Under-fire James Paget Hospital issued third warning notice

Inspectors visited the JPH on March 1 and found 'do not attempt resuscitation' (DNAR) orders were not always completed with appropriate information, some medical records were not up to date and contained anomalies, care plans did not always cater to a patient's individual needs and the trust was not taking proper steps to ensure patients were protected from the risks of receiving unsafe treatment.

CQC inspectors have been to and from the JPH since a failed inspection into dignity and nutrition standards a year ago, in April 2011.

And they had been visiting last month to check on what progress had been made in relation to concerns raised with the trust at the time of an earlier inspection.

The latest formal warning rules that the JPH must improve standards of care or face further action.

In light of the warning notice, new JPH interim chief executive David Hill has vowed to drive forward the necessary improvements.

'The challenges raised by the CQC are my top priority,' said Mr Hill. 'We welcome the fact that the CQC are driving up standards of bedside care across the country including this hospital.

'The JPH fully accepts that the necessary pace of improvement here has not been fast enough and we should have responded more quickly.

'The board, under the interim chairmanship of Peter Franzen, has made it clear that a turnaround in this situation is required including significant changes at management level.

'Those changes or actions will be swiftly implemented.'

The hospital has already taken a number of actions including better communication with, and education of, nursing and medical staff, standardised documentation to reduce duplication and the amount of paperwork, ongoing audits with instant feedback to highlight areas of good practice and to make improvements where necessary and reviewing DNAR forms to ensure decisions are clearly documented.

But he said these actions, which include completely revising and reprinting documentation and training staff to use the documents, will take some months to deliver and embed.

Peter Franzen, interim chairman, said: 'This is a vital time for the JPH.

'We have come a long way over the past year in delivering significant improvements across the organisation, but the pace of change has not been quick enough to meet the level of care we strive to provide.

'I am delighted that David Hill is here to lead on this very important work.'

Andrea Gordon, the CQC's deputy director of operations (regions), said: 'The law says that these are the standards that everyone should be able to expect.

'Providers have a duty to ensure they are compliant.

'We will be returning to the trust to follow up on progress and, when we do, we will expect the trust to be able to demonstrate it has made improvements.

'The JPH needs to address these issues or face serious consequences.'

The CQC has a range of legal powers it can use if it is found the required progress has not been made.

'Where necessary we will use these powers to protect the people who use this service,' added Ms Gordon.

Last year the CQC issued warning notices to the trust in relation to assessing and monitoring the quality of service provision and meeting nutritional needs.

Subsequent unannounced inspections found the trust had complied with the warning notices and improvements had been made.

Ms Gordon added: 'We will continue to monitor the trust and, as with all the services CQC regulates, when we find improvements are needed we will take action where appropriate on case by case basis.

'The JPH has made improvements following our earlier warning notices and it is important that these improvements are now sustained.'