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

The Priory Hospital Hayes Grove

Overall: Good read more about inspection ratings

Prestons Road, Hayes, Bromley, Kent, BR2 7AS (020) 8462 7722

Provided and run by:
Priory Healthcare Limited

All Inspections

12 April 2021, 15 April 2021, 23 April 2021

During a routine inspection

The Priory Hospital Hayes Grove is an independent hospital that provides support and treatment for people with mental illness, eating disorders and people recovering from drug and alcohol addictions.

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

  • The ward environments were safe and clean. The wards had enough nurses and doctors to deliver care to patients, although they continued to have vacancies. At the time of inspection, there were 18 nursing vacancies across the service. Most of the nursing vacancies were covered by staff who were employed via an agency, often on a longer-term block-booked basis. Staff minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.

  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.

  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

  • 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.

  • The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • Staff did not always manage patients physical healthcare needs well in the eating disorder service.

Various between 21 August and 7 September 2020

During an inspection looking at part of the service

We undertook a focussed inspection to follow up on information of concern received by CQC during July and August 2020. During this inspection, we looked at the core service ‘wards for people with a learning disability or autism’ which was provided on the Keston Unit. We did not inspect the other core services provided by The Priory Hospital Hayes Grove.

We identified concerns in relation to the safety, quality and leadership of services as a result of this inspection. We used our powers under Section 31 of the Health and Social Care Act 2008 to take immediate enforcement action and imposed additional conditions on the provider’s registration. This meant that the provider needed to make immediate changes to the leadership of the Keston unit, urgently undertake a review of the sexual safety of the patients on the ward, make urgent changes to the way closed-circuit-television (CCTV) cameras were used in patient bedrooms, and make urgent improvements to the provision of therapeutic activity to aid patients in their recovery.

We had previously inspected ‘wards for people with a learning disability or autism’ in January 2020, where it was rated as inadequate. At that time we used our powers under Section 31 of the Health and Social Care Act 2008 to take immediate enforcement action and placed a condition on the provider’s registration. This meant that the provider could not admit patients to the Keston Unit until improvements had been made. This condition remains in force.

At this inspection we inspected aspects of the safe, effective and well-led key questions. We did not re-rate the key questions we inspected. The previous overall rating for this core service of inadequate remains unchanged.

During this inspection we found:

  • The ward did not have sufficiently skilled leadership and work to improve the culture of the ward was in its infancy. There was no clear service model and a lack of robust plans to transition to an appropriate service model that supported patients to develop skills to enable them to live within the community.

  • The service did not always provide safe care. Sexual safety risks were not adequately identified or managed and the ward remained non-compliant with guidance relating to same-sex accommodation.

  • The service did not always promote the privacy and dignity of patients because closed-circuit television (CCTV) cameras had been activated in patient bedrooms without the consent of patients for the purpose of protecting staff against potential allegations of abuse.

  • There were not enough therapeutic activities available to patients that aimed to develop their daily living skills, despite the fact most patients were being prepared to be discharged to community settings following a significant amount of time spent in hospital.

  • Improvements needed to be made to the quality of staff handover meetings, to minimise the risk of medication errors occurring and to prevent the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because some staff did not wear face coverings correctly.

  • The service had a track record of struggling to sustain improvements including improvements to therapeutic activity provisions, discharge planning and in ensuring the ward complied with guidance on same-sex accommodation.

21 and 22 January 2020

During an inspection looking at part of the service

In this inspection, we only inspected the core service wards for people with a learning disability or autism. We did not inspect the other core services provided by The Priory Hospital Hayes Grove. When we inspected all four core services provided by the hospital in October 2018, we rated it as Good overall. At this inspection, we did not review the overall rating for the hospital.

Due to the concerns we found during this inspection, we used our powers under section 31 of the Health and Social Care Act to take immediate enforcement action and placed a condition on the provider’s registration. This meant that the provider could not admit patients to Keston Ward until improvements had been made.

Our rating of wards for people with learning disability or autism went down. We rated it as inadequate because:

  • The service did not always provide safe care. The ward environment was not entirely clean or suitable for the needs of autistic patients. The wards did not have enough permanent nurses. On some occasions, nurses used restrictive practices when therapeutic approaches may have been more appropriate. Staff did not always have the skills required to develop and implement good positive behaviour support plans. Many staff found it difficult to work with patients who displayed behaviour that staff found challenging. There had been two serious incidents of staff assaulting patients. The service did not have robust systems for ensuring that all staff were aware of risks and incidents.
  • Staff did not always create holistic care plans. Some staff did not have care plans for specific physical health needs. Some care plans did not appear relevant to the patients. Care plans and risk assessments were not updated in a meaningful way.
  • Managers did not ensure that staff received training or supervision. Permanent staff had not received supervision for six months. Agency staff made up a large proportion of staff working on the ward. They did not receive supervision. Agency staff were not required to have any experience of working with autistic patients. Managers did not have systems for assessing or monitoring the competency of agency staff.
  • Staff did not always treat patients with compassion and kindness. We saw staff speaking to a patient abruptly. Patients said that some staff were rude and they found some staff intimidating. Temporary staff had a limited understanding of patients’ needs.

However,

  • Staff followed good practice with respect to safeguarding
  • Staff provided treatments suitable to the needs of the patients cared for in a ward for people with autism and in line with national guidance.
  • The ward teams included or had access to specialists required to meet the needs of patients on the wards.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • They actively involved patients and families and carers in care decisions.

23-24 October 2018

During a routine inspection

We rated the Priory Hospital Hayes Grove as good because:

The service had addressed the concerns raised following our last inspection in February 2017. For example, the service had updated all ligature risk assessments and included steps to mitigate risks in these assessments. On Keston Ward, occupational therapists had developed an activities timetable to suit the needs and interests of patients. This included activities at weekends. Discharge planning on Keston Ward has also improved.

All the services provided care and treatment recommended by national guidance including medicines and psychological therapies. Psychological therapies included cognitive behavioural therapy, mindfulness, family therapy and anxiety management.

The service had robust policies and procedures to ensure that medically assisted withdrawal from drugs or alcohol was done safely in accordance with national guidance. This included monitoring patients’ symptoms of withdrawal four times a day using a nationally recognised assessment tool. All permanent staff had completed training and competency checks in ensuring the safety of patients withdrawing from drugs or alcohol.

Patients across all the services said that staff were kind, friendly and supportive. Patients said they felt comfortable talking to staff and they valued the support they received.

Multidisciplinary teams across all the wards worked well together. These teams had extensive knowledge, skills and experience of planning and delivering care to their specific patient groups.

Staff on Keston Ward maintained safety on the ward whilst providing a least restrictive environment. Staff implemented positive behaviour support plans that followed best practice in anticipating, de-escalating and managing challenging behaviour.

Patients’ representatives attended monthly clinical governance meetings and were involved in decisions about the service.

Services were provided in a comfortable, well-maintained and welcoming environment. Patients said the food was very good. The restaurant offered good quality meals including a range of healthy options.

However,

Staff on Keston Ward did not always carry out and record physical observations and examinations of patients. For example, we found that daily blood test for a patient with diabetes were not being completed every day. We also found that daily monitoring of vital signs for a patient with a complex co-morbidity had not been completed for six consecutive days.

The vacancy level for permanent nurses was above 50% on all wards. This meant that the service relied on agency staff to ensure there were sufficient staff on all shifts. Patients on Keston Ward and the at eating disorders service said the use of agency staff led to inconsistency in the quality of nursing.

Supervision sessions with staff were not held consistently. Records showed that discussions in supervision sessions were not always sufficient to develop staff and improve services.

Incidents were not always investigated in a timely manner. Findings from investigations into incidents were not always shared with ward staff.

The provider could do more to separate the male and female sleeping areas in order to increase patient’s privacy and dignity.

14-16 February 2017

During an inspection looking at part of the service

We rated The Priory Hospital Hayes Grove as Requires Improvement because:

  • We had some concerns with safety systems in place across the hospital. Ligature risk assessments for each ward were not completed accurately, which may have placed patients at risk. The risk assessments were also not available to staff on each ward to ensure that they were taken into account.
  • Staff recorded insufficient details of patient physical restraint and patients were not always offered a formal debrief following a restraint, as is good practice.
  • Patients were not always monitored after receiving rapid tranquilisation to ensure their safety. There were gaps in records of nasogastric feeding, which did not demonstrate that all appropriate safety checks had been undertaken.
  • At the previous inspection in November 2015 we identified that records of stock medicines in the hospital were not being maintained as the medicine were moved between wards. Despite an improvement on the other wards, staff were still not monitoring the receipt of stock medicines from the acute ward to Keston Ward, to ensure that they did not go astray.
  • At the previous inspection in November 2015 we identified that staff on the eating disorder units were not receiving sufficient supervision. At the current inspection we found that staff were not being provided with regular one to one management supervision throughout the hospital, particularly on the eating disorder and autism ward. Team meetings were also not being held regularly to ensure effective team working.
  • Patients were not satisfied with the range and frequency of activities on Keston Ward, and patients on this ward did not receive sufficient support with planning for discharge. The space limitations of the ward were also particularly challenging for some patients with autistic spectrum disorders.
  • Ward managers did not have direct access to all relevant information about their ward’s performance, and ward staff were not always aware of the outcomes from incidents, complaints and audits.

However:

  • At the previous inspection in November 2015 we identified that risk assessments were not detailed enough on the acute ward. During the current inspection, we found that there was an improvement in the recording of individual risks for patients in the acute ward to ensure their safety.
  • At the previous inspection in November 2015 we identified that allegations of historical sexual abuse were not being addressed appropriately on the acute ward. During the current inspection, we found that there were improved systems in place to ensure that disclosures of allegations of historical sexual abuse from patients on the acute ward were treated as safeguarding issues.
  • At the previous inspection in November 2015 we identified that specialist training had not been provided for staff on each ward. During the current inspection, we found that specialist training had been provided to staff on the eating disorder units and autism ward, and there were plans for a comprehensive training programme in substance misuse for acute ward staff.
  • At the previous inspection in November 2015 we identified that on the acute and eating disorder wards there were not clear zones for male and female patients. During the current inspection, we found that the provider had taken appropriate steps to maintain as much separation as possible.
  • Since our last inspection the provider had arranged improved access to an independent Mental Health Act advocate for patients detained under the Act, and an improvement in staff knowledge and completion of mental capacity assessments for patients when needed.
  • There was an allocated psychologist working in the eating disorder service providing support to patients on the two wards. Patients had access to a range of therapies recommended by national institute for health and care excellence guidelines, and were positive about the therapies provided.
  • A designated multi-faith room had been provided for patients.

9 and 10 November 2015

During a routine inspection

We rated Priory Hayes Grove as Requires Improvement because:

  • Safe systems were not in place to monitor stock medications used within the hospital. Staff were not monitoring the transfer of medications from the stock cupboard on Lower Court to other wards in the hospital. The lack of accurate records meant there was no clear audit trail for this medication.
  • The risk assessments on the acute ward, which were being completed as part of the assessment and care planning process, were not comprehensive. When risks were identified there was no clear management plan to minimise risk and ensure that this was incorporated into the care given to patients.
  • The provider had not ensured that staff had the skills and support to provide care to patients with complex health and care needs that were admitted to the hospital. It had not provided specialist training to equip staff with the skills to meet the needs of patients with substance misuse problems, eating disorders and autistic spectrum disorders. Also the provider did not ensure that staff working in the eating disorder service received regular individual supervision.
  • Although there were designated safeguard leads, when people who used the service on Lower Court disclosed allegations of historical physical or sexual abuse, these concerns were not reported to the local authority responsible for safeguarding. In addition, there was no robust audit of safeguarding alerts to ensure these had been appropriately and referred to the local authority.
  • The provider had not ensured that patients’ privacy, dignity and safety was maintained through the provision of same sex accommodation. Although patients had ensuite bathrooms and toilets, the bedrooms were not separated as far as possible into male and female zones.

However:

  • The Priory Hayes Grove Hospital was providing a service where patients felt respected, listened to, safe and supported.
  • The culture and staff morale was positive and staff told us that they enjoyed working at the hospital and caring for people who use the services.
  • Patients had access to a range of appropriate therapeutic interventions.
  • We were told that patients thought the food, which was cooked on site, was very good.
  • There were good levels of staffing across the hospital, which meant that patients received their care and treatment in a timely manner.
  • Most incidents were reported and there was learning from these incidents.

10 September 2014

During a routine inspection

We visited Keston Ward which treats people with Asperger's and autistic spectrum disorders and Lower Court which provides acute mental health care and an addiction therapy programme. We spoke with seven staff and four people who were receiving a service, and the relative of one person who was receiving a service. We also observed care being provided to people who use the service on Keston Ward. We spoke with Keston Ward Manager, Lower Court Charge Nurse, the corporate Quality Improvement Lead, the Clinical Services Manager, and the Hospital Director. . We examined the personal files of 10 people using the service on the day of our visit and also looked at other records relating to the provision of service.

We found that where people did not have the capacity to consent, the provider acted in accordance with legal requirements. However the provider may find it useful to note that for some people their capacity assessments were inappropriately grouped together. Some staff were not familiar with the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards (DOLS). Staff were also unable to tell us the frequency of advocacy visits to the hospital, or identify when the next advocacy visit would take place. These factors could mean that people who use the service are at risk of not being able to give valid consent to their care and treatment and not having their human rights respected.

People experienced care, treatment and support that met their needs and protected their rights. The provider may also find it useful to note that whilst people who use the service told us that they were aware of their care plans, the majority told us that they did not receive a copy of their care plan.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard and that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

13, 17 December 2013

During a routine inspection

Some people using the service and relatives we spoke with were very positive about the service. They told us treatment was having a good effect, in contrast with other hospitals they had attended. For example, one person said; 'I really like it. I've been on a lot of units' This is the most well I've been in the last eight years'. A relative we spoke with said; 'We're very pleased. [Our daughter's] doing very well. She's been in a lot of different hospitals over the years. [The staff] made us feel welcome [and] don't take it out on us.'

Most other people we spoke with told us they liked being at the hospital, and the staff, and that they felt they were getting better. A few people told us they would like staff to be able to spend more time with them, which they felt would be beneficial.

We found people experienced care and support that met their needs. However the provider must take further action to put in place arrangements to assess people's capacity to make specific decisions in relation to their care and treatment; and to establish its authority to continue to provide care and treatment to a person when they lack capacity to make a specific decision. The provider had appropriate arrangements in place to manage medicines safely, and to recruit suitably qualified staff who were of good character and fit for the work. An effective system was in place for monitoring the quality of service that people received.

25 February 2013

During a routine inspection

We inspected the hospital with an Expert by Experience and a Mental Health Act Commissioner. We visited three units at the hospital during our inspection. People using the service told us they were happy with the care and treatment they received and one person said "I have improved since I came here". People using the service said staff were approachable and they could speak to staff whenever they wanted to. However, a small number of people told us they did not agree with their care plans and had not received information on advocacy services to support them in expressing their views. We found that the hospital had not followed the code of practice for depriving people of their liberty in at least one case, and that assessments of capacity had not always been completed. People's needs were assessed and care was delivered in line with their needs. We found that complaints were mainly handled in line with the provider's time scales.

The Mental Health Act Commissioner will produce a separate report which focuses on the experiences of people detained at the service.

28 January 2011

During an inspection in response to concerns

People we spoke to said they felt that they were able to make choices and found the hospital provided good care in pleasant surroundings.

People were happy with the quality of food and their individual rooms; they said that they were provided with adequate refreshments throughout the day.

People we spoke to felt involved in their care and treatment programmes.

People we spoke to said that there were sufficient activities during the week although week-ends were very quiet if they didn't have visitors.

People we spoke to felt that some areas in the grounds were not kept as tidy as they could be.

Some people we spoke to felt that there had been delays in starting their care treatment.

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.