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

The Priory Hospital Woking

Overall: Good read more about inspection ratings

Chobham Road, Knaphill, Woking, Surrey, GU21 2QF (01483) 489211

Provided and run by:
Priory Healthcare Limited

All Inspections

6th December 2022

During an inspection looking at part of the service

Our rating of this location improved. We rated it as good because:

  • The service provided safe care. The ward environments were safe, clean and well furnished. The wards had enough nurses and doctors. Staff assessed and managed risk well. They analysed and minimised the use of restrictive practices through clinical governance, they 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 audits 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.
  • Although there was minimal use of the Mental Health Act 1983 and the Mental Capacity Act 2005, staff understood and discharged their roles and responsibilities safely.
  • Patients reported that staff treated them with compassion and kindness, respected their privacy and dignity, and understood their individual needs. They actively involved patients, families and carers in care decisions.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • Maple Ward, the female only ward had no signage outside the doors to the ward indicating it was a female only area. This meant it was sometimes difficult for male patients to differentiate between the ward areas.

2 June 2021 and 3 June 2021

During a routine inspection

The Priory Hospital Woking provides an acute inpatient service and an inpatient substance misuse treatment programme for men and women of working age.

During the inspection we found several areas of concern. Following this inspection, we wrote to the provider and told them that we required them to provide us with assurance that they would make immediate and ongoing improvements otherwise we would use our powers under Section 31 of the Health and Social Care Act 2008 Act. Section 31 of the Act allows CQC to impose conditions on a provider's registration if the provider does not provide assurance that they are addressing our concerns. The provider responded to us with an action plan that described the immediate and ongoing actions it was taking.

Our rating of this location went down. We rated it as requires improvement because:

  • The management of ligature risks across the hospital was not robust. Not all of the wards were safe for all patients. The older part of the hospital had areas with significant ligature risks. The majority of these ligature points were not easily observable by staff and were in corridors with a closed door. All patients could have access to these areas.
  • Staff did not have written guidance which included patients’ risks of self-harm and suicidality, to determine which type of room a patient would be allocated to: a safer room, safe room or standard room. They did not have guidance on how staff should respond if a patient's risk changed when they were in a standard bedroom.
  • Staff did not safely manage the searching of patients on return from leave or admission. Patients at a community meeting that we observed, told ward staff they still had lighters and illicit substances. Patients told us that searching was inconsistently applied when returning from leave or returning from off the hospital grounds.
  • Staff did not record the rationale for decreasing observation levels or record a rationale in patients risk assessments for deciding which type of room a patient would be allocated to: a safer room, safe room or standard room.
  • The governance processes needed to be strengthened to provide assurance that all the measures needed to maintain patient safety were in place.
  • Patients told us they were involved in planning their care and treatment but did not receive a copy of their care plan.
  • Staff and patients told us that, due to the COVID-19 pandemic, patients were not allowed visitors on site, unless there were exceptional circumstances. Staff told us that this was a Priory wide policy.

However:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers made sure they had staff with the range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new 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.
  • Staff followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • On the whole, staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff felt respected and valued. They said the provider promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.
  • 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 we spoke with were complimentary of the hospital director and director of clinical services. Staff said they were approachable and listened to feedback regarding the service.

10th April 2019

During an inspection looking at part of the service

This was a focused inspection carried out as a result of concerns raised during a recent Mental Health Act monitoring visit. These concerns raised were about the use of the Mental Health Act (MHA), the use of the Mental Capacity Act and management of environmental risks and individual patients’ risks. We therefore focused on these areas in our focused inspection.

  • Staff did not follow all the hospital’s policies and processes when they assessed and managed risks to patients. This meant that staff did not ensure that risks for patients with complex physical health conditions and risks that patients might harm themselves with ligatures were not always fully mitigated.
  • There was insufficient support and resources allocated to the administration of the MHA (we have raised this previously with the provider) which meant the hospital risked acting in breach of the Mental Health Act 1983 and its Code of Practice. The administrator was given insufficient time and training to ensure that all MHA documentation was correct. This meant that there was a risk that patients could be unlawfully detained or treated.
  • Staff did not comply with the Mental Capacity Act 2005. Staff did not assess and record capacity clearly for patients who might have impaired mental capacity. Staff did not ensure that best interests decision-making was in place for all patients who might have impaired mental capacity. This meant that the hospital could not ensure that all patients who might have impaired mental capacity had appropriate support to make decisions where they were able to do so. The hospital could also not ensure that all decisions made on behalf of patients who might have impaired mental capacity were made in the patients’ best interests.

17-18 April 2018

During a routine inspection

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We rated the Priory Hospital Woking as good because:

  • There were sufficient, appropriately trained, staff working at the hospital to meet the needs of the patients.
  • Staff were confident in recognising and responding to safeguarding concerns.
  • Medicines were securely stored and staff safely managed the administration of patients’ medicines.
  • Incidents were reported appropriately by staff using the hospitals electronic system and the lessons learned from investigating incidents were shared to all staff.
  • Patients received a comprehensive assessment from a doctor and ongoing monitoring of their mental and physical health by the hospital’s clinical staff.
  • Patients had access to a structured treatment programme that matched their needs.
  • The hospital’s multi-disciplinary team was cohesive and met regularly to review patient needs.
  • Staff used relevant tools to monitor patient progress and risks.
  • Patients’ concerns and complaints were recorded and investigated within the hospital policy target times.
  • The governance structure and processes were effective. There was a yearly schedule for clinical audit and plans in place for continuous improvement in the treatment programmes available to patients.

However

  • The amount of staff who had completed the training for the prevention and management of violence and aggression was below the hospital target.
  • The quality of patient care plans and risk assessments was variable and not all plans contained complete information.
  • Staff individual supervision rates had fallen below the hospital target due to a vacancy at ward manager level.
  • The administrative resource allocated to the Mental Health Act was insufficient for the amount of detained patients.

19 to 21 April 2016

During a routine inspection

We rated Priory Hospital Woking as good because:

  • All areas of the ward were clean and well maintained.
  • The feedback we received from the staff and the patients was that there was always enough staff available to meet the patients’ needs
  • Risk assessments were updated on a weekly basis and, in some cases, three to four times a week based on the individual patient’s needs and following incidents.
  • There was a strong culture of safeguarding adults and children within the staff team and staff were aware of who the local safeguarding lead was and the process to follow when considering safeguarding issues and how to raise a safeguarding alert.
  • All patients received a comprehensive physical health check by the resident medical officer on admission and we saw evidence that patients received additional physical healthcare when needed.
  • The patients were all aware of their treatment goals and had discussed these with their consultant and key worker. There was evidence in the care plans that this was well documented and plans were orientated towards recovery.
  • The patients we spoke with all felt comfortable to complain both informally to the management and formally if necessary.
  • Well-structured local clinical governance meetings were held on a monthly basis at the hospital and we saw evidence through the minutes of these meetings that the actions that were identified relating to the pillars of clinical governance were allocated to particular staff members and were being signed off and actioned.

However:

  • There were no occupational therapists employed at the hospital and there was no structured occupational therapy or recreational activity happening, the patients who were not receiving therapeutic treatment for addictions had little activity to occupy their time.
  • Patients told us that they were not able to have a key to their room and so were sometimes concerned about other patients being able to go in and out of their rooms if they forgot to ask a member of staff to lock their door. This was a blanket restriction as patients were not risk assessed regarding their safety to be able to lock their bedrooms.
  • It was unclear how the medical team was organised. Eight consultants worked in a self-employed capacity. The consultants worked cohesively with their individual teams supporting their individual patients but there did not appear to be a clear chain of responsibility for the psychiatry department.
  • The staff did not have an awareness of the vision and values of the Priory group. Staff members told us that they felt they had not been involved in the overall changes that the Priory group was going through at the time of the inspection.
  • The clinical review meetings we observed did not include consistent formal discussions around risk.
  • During the weekly ward meeting we did not observe that the nursing staff and the resident medical officer gave any feedback to the patient and the consultant on the patient’s clinical progress.
  • We were told that the therapists did not regularly record attendance for the inpatients who attended therapeutic groups and so it proved difficult to evidence clinical effectiveness for the inpatient groups.

23 December 2014

During an inspection looking at part of the service

We carried out this inspection to follow up on non-compliance from our previous inspection on 31 October 2013.

At the previous inspection we found that there were issues of non-compliance with infection control standards in the kitchen. Food was not stored safely and cleaning schedules were not consistently implemented and recorded.

At this inspection we found that the provider had addressed this. The kitchen was clean, and food was stored correctly.

The service had robust systems for checking cleanliness and staff were confident in using these systems.

31 October 2013

During a routine inspection

This was a joint inspection carried out with the Mental Health Act Commissioners. At this unannounced inspection we spoke with patients, staff and the registered manager. We also observed care practices and looked at records.

Patients we spoke with told us that staff were caring and thoughtful. We found that there was a mental health advocate service available to patients if they needed.

The patients that we spoke with told us that they thought the food at the hospital was good. We saw that patients had access to fresh food and drink throughout the day. Those patients that needed it were offered nutritional advice and support from staff.

On the day of our inspection we found that the overall cleanliness of the hospital was good. However there were some areas of the kitchen that needed a deep clean and none of the cleaning schedules in the kitchen were up to date.

We looked to see that staff had received all of the training appropriate to their roles and confirmed that this was the case. Staff that we spoke with told us that they always undertook training and that they felt supported.

There were effective systems in place to monitor complaints. Patients told us that if they wanted to make a complaint they would know how to. We saw that the hospital recorded all complaints and resolved them where they could to the patient's satisfaction.

14 March 2013

During a routine inspection

The people we spoke to were very complimentary about the care they received at the hospital. One person told us "My key worker is wonderful and has helped me to explore and deal with all the issues that I didn't know I had until I came here." Another person told us "This is my third visit and I feel very safe indeed here. My doctor is fantastic, but in fact you can go to anyone here and they will give you time and support." This was supported by our own observation that the staff appeared to know their patients well and went about their work in a friendly, calm and professional way.

The care records we reviewed were person centred and well maintained and there were procedures in place to keep records secure and confidential.

The provider had taken steps to protect people from abuse and to deal appropriately with concerns if they were raised. They had also taken steps to ensure that medicines were managed effectively and safely.

Staff working within the service were vetted and received induction training before starting work at the hospital. There were also systems in place to audit and monitor the quality of the services being provided.

30 January 2012

During a routine inspection

People who used the service told us they were involved in the planning of their care; that the consultant psychiatrist discussed their support options and treatments with them and their family. They said that they were provided with the patient information booklet, (service user guide) and that staff respected and recognised their individuality and human rights.

One person told us they were very much involved in their care. For example, if they wanted to take their medication earlier or later within reason then that would be ok with the staff. They said they were able and were allowed to make choices.

Another person told us they have made the decision not to attend residents' meetings. Instead they said they spoke with their psychiatrist or their named nurse and if their nurse was not on duty they would speak with another nurse.

People told us their care needs were based on their individuality, such as mental health and medical condition, likes and dislikes, social and day time activities and to maintain relationships with their families.

People said their treatment included their total involvement in their care. They said the therapy sessions had helped them to open up and discuss their feelings. They told us they liked the support they received from their therapist, psychiatrist and nurses.

People told us they did not feel they needed an advocate as they were quite able to discuss issues of concerns with their therapist , nurse or consultant. People said they felt very safe at this service. This statement was supported in the satisfaction survey undertaken by the service for the fourth quarter of 2011 in which 94.74% of people said they always felt safe.

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.