The London NHS Executive decided to investigate the way Kingston and District Community NHS Trust (KDCT) manages the hospital after an internal inquiry earlier this year concluded that Alzheimer patients had been abused by staff on Fuchsias Ward and blamed trust managers for failing to prevent it.

As a result the trust has already implemented a major improvement programme.

The new report, while it accepts that the trust is "developing sound systems for controls assurance and clinical governance" recommends that it goes even further to protect patients.

Recommendations include:

q An overhaul of the complaints procedures with better monitoring of the speed complaints are dealt with.

q Spot checks on wards at night and weekends.

q Training for senior managers at the trust, health authority and community health council in how to spot warning signs of inadequate patient care.

q "Untoward incidents" to be reported simultaneously to region, board members and the health authority.

q Board members to shadow nursing staff once a year.

q A clearer, streamlined management structure.

The trust has accepted, and promised to implement, all the recommendations.

Although junior staff directly involved in the abuse were disciplined or sacked the report's author, George Gibson, chairman of Surrey/Sussex NHS Trust, did not recommend disciplinary action againstany managers.

Trust chairman Patricia Gregory added: "He does not believe further action is needed against staff, including the chief executive."

And directors at KDCT gave a vote of confidence in chief executive Fred Little at a board meeting on Monday.

However, the trust is to be dismembered later this year with mental health services being transferred to South West London and St George's Trust in the Autumn, six months earlier than expected, a change which should help minimise damaging uncertainty.

A proposal to allow an in-house team to manage mental health services in Kingston and Richmond was rejected by the health authority, council and other experts.

Trust chief executive, Fred Little, said the report showed the right team was in charge to govern the trust through the turbulent period ahead.