Health watchdogs have served a mental health trust with a warning notice after concerns were raised over the use of sedation and “blanket restrictions”.

The Care Quality Commission (CQC) inspected the acute wards for adults of working age and psychiatric intensive care units (PICU) at Littlebrook Hospital, in Dartford, Priority House, in Maidstone, and St Martin’s Hospital, in Canterbury.

But the Kent and Medway NHS and Social Care Partnership Trust (KMPT) sought to assure it has already put measures in place since the visit in May and is working to resolve the issues raised.

Following the inspection, the wards fell from “good” to “requires improvement”.

They were rated "requires improvement” for being well-led and “inadequate” for being safe and the trust was issued with a warning notice regarding rapid tranquillisation (sedation).

In their report, inspectors raised concerns that staff were not always aware of the potential impact these medications had on a person's health or that their administration was justified.

The trust cares for people with complex mental health needs and sometimes uses measures to safeguard them or others.

Yet, across all three hospitals, most people told inspectors they felt safe and the staff treated them with respect.

CQC deputy director of operations in the south, Serena Coleman, said: “During this inspection of KMPT, we saw staff working hard to meet people’s needs.

“However, we also found some staff were not always using the least restrictive options to make sure that people’s behaviour was not controlled by excessive use of medicines.

“As required medication, such as lorazepam and promethazine, was being used quite frequently but we could not always find records to explain why these medications were necessary.

“There were examples where reviews had not happened for long periods, meaning staff could not be sure it was still appropriate to administer to people.

“We also found that staff did not always follow the trust’s guidelines on documenting the monitoring of people’s physical health after administering medicines for rapid tranquilisation. This made it difficult for the trust to review these and ensure they were appropriate.

“In some of the sites we inspected, we also found restrictive practice or blanket restrictions such as people not having independent access to drinking water, gardens and certain rooms on the wards.

“For example, at Littlebrook Hospital and Priority House, there were designated areas where people could have access to hot and cold drinks.

“We have given the trust a warning notice which will direct focus on the improvements we want to see regarding rapid tranquillisation implemented and embedded.

“If not, then we will not hesitate to take further action to ensure people are safe.”

The report, published today (August 3), highlighted issues with “restrictive practices” and said “blanket restrictions were used” such as in most wards there were no available cups for patients – this has now been changed.

But it added: “Staff made every attempt to avoid using restraint by using de-escalation techniques and restrained patients only when these failed and when necessary to keep the patient or others safe.”

Inspectors also found emergency equipment was not always regularly checked, care plans were lacking but these were then updated, and at St Martin’s Hospital people had limited access to showers on the wards but those that were out of action have since been fixed.

However, they found most workers felt respected, supported and valued and there was “ a commitment from all staff to do a good job.”

The report added: “Despite some challenges, most of the staff we spoke with were positive and felt proud working for the trust and within their teams.”

Chief Nurse at KMPT, Andy Cruickshank, said: “The safety and wellbeing of our service users are at the heart of everything we do and so we are committed to continuously improving the care and services we provide.

“The findings of these inspections provide valuable feedback to help us do that.

“We acted swiftly in response to the CQC’s warning notice on rapid tranquilisation to immediately address their concerns.

“One of many measures we put in place was the introduction of new bespoke training, which over 93% of staff have already completed.

“Many of the systemic areas identified for improvement were issues we were already working to resolve, and we will continue this work at pace.

“However, it is encouraging the CQC found our staff are caring and hard-working and service users told the CQC they felt safe, the staff treated them with kindness and respect, and their family members provided positive feedback.”