Priory Hospital Roehampton provides inpatient child and adolescent mental health services. The service provides mental health care and treatment for children and young people aged between 12 and 18.
We did not re-rate the overall service following this inspection. It remained good overall. At our inspection in April 2021 we rated the domain of safe as requires improvement. We rated effective, caring, responsive and well-led as good.
This was a focused inspection that covered specific aspects of safe, effective, caring, responsive and well-led. We undertook a short announced focused inspection of this service due to the increase in the number of self-harm incidents reported to the CQC by the provider and to follow up on the actions taken by the service to address the breach of regulation from our previous inspection.
The service had made many improvements since our last inspection in April 2021, but further work was needed to fully address the breach of regulation and to ensure that improvements were embedded and sustained.
The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. There was now a clinical psychologist, deputy ward manager and ward consultant for Lower Court. Managers ensured that these staff received training and supervision. The ward staff worked well together as a multidisciplinary team.
The ward environments were safe and clean.
Staff assessed and managed risk well. They minimised the use of restrictive practices and had arrangements in place for safeguarding.
Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed.
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.
Staff treated patients with kindness and respect.
The service was well led. Governance processes had been strengthened and mostly operated effectively and performance and risk were managed well.
Staff feedback was positive, they reported that morale and the culture within the service were improving. Staff felt respected, supported and valued. They could raise any concerns without fear and reported that their concerns were taken seriously. Leaders were visible in the service and approachable for patients and staff.
Whilst the service had a robust improvement plan for the recruitment, retention and development of qualified, non-qualified and therapy staff, there was still a significant use of agency staff. Vacancy rates for nurses and the use of agency staff were slowly reducing.
Not all agency staff were aware of the potential environmental risks. The quality of induction for agency staff was not consistent across the service. Not all agency staff had a full understanding of safeguarding in relation to children and young people. Agency staff who were not registered nurses did not have the opportunity to routinely access and review patient records. Regular agency staff did not receive supervision.
Regular staff meetings and debriefs following incidents on Lower Court did not take place.
Systems to ensure that learning from incidents were not fully developed to ensure that learning was fully embedded.
The care pathway on Lower Court was not clear. The service had commenced a strategic review of the CAMHS service.