The Care Quality Commission
  • Mental Health
  • Independent mental health service

The Priory Hospital Bristol

Overall: Good read more about inspection ratings

Heath House Lane, Stapleton, Bristol, BS16 1EQ (0117) 952 5255

Provided and run by:
Priory Healthcare Limited

Important: The provider of this service changed. See old profile

All Inspections

14, 15, 19 and 21 April 2021

During a routine inspection

The Priory Hospital Bristol is an independent hospital registered to provide care and treatment for up to 85 people with mental health conditions.

Our rating of this location stayed the same. We rated it as good because:

• All of the ward teams included or had access to a range of specialists. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

• Generally, the hospital provided a range of care and treatments suitable to the needs of the patients and in line with national guidance about best practice.

• The hospital generally provided safe care and patient areas in all wards were clean.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• Patients told us that staff explored their goals and they felt that staff were passionate about supporting them to achieve these.

• Staff said they felt valued by the organisation. They felt able to give feedback and senior managers were visible in wards.

• We found improvements in the management of safeguarding procedures. A safeguarding lead was appointed creating full oversight. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for patients and staff.

• Staff felt respected, supported and valued. They said the hospital promoted equality and diversity in daily work and provided opportunities for development and career progression.

However,

• Audits about the cleaning of the clinical rooms were not robust in identifying shortfalls. Clinic rooms needed cleaning

and were poorly organised. Checks on emergency equipment were not being completed and key items, such as defibrillations pads were missing for the emergency bags and some emergency medicine were missing.

• There were outstanding maintenance issues in the long stay and rehabilitation wards. For example, broken viewing panel in a bedroom, two bedrooms used for storage and broken automatic door stops.

• Patients in all acute and long stay wards had limited opportunities for occupational therapies due to occupational therapist (OT) vacancies.

• Registered nurse vacancies were currently at 60% across the hospital. Although recruitment for substantive staff was ongoing this resulted in difficulties covering shifts of registered nurses. Despite attempts at securing bank and agency staff to cover vacancies the number of registered nurses on each ward could not always be maintained and addition health care assistants were used to cover gaps to support patient care. We were told agency staff didn’t have access to patient’s electronic care records.

• A range of patient records were not always comprehensive or updated regularly. This included risk assessments, care plans and mental capacity assessment records. Risk assessments or care plans in the psychiatric intensive care unit (PICU) lacked detail on how staff were to de-escalate or the least restrictive measures to take when patients behaviours placed them and others at risk of harm. Care plans in acute, PICU, long stay and rehabilitations wards did not always include meaningful discharge plans. In addition, they were not always personalised and in the rehabilitation wards goal setting was not always clear and in progress towards recovery was not always evident.

24, 25, 26 August and 9 September 2020

During an inspection looking at part of the service

On 24 August 2020 we undertook an unannounced night time focused inspection at The Priory Hospital Bristol at the wards for children and young people (Banksy and Brunel wards). We returned on site during working hours on 25 and 26 August 2020 to continue our inspection of wards for children and young people, but also acute and inpatient wards for adults of a working age that we had received concerns about (Redcliffe and Upper Court wards). We also held a number of remote interviews with staff and carers that concluded on the 9 September 2020.

On 7 September 2020, following our inspection, we served the provider an urgent notice of decision to impose conditions on their registration under Section 31 of the Health and Social Care Act 2008. Section 31 of the Health and Social Care Act 2008 Act is an urgent procedure whereby CQC can vary any condition on a provider's registration in response to serious concerns. We took this urgent action as we believed that people would or may be exposed to the risk of harm if we did not do so.

The conditions placed required the provider to, within a set period of time, confirm in writing that it had enough suitably qualified and competent staff on wards at all times, reviewed all care records on Redcliffe and Upper Court, put in place robust processes for the management of medicines, ensured that all staff had an induction and had access to information to enable them to deliver safe care and could manage risks appropriately.

The provider was also required to report to us on a regular basis so that we could monitor whether it was complying with the conditions. This process was ongoing at the time of publication of this report.

We only inspected areas of the service that we had received concerns about. We did not inspect the key questions of are services caring or responsive as part of this inspection. We did not inspect all aspects of the key questions of are services safe, effective and well led as part of this inspection. This means we have not changed the ratings for this service overall.

Due to an agreement between the provider and NHS England, both child and adolescent mental health wards were due to be closed by the end of September 2020 with all patients discharged to other placements or the community. As these wards are now closed, the rating for these wards does not apply.

During this inspection, we found:

There was not enough staff to ensure patients had access to planned activities and the leave they were entitled to on Redcliffe and Upper Court wards and staff confirmed this.

There were significant staffing issues on the child and adolescent wards. There were high vacancy rates for nursing posts on both wards and high vacancy rates for healthcare assistants on Brunel ward. There were high rates of sickness on across both Brunel and Banksy wards. This meant that there was high usage of agency staff who did not necessarily know the ward or patients well.

Staff did not have access to the information they needed to provide good care. The wards for children and young people had high usage of bank and agency staff, who did not have access to the electronic care records system or the incident reporting system. They did not have good sight of the risks of the ward environment because their induction was brief and did not cover all they needed to know to do their job. Paper files were incomplete and disorganised. Staff struggled to find information we requested while we were on site.

Systems and processes for safely prescribing, administering, recording and storing medicines were not always followed. Not all registered nursing staff were aware of where emergency medicines were being stored. Access to medicines for disposal was not restricted to authorised staff. Staff did not store and manage all medicines and prescribing documents in line with the provider’s policy.

Processes were not in place to ensure medication to support patients challenging behaviour was used only after appropriate de escalation techniques had been tried. Staff had not documented their decision making when they did not follow national guidance in what medicines they used to rapidly tranquilise patients. When rapid tranquilisation had been administered there were no physical observations recorded as recommended by the National Institute for Health and Care Excellence (NICE) guidance.

Staff on the wards for children and young people did not always raise incidents or allegations of abuse appropriately. We found that there had been incidents recorded of young people being administered medicines against their wishes, outside of a legal framework. This had occurred multiple times and had not been reported as an incident. Further, we saw documentation that a young person had made multiple self harm attempts but these were not recorded as incidents. We saw staff had documented two safeguarding concerns in care records but had not reported these to the local safeguarding authority for investigation.

Staff had not assessed and planned patients' care around all their needs. We saw that six out of eight care plans across Redcliffe and Upper Court were not personalised and did not adequately reflect patients' views. Five of these eight care plans were not recovery focused or holistic in their assessment of patients' needs.

Only 61% of staff on Redcliffe ward were up to date with their training in the Mental Health Act and only 67% were up to date with their training in the Mental Capacity Act. Staff had not always appropriately documented patients capacity or consent on Redcliffe Ward.

The hospital senior leadership team had undergone significant upheaval since our last inspection. There was a new hospital director in post, a new hospital deputy director and a new medical director since February 2020. There were also vacancies for ward managers for the wards for children and young people. A new interim hospital manager was appointed but did not start in post until after this inspection.

Staff raised concerns with the culture of the wards for children and young people. Staff told us that the planned closure of the wards had affected morale of the staffing team. Staff on Brunel told us they felt undervalued. They said that there were frictions between the day shift (staffed mostly with permanent staff) and the night shift (staffed mostly with bank and agency). Agency staff on both wards said that they did not always feel comfortable raising concerns.

Governance systems were not robust enough to ensure good care at the hospital. Systems did not ensure staff were up to date with important mandatory trainings in the Mental Capacity Act and the Mental Health Act. Staff reported having good access to information but were unable to provide information to the inspection team in a timely way while on site. Systems were not in place to ensure all medicines for rapid tranquilisation were administered under a legal framework or in line with national guidance.

There were also issues with processes to ensure a suitable mix of skilled staff on shifts on the wards for children and young people. Audit processes around the quality of care records at the hospital had not ensured good clinical record-keeping.

Managers had not ensured the hospital risk register was reflective of current risks. We found that 75% of the items on the hospital risk register had actions that were out of date and did not reflect the current risks on site. It was not clear who had oversight of the risk register or where this was supposed to be reviewed.

Senior leaders in Priory Healthcare were not fully aware of the issues at this hospital until we raised these with them. This demonstrates a lack of robust oversight and assurance.

However:

The provider had addressed the blind spots and issues with anti-barricade doors raised at our last inspection.

Staff on Redcliffe and Upper Court wards knew what incidents to report and were able to demonstrate how learning from incidents had changed practice.

Staff on the wards for children and young people were more up to date with their mandatory training in the Mental Capacity Act. Ninety-four per cent of staff were up to date with their training in the Mental Capacity Act.

Staff on Redcliffe and Upper Court reported having capable, approachable leaders. They said that the ward culture was good and they were able to raise issues of concern without fear of reprisal.

8-10 January 2019

During a routine inspection

We rated the Priory Hospital Bristol as good overall. This was the same rating as the previous inspection in April 2016. We rated the key questions, are services safe, effective, caring, responsive and well-led as good.

The reason for the rating of good overall was as follows:

  • The provider managed risks well. The hospital had an up-to-date risk register that highlighted key concerns and had plans in place to manage these. Staff completed regular environmental and patient risk assessments.Managers adjusted staffing levels to meet changing needs, bringing in extra bank and agency staff who were familiar with the wards to cover any shortfall. The hospital ensured all agency and bank staff used were familiar with the wards and had access to the same induction, support and training as permanent staff.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The provider had clear processes for monitoring and investigating incidents and complaints. The provider also undertook a variety of audits to monitor and improve the quality and safety of the service. Systems were in place to learn from these and improve practice as a result.
  • Staff provided a range of care and treatment interventions suitable for patient groups in line with guidance from the National Institute for Health and Care Excellence (NICE). Robust arrangements were in place to meet patients’ physical and mental health needs.
  • Staff were discreet, compassionate, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it.
  • The ward managers and senior leadership team provided strong and effective leadership and staff members had confidence in them. Managers within the service promoted an open and honest culture. Staff felt able to raise concerns, report incidents and make suggestions for improvements without fear of consequences. Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.
  • Staff felt respected, supported and valued by senior managers and leaders. They were proud to work at the hospital and felt positive about their work and the support they gave patients. The provider recognised staff success within the service through star awards, nominated by other staff members or by patients.

However:

  • On the acute wards for adults of working age, care plans were not personalised or collaborative and used generic statements for goals and interventions. Care plans and risk management plans were not updated to reflect progress or change in needs. However, on the long stay/ rehabilitation, child and adolescent mental health and eating disorders wards, patient records were person centred, detailed and up to date. They included comprehensive mental and physical health assessments, with detailed and holistic care plans that included the patients’ voice.
  • The acute wards for adults of working age were not in a suitable environment for the service, as they did not have adequate space to support treatment and care. The communal room in each of the acute wards did not have anti-barricade doors and were a safety risk due to the limited space and the lack of alternative access to the rooms.
  • On the child and adolescent mental health wards, multi-disciplinary working needed to improve to ensure good communication between the different staff meeting the complex needs of the young people using the service. Some staff experienced significant levels of violence and racial abuse from patients in the child and adolescent mental health service. Staff felt the aftercare and support available following these incidents could be improved.
  • Staff did not always record that patients were being told of their rights under the Mental Health Act (1983). Not all informal patients were aware of their rights. Some staff were also not clear about their responsibilities under the Mental Capacity Act 2005 and did not see this as part of their role.
  • On the acute wards, staff were not aware of the results of clinical audits and where improvements were needed.

4 May 2017

During an inspection looking at part of the service

At the comprehensive inspection of The Priory Hospital Bristol on the 18 – 21 April 2016 we rated the service as ‘good’ overall. During comprehensive inspections we always ask the following key questions; are services safe, effective, caring, responsive and well-led. We rated the key questions, are services effective, caring, responsive and well led as good.

However, we rated ‘safe’ as ‘requires improvement’, because of the poor management of ligature point (a ligature point is anything that a person could use to attach a cord, rope or other material for the purpose of hanging or strangulation) risks on Lower court and Upper Court wards; the fire doors on Lower Court weren’t alarmed so could be used by patients to easily abscond and there was inadequate cleaning in bathrooms and of mats used to cushion patient falls from bed in Garden View ward.

Following the inspection we served a warning notice against Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 – safe care and treatment which required the hospital to:

  • Ensure the appropriate management of ligature risks, including having adequate governance processes and systems in place that identify ligature points and risks.
  • Ensure that fire doors were adequately controlled to manage patients absconding from the ward.

We also served a requirement notice that required the hospital to:

  • Ensure all areas of the ward follow appropriate infection control procedures.

On the 16 May 2016 the hospital sent us an action plan that detailed how it would meet the warning notice and requirement notice. This action plan included reviewing the ligature audits of the wards to ensure that all ligature points were noted and risks mitigated. It identified the changes the hospital would make to the environment to reduce the ligature risks, and it identified that it would introduce an audit tool to look at any blind spots on the wards (places that could not easily be observed by staff where patients may harm themselves or others). The plan also included stated that the hospital would review the systems around the fire doors to ensure they opened when the fire alarm was triggered, to help reduce the risk of people who were detained under the Mental Health Act from leaving the ward without an escort. The hospital also said it would review the facilities on Garden View and make changes to allow proper cleaning.

On 4 May 2017 we undertook an unannounced, focussed inspection to check that the hospital had addressed all of the concerns identified in the warning notice and requirement notice. Since our last inspection (April 2016) we have received no information that would cause us to re-inspect other aspects of the key question, are services safe.

We found that multiple changes to the environment had been made, including the removal of ligature points and changes to reduce the likelihood of patients tying a ligature. For example, they had mitigated the risks by putting boxes around items such as extractor fans and fire alarms. The hospital had re-furbished the rooms on Upper Court to provide purpose built furniture to reduce the chance of a patient tying a ligature; it had replaced the doors of ensuite bathroom across Brunel, Redcliffe and Upper Court to reduce the risk of ligatures. In addition, bedroom doors on these wards had been replaced to ensure that patients could not barricade themselves in their room. Mirrors had also been installed to reduce blind spots (places on the ward not easily visible by staff on the ward).

The hospital had taken steps to address the poor infection control procedures on Garden view. The mats used to minimise injury to patients who were at risk of falling out of bed were clean and well maintained. Night staff had responsibility for cleaning these and the cleaning rotas recorded staff had cleaned the mats. The hoists in the communal bathroom had been repaired and the damaged area near the sink in the communal bathroom had been repaired, allowing it to be easily cleaned.

As a result of the improvements made by the hospital, we judged that it had met the requirements of both the warning notice and requirement notice. As such we lifted the warning notice and requirement notice and rated the safe as ’good’.

18 April – 21 April 2016

During a routine inspection

We rated The Priory Hospital Bristol good because:

  • Staffing levels were established based on the number of patients and on the clinical needs of patients. We saw evidence that although there were some vacancies across the wards, the service had ensured that either permanent, bank or agency staff covered all shifts. The hospital used agency staff that were familiar with the wards and had medical cover should patients need a psychiatrist.
  • We saw evidence that staff had reported incidents, and that these incidents had led to learning within the hospital. Learning from incidents was reviewed by the Priory group’s quality improvement lead and were fed back to staff through meetings and an internal staff newsletter.
  • We saw that there had been adaptations to the ward environment to meet the needs of people with dementia to make the ward safer. Wards all had access to outside space, and there was access for patients with different mobility needs. We found that changes had been made to make sure the wards complied with same sex accommodation guidelines. Patient’s beds were kept for them while they were on leave.
  • Staff were experienced and had access to training to help them meet the needs of their patients. This included specialist training on eating disorders, and on alcohol misuse. Patients had access to staff from a range of disciplines and staff ensured that the treatment on offer was based on national guidance.
  • The care records we reviewed showed care plans that covered a variety of the individual patients needs and patients told us they were involved in their care. This meant that they received health checks on admission, as well as annual health checks and that staff could engage other local healthcare providers to meet the patients’ needs. For example, staff referred patients for podiatry and dentistry.
  • Staff were caring and respectful in their approach to patients. We saw examples of staff interacting with patients in a positive way, helping to respect their dignity and involve them in the care they received. Staff were aware of patients’ needs and the environment and this helped them to ensure that they cared for patients appropriately. Staff on Oak Lodge wore dressing gowns at night to help reduce the distress of patients with dementia.
  • Staff ensured that patient’s spiritual and dietary needs were met. They were clear on the process on how a patient would make a complaint and we saw evidence that patients had the opportunity to feedback on the service, as well as become involved in recruiting staff.
  • We saw that staff had good morale. They spoke positively of the hospital manager and the deputy hospital manager. The deputy visited the wards daily and all of the staff were aware of the senior management within the hospital.
  • Staff on the wards followed the Priory groups’ governance systems. These systems allowed them to get data on their performance, which led to quality improvement targets. Lotus ward had received accreditation with the Royal College of Psychiatrists quality network for eating disorder services. There were also research projects taking place on that ward in partnership with local universities.

However:

  • There were multiple ligature points on both Upper and Lower court. Identified ligature points did not have adequate management plans and the ligature assessments did not identify all ligature risks. Governance arrangements did not demonstrate planned improvement to areas where there were ligature risks on Lower and Upper Court. We bought this to the attention of the hospital director who undertook an audit of some areas that had been missed off the annual audit. Staff on Garden View did not have a good understanding of ligature risk and did not recognise risks on the ward.
  • Visiting arrangements did not ensure the safety of patients on Lower Court as visitors were allowed in patient bedrooms, including male visitors in female areas.
  • Audits did not identify all infection control risks on Garden View. Bed mats, which were used to cushion potential falls out of beds, were stained and had unpleasant odours.
  • We identified de-facto seclusion occurring on Garden View for one patient. We asked that this be referred to the local safeguarding team. The ward manager addressed this without further delay.

The hospital had taken some action to address concerns that had been raised at the previous inspection. We found that it had made amendments to the environment on the long stay/rehabilitation wards to remove worn carpets. We also saw documented evidence of mental capacity decisions being undertaken appropriately, as well as appropriate storage and administration of medication on Oak Lodge. The hospital had also made changes to adhere to the guidance on mixed sex accommodation and we saw evidence of care records containing a good personalised risk assessment.

However, we were concerned that multiple ligature risks on Lower and Upper Court that had not been properly assessed or identified by the provider.

This is a breach of regulation 12 of the Health and Social Care Act 2008 and as a result, we issued a warning notice on the 29th April 2016, requesting compliance with regulation 12 by the 13th May 2016. Following this notice, the hospital had submitted an action plan to address this.

10 and 11 February 2015

During a routine inspection

The hospital had ongoing issues with the recruitment and retention of staff, resulting in staff being moved around the wards regularly. Several wards regularly failed to meet their ‘staffing ladders’ (identified staffing levels and skill mix based on the needs of patients).

There was good uptake of mandatory training and specific specialist service training was being planned such as dementia awareness.

There was limited evidence of learning from incidents. For example, risk assessments were not always updated following incidents resulting in a lack of learning so similar incidents happened repeatedly or there was an escalation in severity of incidents. This left some patients feeling unsafe on the acute ward.

The management and monitoring of medicines and control drugs on some wards did not meet recognised good practice standards.

There was a capital investment programme to develop the buildings and environment. Currently, Rosewood was closed for remodelling and plans for redeveloping the service provided from this ward were being consulted upon.

For some patients in complex care with progressive illnesses, the wards are their home rather than a hospital ward from which they will move on. Areas across Complex Care were worn such as the Oak Lodge lounge and carpets across the unit were dirty and smelled of urine. Some areas also lack a personalised homely feel. The hospital managers were aware and provided evidence of longer term plans to rectify.

The risks from ligatures in the acute area of the hospital were not being managed; there were blind spots with unidentified ligature risks in a number of communal areas and within the hospitals’ identified ‘reduced ligature rooms’.

The privacy, dignity and safety of patients on lower court were not always met as female patients sis not have access to a female only lounge.

The quality of the capacity assessments within complex care were poor, with limited evidence on what had been considered and how any decision had been made.

Most of the service provided good physical health monitoring. However, there were pockets of poor practice and poor recording on fluid charts in complex care which delivered care to a very vulnerable patient group.

The care and support provided to patients by all staff was very good. Patients had one-to-one sessions with staff, were able to go out of the hospital as they wished had an excellent choice of food.

The Priory Hospital Bristol was in the process of developing its senior leadership team. The hospital director had been in post for six months and a number of new senior managers had been appointed. A deputy director of nursing and a clinical director were about to commence to strengthen clinical leadership. The hospital was in the process of restructuring its services, developing its infrastructure and governance arrangements although these were at a relatively early stage of development. Most of the staff we spoke with said that there had been a significant change in the severity of illness of the patients being cared for at the hospital over recent years. The majority of patients were now acutely ill and/or had complex needs.

We found that the hospital was developing an increasingly open culture and delivering and increasing responsive service. Staff said they felt supported and received good supervision. They also felt the hospital director could be approached at any time and that issues were resolved. Following a clearer focus on achieving good outcomes for patients, staff noted that morale had improved in the last six months. Despite the improvements made, we observed poor practice on the wards as outlined in the report.

During a check to make sure that the improvements required had been made

We reviewed the electronic records we held of events notified to us by the service. We are satisfied that the service has consistently reported events which affected the welfare, health and safety of people who used the service. Where appropriate the provider had notified CQC and this was consistent with our electronic record of events notified.

21, 22 November 2013

During an inspection looking at part of the service

We carried out a follow up inspection to the Priory Hospital Bristol on 21 and 22 November 2013 as we had identified areas for improvement in April 2013.

One patient on Hillside ward told us 'Staff are nice'. A family member we spoke with on Oaklodge told us 'I want it on record that they have been superb ' really touched'.

Some people were unable to tell us about their care. We carried out observations of the interaction between members of staff and the patients they supported and found staff to be caring and respectful in their approach. Improvements had been made in how observations of patients were carried out.

We visited all the three wards at the Complex Care Unit (formerly known as The Priory Grange Bristol). These wards cared for people with severe mental health and physical problems. We also visited Lower Court (addiction treatment for substance and behavioural dependency and eating disorder) and Rosewood (rehabilitation pathway/palliative care).

Recruitment of staff had helped to reduce the use of agency staff with further staff in the process of being recruited. Comments from staff were positive about the support they received from their ward managers. Records were accurate and regularly updated. However more frequent clinical supervision of staff still needs to be addressed.

10, 11 April 2013

During a routine inspection

The specialist advisor who accompanied us had clinical experience in mental health services.

People we spoke with had mixed views about their care and treatment. Comments ranged from 'top quality' to others telling us that they were not involved in their care. We were told 'Staff are respectful, wonderful' whilst others felt that this was not the case. We observed staff with a caring and friendly manner.

We observed that practice varied between wards we visited with some people saying they were more involved with their care than others. We noted that some new practices were being implemented such as protected time on some wards. This allows people to take part in activities or engage in one to one time with staff without interruptions.

People told us that they felt safe and knew how to make a complaint. Staff had a good knowledge of safeguarding people from harm and knew how to raise concerns.

We found that there had not always been sufficient numbers of staff on duty. We were told a recruitment process had started.

Some staff had not been supervised on a regular basis. We were told new clinical supervision training was to start. We were not assured that a robust plan was in place to deliver this effectively.

We found records about people's care and treatment had not always been maintained to ensure their safety. This had not been picked up as part of the record keeping audits demonstrating a lack of rigor in processes of audit and quality monitoring.

9 July 2012

During an inspection looking at part of the service

When we carried out a visit to the Priory Hospital Bristol during December 2011 and January 2012 we found improvements were needed. We visited the Hospital on 28 and 29 June and 9 July 2012 to see if improvements had been made in respecting and involving people with their care, welfare and safety. We also looked at how improvements had been made in offering people different activities, supporting staff with their training. and in record keeping.

We found that improvements had been made with people being listened to and involved with their care in a respectful way. People were supported more safely through improved management of risk; there was a more consistent approach in providing staff with appropriate and updated information to support people with their needs. Staff training had been updated with more staff receiving suitable training.

External managers from within the organisation had been involved in working with staff and an interim hospital director had overseen improvements. We saw that this had helped in making positive changes that impacted in the management and leadership of the wards. This had resulted in better outcomes for people using the service. A new hospital director is now in place.

We had been sent copies of a compliance monitoring visit by the Priory Group in April 2012 and a quality improvement action following our previous inspection. We saw a robust approach in the monitoring of practices in the hospital with activities undertaken to address shortfalls with compliance.

We visited the area of Lower Court ward that provides treatment for people with eating disorders, and three wards on the Grange unit, Garden View, Oaklodge and Rosewood. Both Garden View and Oaklodge wards provided treatment to people who have a mental disorder and people with degenerative disorders such as Huntington's disease and early onset dementia. Rosewood ward is a rehabilitation ward for slow stream rehabilitation and provides palliative and physical healthcare for some people.

On all the wards there may be those people using these services who may also be liable to be detained under the Mental Health Act (1983).

We spoke with a total of four people using the service. Some people told us they were well supported by staff and happy with their care and treatment; that they felt safe and that they had no complaints. Some other people told us about their future plans and that they were now able to leave the Priory.

Other people spoke to us about their concerns which included food and the medication they were given. We followed these concerns up by speaking with the ward managers and staff. We looked at records to show us how people had been supported to make decisions about their choice of food and treatment. We found staff had supported people appropriately with their care and treatment.

Some people were unable to tell us how they were cared for due to their dementia or mental health needs. For these people we carried out observations of their care and interaction with staff in the communal areas of wards.

We spoke with staff in differing roles. These included the director of the Priory Hospital, the medical director/consultant, the clinical services manager of Lower Court, and the manager of the Grange. We also spoke with four ward managers, five registered nurses, three healthcare assistants, and an occupational therapist.

5 January 2012

During an inspection in response to concerns

We carried out visits to the Priory Hospital on 9 December 2011 and 4 and 5 January 2012. This was due to concerns raised with us on several occasions through an anonymous whistleblower alleging wards were unsafe and patients were being neglected due to short staffing.

A further whistleblower then raised a number of serious allegations using the provider's whistleblowing procedure. This resulted in ongoing police and safeguarding investigations.

We visited all the wards at the hospital.

The three wards on the Grange unit are Garden View, Hillside and Oaklodge. They provide treatment to people who have a mental disorder and people with degenerative disorders such as Huntington's disease and early onset dementia.

Lower Court ward provides treatment for people with eating disorders, psychiatric assessment and treatment including substance abuse.

Rosewood ward is a rehabilitation ward for slow stream rehabilitation and provides palliative and physical healthcare for some people.

On all the wards there may be those people using these services who may also be liable to be detained under the Mental Health Act (1983).

During our visits we spoke with people on the majority of the wards.

Some people told us that they were independent and made their own drinks and that they were helped by staff with things like checking their bath water.

They said they went out to Bristol for a half day every week which they enjoyed and said they would like to go out more.

They told us they spent their time watching television, writing poetry and sometimes did some cookery. They also expressed their view that there was not enough occupational therapy (OT) support on the ward to help people to be involved with other activities.

Some people told us they were well supported by staff and happy with their care and treatment.

Some people were unable to tell us how they were cared for due to their dementia or mental health needs. For these people we carried out observations of their care and interaction with staff in the communal areas of wards.

We spoke to staff on the wards in differing roles. These included ward managers, registered nurses, healthcare assistants, an occupational therapist, a speech and language therapist, agency nurses and a domestic.

The provider has recently engaged external managers who have been involved in working with staff on some of the wards to assist with improving outcomes for people and the management and leadership of the wards.

22 August 2011

During an inspection in response to concerns

We carried out a visit following some concerns that were raised by an earlier inspection by our inspectors who check that people detained under the Mental Health Act 1983 at the hospital are being cared for in accordance with the Act. Some concerns had been identified at this earlier visit and we were concerned that the provider had not responded to let us know how they intended to address the issues we had raised. This was a joint visit to the service by a Mental Health Act Commissioner, two Compliance Inspectors and a Pharmacist Inspector under the respective legislative frameworks.

The areas we visited at the Priory Hospital were Lower Court and the Grange.

Lower Court provides treatment for people with eating disorders and addiction problems.

The Grange provides treatment to people who have a mental disorder and people with degenerative disorders such as Huntington's disease and early onset dementia. People using these services may also be liable to be detained under the Mental Health Act (1983).

We spoke with five people who told us they were happy with their care and accommodation, and that they liked the staff. We saw people had activity timetables that included activities such as walks, trips to the local hairdresser, shopping and having refreshments away from the ward. We were told people had been to the recent Bristol balloon fiesta and to Horseworld. Whilst we were carrying out our visit we saw people were involved in a cookery activity, which was supported by occupational therapists.

We saw 'patient forum' records showing that people were involved in making choices about their meals.

We were told by people they were listened to by staff.

Some people said they did not know who to complain to and said they had not been given information about how to make a complaint.

People said that if they wanted information about their medicines they could ask their consultant or staff on the unit. This information was not always offered if they did not ask. They were happy with how they were given their medicines. They told us that they could go to the clinic room to collect their medicines at the appropriate time but, if they did not, staff would come and find them.

At the time of our visit to the Priory, we identified major concerns under Outcome 7 Safeguarding people who use services from abuse. However since our visit a meeting was held with Bristol City Council Safeguarding Lead on 12 October 2011. The Priory submitted an action plan framework setting out proposed action and we will be monitoring this.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.