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The Priory Hospital Roehampton Good

Inspection Summary


Overall summary & rating

Good

Updated 3 May 2019

We rated The Priory Hospital Roehampton as good because:

  • Staff provided emotional and practical support for patients. Staff took the time to understand patients and their needs and were sensitive, discreet and compassionate when providing care. Patients reported that staff were polite and helpful and treated them with kindness and respect.

  • Staff undertook a comprehensive risk assessment of all patients when they were admitted. Specific areas of potential risk were highlighted and staff put in place effective risk management plans. Potential patient risks were reviewed during nursing handovers and multidisciplinary meetings. Patients had comprehensive mental and physical health assessments when they were admitted to the hospital. Patients mental and physical health were reviewed regularly during their admission.
  • Patients’ treatment followed best practice guidance, including guidance from the National Institute for Health and Care Excellence (NICE). Patients had access to a range of evidence-based psychological treatment and therapy.
  • Patients were involved in their care. They developed their own care plans and their individual needs were met. Staff involved patients’ relatives or carers in their care and treatment, if the patient consented.
  • The hospital safeguarding lead was a qualified social worker. They met with the substance misuse therapy team each week to discuss patients. The aim of this meeting was to identify if any safeguarding issues had arisen during patient therapy groups.
  • The acute wards provided support groups for the family members and carers of patients. These included sessions with and without the patient being present.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. We saw examples of where staff had made improvements to the service as a result of feedback from patients, families and carers.
  • Senior leaders provided strong leadership. Two new senior managers had, in a short space of time, made a demonstrable impact to the safety and quality of care provided to patients. Staff found ward managers and senior managers accessible and approachable. Staff felt confident that they could raise concerns. Staff spoke highly of the management team and their colleagues, and felt respected, supported and valued. Senior managers met monthly with staff for breakfast. This provided an opportunity for informal conversations to generate ideas and discuss issues.
  • There was a comprehensive governance system to monitor the quality and safety of services. This included a system of audits, procedures and practices which monitored the safety and quality of care. For example, the system of audits for patients having substance misuse detoxification was detailed and ensured best practice guidance was followed at each stage of treatment. Significant amounts of managers’ time was focused on identifying how the safety and quality of care could be improved. Incidents and mistakes were viewed as learning opportunities and there was shared learning across the services. There was a culture of openness and transparency.

However:

  • Staff did not provide written information to patients that left alcohol or drug detoxification treatment early. Patients were verbally given advice from staff regarding their reduced tolerance and complications of alcohol withdrawal such as seizures. The ward manager planned to produce written information for patients shortly after the inspection.
  • Although Lower Court filled shifts for registered nurses with bank and agency staff, there were five registered nurse posts vacant at the time of the inspection. There was potential for this to affect the consistency of care to young people.
  • Some patients being admitted for alcohol or drug detoxification did not provide consent for hospital staff to contact their GPs. This meant information concerning potential risks in detoxification treatment was only based on information the patient provided. However, patients had a comprehensive assessment on admission and their detoxification was monitored closely. Any risks to the patient during treatment were identified quickly.
  • For two hours a day, young people on Lower Court could only access their bedrooms with the support of staff using a fob system. This restriction meant young people could not get to their bedrooms without staff assisting.
  • The garden on East Wing was bare with high fences. The garden lacked comfort and did not allow for a therapeutic atmosphere.

  • Three young people on the child and adolescent eating disorders ward, Priory Court, said that some staff were rude and made inappropriate comments.
  • Four young people on the child and adolescent mental health ward, Lower Court, said that staff did not always knock on their bedroom doors before entering.
  • Some young people on Priory Court described a lack of activities at weekends which led to them becoming bored.
Inspection areas

Safe

Good

Updated 3 May 2019

We rated safe as good because:

  • Staff undertook a comprehensive risk assessment of all patients when they were admitted. Specific areas of potential risk were highlighted and staff put in place effective risk management plans. Potential patient risks were reviewed during nursing handovers and multidisciplinary meetings. Patients having alcohol or drug detoxification had a pre-admission risk assessment, and were only admitted if risks could be managed by the hospital. Patients having alcohol detoxification are particularly at risk of serious complications during treatment.

  • The management team worked hard to ensure safe staffing levels, and there were very few nursing shifts that were short of staff. ‘Flash meetings’ took place daily where staffing and patient risks were reviewed for all patients in the hospital. Staff were redeployed as required to ensure patients were kept safe.

  • There had been a number of changes to minimise the risks of the ward environments. Due to restrictions on building development a number of ligature risks remained. However, these risks were effectively minimised by the thoughtful positioning of staff, closed-circuit television cameras, admission criteria, use of observations by staff and individual patient risk assessment.

  • Staff knew how to identify issues requiring adult and children safeguarding referrals. Staff could describe direct and indirect risks to adults at risk and children. The hospital safeguarding lead met with the substance misuse therapy team weekly. The aim of this meeting was to identify if any safeguarding issues had arisen in patient therapy groups.

  • Staff were trained in using physical interventions. When it was necessary to restrain a patient they were not restrained in the prone position. This followed guidance from the National Institute for Health and Care Excellence (NICE) (Violence and aggression: short-term management in mental health, health and community settings, 2015). There had been 206 incidents of restraint in the last three months. The majority of these restraints concerned a small number of young people.

  • Overall, over 75% of staff had completed mandatory training. This meant staff had the knowledge and skills necessary for their roles. Most staff members who had not completed individual mandatory training courses were booked to undertake them.

  • Emergency equipment and emergency medicines were in place on all the wards and were checked by staff regularly. On West Wing, the staff response to a patient having a seizure was textbook.

However:

  • If patients left alcohol or drug detoxification treatment early they were not provided with written information concerning their safety after they left hospital. Patients were verbally given advice from staff regarding their reduced tolerance and complications of alcohol withdrawal such as seizures. The ward manager planned to produce written information for patients shortly after the inspection.

  • Although Lower Court filled shifts for registered nurses with bank and agency staff, there were five registered nurse posts vacant at the time of the inspection. There was potential for this to affect the consistency of care to young people.

  • Some patients being admitted for alcohol or drug detoxification did not provide consent for hospital staff to contact their GPs. This meant information concerning potential risks in detoxification treatment was only based on information the patient provided. However, the systems for monitoring the care and treatment of patients having detoxification minimised risks to the physical health of patients.

  • For two hours a day, young people on Lower Court could only access their bedrooms with the support of staff using a fob system. This restriction meant young people could not get to their bedrooms without staff assisting.

  • The nasogastric feeding rooms on East Wing did not provide a clean environment. The seats and trolley for nasogastric feeding were unclean. There were no cleaning records available to show when the rooms had last been cleaned. We raised this during the inspection and the provider responded immediately.

Effective

Good

Updated 3 May 2019

We rated effective as good because:

  • Patients had comprehensive mental and physical health assessments when they were admitted to the hospital. Patients mental and physical health were reviewed regularly during their admission.

  • Patients’ treatment followed best practice guidance, including guidance from NICE, such as depression in adults: recognition and management (NICE, 2018) and psychosis and schizophrenia in adults: recognition and management (NICE, 2014). Patients had access to a range of evidence-based psychological treatment and therapy.

  • Clinical audits were undertaken frequently and the results were used by staff to monitor and improve patient care. The system of audits for patients having substance misuse detoxification was detailed and ensured best practice guidance was followed at each stage of treatment.

  • Different healthcare professionals worked together effectively as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

  • Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment.

  • The service made sure staff were competent to carry out their roles Staff had access to regular supervision, appraisals and team meetings.

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

Caring

Good

Updated 3 May 2019

We rated caring as good because:

  • Staff provided emotional and practical support for patients. Staff took the time to understand patients and their needs and were sensitive, discreet and compassionate when providing care. Patients reported that staff were polite and helpful and treated them with kindness and respect.

  • Patients were involved in their care. They developed their own care plans and their individual needs were met. Staff involved patients’ relatives or carers in their care and treatment, if the patient consented.

  • The acute wards provided a range of support groups for carers and family members of patients. This included group sessions with patients and group sessions for families and carers alone

  • Patients were asked to complete a survey, 72 hours after they were admitted to the hospital. This survey focused on practical matters, such as whether patients had been provided with information and the quality of the food. A quarterly patient survey was also undertaken and the provider used the feedback to improve services. Patients could also feedback about the service in other ways, Patients were able to provide feedback in ways that suited their individual needs.

However:

  • Three young people on the child and adolescent eating disorders ward, Priory Court, said that some staff were rude and made inappropriate comments. Four young people on the child and adolescent mental health ward, Lower Court, said that staff did not always knock on their bedroom doors before entering.

Responsive

Good

Updated 3 May 2019

We rated responsive as good because:

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. We saw examples of where staff had improvements to the service as a result of feedback from patients, families and carers.

  • Plans for patients’ discharge started when they were admitted to hospital. This prevented patients’ discharge being delayed.

  • Patients’ relatives and carers were involved in their care and were invited to multidisciplinary meetings.

  • Changes to the environment on Garden Wing ensured that patients with reduced mobility could receive care and treatment. Three bedrooms with ensuites had been adapted for use by patients using wheelchair.

  • Staff and managers knew how to contact interpreters and obtain information for patients in non-English languages.

However:

  • The garden on East Wing was bare with high fences. The garden lacked comfort and did not allow for a therapeutic atmosphere.

  • Some young people on Priory Court described a lack of activities at weekends which led to them becoming bored.

Well-led

Good

Updated 3 May 2019

We rated well-led as good because:

  • Two new senior managers had been recruited to the hospital recently and joined the existing senior management team. In a short space of time they had made a demonstrable impact to the safety and quality of care provided to patients. This included developing a strong safety culture of learning from incidents and complaints.

  • Staff found ward managers and senior managers accessible and approachable. Staff felt confident that they could raise concerns. Staff spoke highly of the management team and their colleagues, and felt respected, supported and valued. They told us that since the last inspection many positive changes had been made and they felt supported during this process.

  • There was a comprehensive governance system to monitor the quality and safety of services. This included a system of audits, procedures and practices which monitored the safety and quality of care. A significant amount of managers time was focused on identifying how the safety and quality of care could be improved. Incidents and mistakes were viewed as learning opportunities and there was shared learning across the services. There was a culture of openness and transparency.

  • Senior managers engaged with staff to get ideas for the overall improvement of the service. They met weekly with staff for breakfast. This was an opportunity for informal conversations to generate ideas and discuss issues.

  • The senior management team had a strategic focus. The director of nursing had started to engage with other services and higher education institutions to adopt best practice and to tackle emerging areas of concern. Liaison with other services meant that staff in the hospital learnt from other services.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 3 May 2019

Specialist eating disorder services

Good

Updated 3 May 2019

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 3 May 2019

Hospital inpatient-based substance misuse services

Good

Updated 3 May 2019