Five compliance inspectors carried out a planned visit to Darent Valley Hospital on the 4 and 5 October 2012. During the time we spent in the hospital we visited nine wards and the accident and emergency department (A&E). We also included a short visit to the newly opened Evergreen unit which specialised in the medical and health assessment of older people.

We were supported on the inspection by an Expert by Experience. This was a person who had personal experience of using or caring for someone who had used this type of care service. We also used the Short Observational Framework for Inspection (SOFI) in Beech and Spruce wards as some patients had dementia and/or were not able to tell us about their experiences. SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We spoke with 43 patients and 12 relatives of people who used the service. In addition we spoke to 28 members of staff working at all levels within the hospital. The staff told us that they felt well supported. They said that they liked working at the hospital and had the training and information they needed. We found that significant progress had been made in the four outcome areas that required improvement at the last inspection. We met with senior Trust staff. They told us about their systems for monitoring the quality of the service and about improvements they had made and were planning.

We were told that most patients or their representatives had been involved in making decisions about their care and treatment. We spoke with patients who said that their privacy and dignity was respected and confirmed that staff drew curtains around their bed when attending to their personal care needs. During the SOFI exercises we largely observed that patients who required help to eat were given appropriate assistance by staff, and were helped in a respectful way and were not rushed. Most patients told us they appreciated the way staff supported them and provided care. We were told, "They give you their time although they are very busy". Most patients were positive about the quality of care they had received and felt their overall experience of the hospital had been a good one. For example, one patient said, "I simply can't fault the care given to me here".

We received positive comments from patients about the standards of cleanliness in the hospital and the hygiene control measures in place to protect them from unnecessary harm. For example, a patient told us, "I've got no complaints about the cleanliness and I see staff washing their hands and using the hand sanitizers”. Another patient told us they were more than satisfied with hygiene levels on the ward. They said that staff took infection control measures seriously, wore aprons and gloves and washed their hands regularly. A very small number of staff however were observed to not always wash their hands between seeing to patients, or when they moved from different bed bays, this did not reflect best practice. Where we had concerns our observations were brought to the attention of senior staff on duty and issues were dealt with quickly and appropriately during our visit.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Four compliance inspectors carried out a visit to Darent Valley Hospital on 13 and 15 June 2011 and a fifth inspector carried out a specific observational exercise called a Short Observational Framework for Inspection (SOFI) on one ward on 15 June 2011.

During the time spent in the hospital we visited nine wards, (Beech, Cedar, Ebony, Juniper, Linden, Maple, Oak, Redwood and Spruce) and the Accident and Emergency department, including the Emergency Department Walk In Clinic (EDWIC).

We spent time speaking with people who use the service and their relatives to find out about their views and experience of the care the hospital gave. We spoke to staff at all levels from ancillary staff on the wards to the Trust board. We spent time talking with the people who had overall responsibility for infection control and to those with responsibility for handling complaints. We observed care practice; including a specific observational exercise (SOFI) and reviewed samples of documentation such as care plans, monitoring charts and information that the hospital gives to people on all the wards we visited.

Throughout the time of our visit we spoke to twenty-six of the people who used this service and seven of their relatives. They said that the hospital was kept clean and had suitable day time facilities for visitors although some visitors told us that parking could be difficult. They said they were happy with the visiting times and that these could be flexible if there was good reason. Most people praised the staff for the quality of care they received and for their diligence, helpfulness and kindness. There were a few people who told us that some staff were less thoughtful, particularly when it came to meeting basic care needs.

Nearly all of the people we spoke to told us that they thought the standards of care were generally high and that they were treated with respect and dignity.

People told us that they had been given good explanations about their treatment and that they had been asked to give their consent. On all of the wards we visited we found that some people were not able to make their needs known or give consent due to their failing mental capacity.

The people who used this service told us that their care was generally good. They said that the nurses were kind and respectful but were often very busy and took a long time to answer call bells. Some people told us that they were concerned that some people did not have access to call bells because they were in an additional bed in the window area or because, due to confusion, they did not understand how to use the call bell.

People’s views on the quality of the food varied. They told us that there is always a choice for the main meal. They said that they could choose between two hot meals, sandwiches and a salad. Some people told us that they did not like the food and that the quality was poor whilst others said that they enjoyed their meals and that the food was good. All the people we spoke to said that they were offered plenty to eat and drink. Some said that they did not feel like eating and had to leave a lot of their food. They described mealtimes as, “Not the most enjoyable experience”; “Quite lonely in a single room, it would be nice to have a dining room to share with other people”; “Very good”; and “OK”.

Our rating of this hospital stayed the same. We rated it as requires improvement.