and evacuation which fell below the service’s target and not all staff had attended fire evacuation drills in line with the provider’s policy in the inpatient services. The service did provide an action plan which showed that the remaining staff had been booked onto a training session.
• There were staff vacancies across all core services. Some community health services teams were reporting they were quite stretched. On the inpatient units, we saw that shifts were covered by bank or agency staff who did not always know the patients well.
• The ward environment in the Kestrel ward was not dementia friendly so patients could not always orientate themselves. The wards did not have dementia assistive aids in place.
• Some services such as the podiatry service and speech and language therapy had a high waiting list, which meant that people might not always be able to access the services when they needed them.
• On the Community inpatients wards, we saw that staff did not ensure that patients’ maximum dosage for medicines were stated on their medication chart. For example, we saw that there had been no indication for eight different medications on one patient record. For another patient with a low weight, no maximum dosage was shown for paracetamol.
• The continence team did not have a bladder scanner. Although staff informed us that there was a purchase order for a bladder scanner, the teams have been without a bladder scanner for over two months.
• Some services such as the podiatry service and speech and language therapy had a high waiting list, which meant that people might not always be able to access the services when they needed them.
• Patients we spoke who were receiving care from the community health services for audits teams reported that staff did not routinely collect feedback and the provider was not actively engaging with patients and carers to plan and deliver services.
• The phlebotomy clinic was quite small with two patient chairs next to each other. This impacted on dignity and privacy. Although staff told us they could draw the curtains, people in the room could still overhear the conversations of others.

Updated 19 October 2022

We rated the service as good because:

• The service controlled infection risk well. The environments where staff cared for patients were clean and well maintained.
• Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment. Staff ensured that care plans were detailed and supported patient treatment and recovery. They ensured patients who were at the end of their lives received timely pain relief.
• Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people and took account of patients’ individual needs.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.

However:

• Staff did not always ensure they kept up to date with their mandatory training. Some teams such as the community nursing teams, and speech and language therapy teams were not up to date with their basic life support and anaphylaxis training.
• The continence team did not have a bladder scanner. Although staff informed us that there was a purchase order for a bladder scanner, the teams have been without a bladder scanner for over two months.
• Some services such as the podiatry service and speech and language therapy had a high waiting list, which meant that people might not always be able to access the services when they needed them.
• Patients reported that staff did not routinely collect feedback and the provider was not actively engaging with patients and carers to plan and deliver services.
• Team leaders did not always record clinical supervision with staff.
• The phlebotomy clinic was quite small with two patient chairs next to each other. This impacted on dignity and privacy. Although staff told us they could draw the curtains, people in the room could still overhear the conversations of others.

Updated 19 October 2022

We rated it as good because:

• Staff understood how to protect patients from abuse, and managed safety well. All patients that we spoke with told us that they felt safe on the wards.
• Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Managers and staff gave us examples of recent lessons learnt from incidents and changes that had been made to prevent this from happening in the future.
• The service controlled infection risk well. Staff followed national guidance for the use of personal protective equipment (PPE) and the ward had a hand hygiene station at the entrance to enable all staff and visitors entering the ward to utilise this and reduce the risk of spreading COVID-19. The service had a recent hand hygiene survey which was 100% compliant.
• The service used systems and processes to safely prescribe and store medicines.
• Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. The patients we spoke with were happy with their care; one patient described the service as “excellent”.
• The service planned care to meet the needs of local people and took account of patients’ individual needs. People could access the service when they needed it and received the right care in a timely way. It was easy for people to give feedback and patients we spoke to told us they felt confident to raise concerns about the care received.
• Leaders ran services well and staff felt respected and supported. They were focused on the needs of patients receiving care and clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all staff were fully compliant with the essential safety training modules of fire safety and evacuation which fell below the service’s target and not all staff had attended fire evacuation drills in line with the provider’s policy. The service did provide an action plan which showed that the remaining staff had been booked onto a training date.
• The ward environment did not provide enough space for the safe storage of large equipment, such as hoists, which were stored on a corridor within the ward and created both a trip and evacuation hazard for any patients located in the side rooms off this corridor.
• There were some vacancies on the ward and shifts were covered by staff taking on overtime, or bank and agency staff who were not always experienced.
• Patient notes were not always secure as they were stored in a cabinet which had locks broken.
• Staff made sure patients had enough to eat and drink, including those with specialist nutrition and hydration needs. Although, patient feedback on the food was entirely negative around both the quality and quantity.
• The ward environment was not entirely dementia friendly so patients could not always orientate themselves. There were no explicit aids in place within the environment to assist these patients in orientating themselves
• Staff told us they received one-to-one meetings with their managers on an ad-hoc basis, and clinical supervision was being carried out, although for one staff member, they had not received clinical supervision for over a year. Managers did not routinely record clinical supervision with staff.
• Senior leaders were not present or visible on the wards and some staff felt that they did not always manage issues escalated to them.
• Staff did not ensure that patients’ maximum dosage for medicines were stated on their medication chart. For example, we saw that there had been no indication for eight different medications on one patient record. For another patient with a low weight, no maximum dosage was shown for paracetamol.
• There was not always enough nursing and support staff on to cover shifts. Some staff told us that they often worked extra hours to cover, and some of the agency staff who worked on the wards did not have the requisite skills and experience which increased the workload of regular staff.