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An NHS trust in Basildon which hit the headlines over high death rates and filthy conditions has been told it could face action by a regulator.
The Care Quality Commission (CQC) said Basildon and Thurrock University Hospitals NHS Foundation Trust needs to improve to meet standards on quality and safety or it could face enforcement action. Powers include closing the trust, closing services and issuing fines.
The trust was last issued with a warning in December over "major concerns'' about the way it deals with serious untoward incidents (SUIs), such as missed diagnoses.
In 2009, action was taken against it after inspectors found blood-stained floors, curtains and equipment, and badly soiled mattresses in the A&E department.
Equipment was being used repeatedly that should only be used once, and resuscitation room equipment was past its use-by date.
Other items found at the trust included blood pressure cuffs stained with blood, suction machines contaminated with fluid inside and out, and mould.
The CQC has now told hospital managers they are failing to meet several essential standards, including care for individual patients and the general running of the trust. Inspectors said there were concerns about nurse care planning and assessment, and the way patients were discharged.
The CQC also called for proper checks on hospital equipment. It said: "Checking of resuscitation trolleys in some areas was inconsistent and could impact on patient safety.''
Records "contained staff errors, for example, we noted that a defibrillator had a low battery because it had not been plugged in as part of the checking process. On another ward, the extension lead had been plugged in but not switched on.''
Alan Whittle, chief executive of the trust, said there were many examples of improvement found by inspectors.
"This is a much more positive assessment than previously.
"Inspectors found patient feedback about their care and treatment across Basildon Hospital was generally positive, as were views about cleanliness and hand hygiene across all areas.
"They found significant improvements in many areas, in particular stroke services, where our mortality ratio is around a fifth lower than the national average.
"It is also worth noting that, overall, our mortality ratio is now the lowest in Essex and has been at or better than the England average for the last 18 months.''
He added: "We have already provided the CQC with a plan of action to address the four areas where they have moderate concerns".