All inspections: Woodbourne Priory Hospital

Governance processes were not always effective. Managers did not have oversight or take action in line with the providers policy in relation to environmental risk assessments, fire safety and evacuation procedures. We found there was no process in place for managers to ensure that physical health checks were carried out as per national guidance or that medical equipment and devices were in date calibrated and cleaned regularly.
We found concerns relating to infection prevention and control management, and some of the ward furnishings were not properly maintained within the acute wards. Cleaning records had not been completed in line with the provider's policy. The treatment room on Mulberry Ward was not clean and the fridge used to store specimens was dirty. Clinic rooms were not checked for out of date items regularly.
We were not assured that if males patients were admitted to the eating disorder service that the service would remain compliant with guidance on mixed sex accommodation. The allocated female lounge could, at times be used by families and carer to visit.
Within the acute wards and the eating disorder service staff did not maintain the privacy and dignity of patients at all times. In one care plan out of 23 reviewed we found negative and derogatory language which did not promote the patient’s dignity. Nine out of ten bedrooms on Aspen ward did not have curtains to maintain patients privacy. Staff walked through patient visit areas which impacted on the privacy or patients and their visitors.
Managers of the eating disorder service did not ensure that regular team meetings took place to or minutes meetings of the meeting shared in a timely way to discuss the outcomes of incidents or to provide staff with updates regarding ward processes.
Not all children and young people’s care plans were personalised, holistic and recovery orientated. Staff did not always actively involve children and young people or their families and carers in care decisions. We spoke with some children and young people who said they did not feel safe on the ward and that they whilst they were on enhanced support they have managed to hurt themselves. We were concerned as staff did not always follow the providers policy and procedures on the use of enhanced support.
Not all staff had the required training to ensure that they could meet the needs of the patients in their care.

However:

The service provided safe care. The majority of the wards seen were safe and clean. The service had enough staff. Staff assessed and managed risk well and followed good practice with respect to safeguarding. They minimised the use of restrictive practices and followed best practice in anticipating, de-escalating and managing challenging behaviour. It was evident that staff prescribed, administered, recorded and store medicines safely.
Leaders had a good understanding of the services they managed and could explain clearly how teams worked to provide high quality care. Leaders were visible in the service and approachable for patients and staff.
The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and wider service.
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. Staff worked well together as a multidisciplinary team. Ward teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
With the exception of the child and adolescent ward, staff had developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. They actively involved patients and families and carers in care decisions.

This was a focused inspection. Because of its limited scope, we did not rate any key questions at this inspection. You can view previous ratings and reports on our website at www.cqc.org.uk

The service did not ensure that the ward had enough suitably qualified staff to meet the needs of all children and young people.
The service did not ensure that risk assessments were always updated following incidents which indicated a change to risk factors
The service did not ensure that there was an effective system in place to manage the use of agency staff
The service did not ensure that staff received adequate support following incidents

However:

All ward areas were clean, well-furnished, and well maintained.
Children and young people said they felt safe, and that staff worked hard to meet their needs.
Staff understood how to protect children and young people from abuse.

Woodbourne Priory Hospital is owned by the Priory which merged with Partnerships in Care in November 2016. Woodbourne Priory Hospital is registered to provide care and treatment to children, young people and adults with mental health conditions, including those whose rights are restricted under the Mental Health Act. This was a focussed inspection in response to the publication of the prevention of future deaths document that was created after the coroners hearing into the death of a service user at the service in September 2020

Our rating of this service went down:

The service did not always provide safe care. Staff assessed and managed risk but not always responsively.
Governance systems put in place following a serious incident had not been fully embedded and we found systems to responsively capture and mitigate risks were failing.
There were inappropriate admission onto Acer Ward, which was designated by the hospital as a community facing ward. We were told that admissions to Acer ward would be limited to transfers from more restrictive areas of the hospital as patients recovered and specific spot purchased beds for patients that presented lower risks. When we reviewed recent admissions we established that some patients had been admitted from the community directly onto the ward that did not fit the admission criteria of low risk.
The majority of actions from independent and internal investigations had been addressed. However, there was still work ongoing to address some of the environmental issues that had been identified. Work was ongoing to address groundwork in the garden area of Beech Ward.

However:

The management team were responsive to concerns and responded quickly to information brought forward at the coroner’s inquiry and from the CQC inspection.
The daily ‘flash’ meetings allowed for an early review of incidents and the opportunity for lessons to be shared.

We served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. We told the provider we were considering whether to use our powers to urgently impose conditions on their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within a short timescale that described how it would address our concerns. The provider’s response provided enough assurance they had acted to address immediate concerns and we therefore did not progress with urgent enforcement action at that stage.

We did not rate The Manor at this inspection. We inspected Woodbourne Priory Hospital on 20-22 June 2017 and gave an overall rating for the hospital. The Manor was not opened until August 2017, therefore we will inspect and rate the ward at our next comprehensive inspection of Woodbourne Priory Hospital.

On this inspection, we found that:

There were sufficient numbers of skilled staff available on the ward for patients to access. There was good access to medical cover 24/7. Staff showed good knowledge of safeguarding and had a clear line of governance for reporting concerns.
Staff carried out environmental risk assessments of the ward area daily. Patients had individual risk assessments and detailed contingency plans in place in the case of emergencies.
Patients had detailed care plans in place and were aware of and in agreement with their therapy programme. The service offered a comprehensive therapy programme that offered therapies recommended by The National Institute for Health and Care Excellence.
Staff learned from incidents and the provider ensured learning from other areas of the service was shared.
All patients we spoke with were positive about their treatment and their experiences on the ward.
Staff knew who their senior managers were and told us they could raise concerns if needed and would be supported to do so. There were opportunities for staff to develop. Staff morale on the ward was good.

However:

The ward did not have a designated room for patients to see visitors with children. This was not in line with Priory policy and a potential safeguarding risk.
Nursing staff were not given guidance on what order they should administer as needed (PRN) medication. This meant that they may not have issued PRN medication in the order intended by the prescribing consultant.
There was no documented admission criteria and no standard operating procedure available at the time of inspection.
Not all staff were specially trained or showed good knowledge of identifying risks in treatment and detoxification for substance misuse. Less than half of the ward staff had been trained in this area at the time of inspection. Recent changes in leadership of the hospital had led to a delay in organising specialist training.

We did not rate Woodbourne Priory Hospital following our inspection.

At this inspection we found that:

Staff did not label topical medications for use on individual patients, therefore risking cross-infection.
The provider’s Rapid tranquilisation policy did not accurately reflect the current NICE guidelines [NG10] Violence and aggression: short-term management in mental health, health and community settings, issued May 2015. The service did not monitor deviation from the guidelines.

Staff did not have access to guidance which covered individual patients medicines that were being used in the management of violence and aggression.

However:

At our last inspection we found that staff had not always completed security checks on Beech Ward. On this inspection, we found that the provider had put in place processes to address the issue and staff on all wards had completed ward security checks as required.
At our last inspection we found that mandatory safeguarding training completion was low. During this inspection we found average mandatory training rates had increased across all wards and the majority of staff had completed mandatory safeguarding training.
At our last inspection we found that staff had not always adhered to Priory’s policy on standards of dress, uniform and personal appearance. On this inspection, we found ward managers monitored this and completed regular audits of infection control.
Staff monitored room and medication fridge temperatures and ensured they were kept within a safe range.
Staffing levels were appropriate across all wards and Aspen Ward had increased from five day staff to six. This meant staff had more time to complete clinical duties and spend time with patients. Staff were always able to facilitate escorted leave.

We rated Woodbourne Priory Hospital as good because:

Staff carried out environmental assessments and identified and removed areas of risk on most wards.
Medications were stored safely and staff followed good management and administration processes on wards. There were adequate numbers of staff on wards and the provider could adjust staffing levels upwards as needed. Staff reported incidents and lessons were learned from incidents. There were good processes in place across all wards to share lessons learned.
Staff completed comprehensive assessments of patients on admission. Doctors monitored patients’ physical health regularly and following use of rapid tranquilisation. Care plans were holistic, recovery-orientated and included patients’ views. Patients had access to a therapy programme while on the ward.
Where patients were detained under the Mental Health Act 1983, their rights were protected and staff complied with the code of practice. There was a Mental Health Act administrator responsible for scrutiny of detention paperwork. Patients had access to Independent Mental Health Advocacy (IMHA). Mandatory training rates, including safeguarding training, overall were good across most wards.
Staff were caring, friendly, and respectful towards patients. Staff had a good understanding of patients’ needs and involved relatives in patients’ care. Patients had the opportunity to give feedback to the service about their care and treatment.
The governance structure that supported the safe delivery of services was good. Senior managers had good oversite and communicated well with ward staff. Staff knew how to use the whistleblowing process and felt able to raise concerns. Staff carried out quality walk arounds to ensure good quality services were maintained. Staff demonstrated the values of the organisation in their work.

However:

Emergency equipment was found to be out of date on two wards, despite staff signing to say it had been checked. Maple and Rowan wards we found out of date equipment in the emergency bag on the ward, despite staff signing to say it had been checked.
We found that the Mental Capacity Act diagnostic test was not present on the capacity assessment form. This meant that capacity assessments did not cover all areas required.
Staff did not carry out routine audits of paperwork relating to the use of the Mental Capacity Act at the time of our inspection. We did not find that capacity to consent to treatment was recorded correctly in all records.
Staff were not recording discharge plans comprehensively in care records on Maple, Beech and Aspen wards and patients we spoke with were unaware of their discharge plans.
Risk assessments on Maple and Beech wards were not consistently recorded in a clear manner and care plans included jargon.
Compliance rates for safeguarding adults and children training were very low on Maple, Beech and Aspen wards.
Recording of staff supervision was not consistent across all wards and did not take into account managerial and reflective practice sessions.
Not all staff were aware of the values of the organisation. The organisation had undergone a merger and rapid expansion in the 12 months before inspection and the values of the organisation had not yet been embedded.

We carried out a focused inspection on Aspen Ward.
We found the layout of the ward meant that staff could not see all parts of the ward. Staff had mitigated this with regular observations of the ward. However, incidents had occurred between patients while staff were elsewhere in the building carrying out observations.
We found that following the reporting of incidents to staff, measures were immediately put in place to safeguard patients on the ward. The service had taken steps to keep patients safe and to reduce the likelihood of further similar incidents from occurring.
The service had reported the incidents to external agencies including the police and local authority where appropriate.
The service had put temporary measures in place to ensure patients were kept safe while they found a longer term solution. The service were also in the process of investigating the incidents internally and learning from the incidents.

Staffing levels on Aspen, Maple, Beech and Mulberry wards were appropriate and met required staffing levels for the ward.
Bank and agency staff were inducted to the ward and all nursing staff employed on a bank or agency basis were interviewed to ensure they were suitable for the position
Patient records showed that risk assessments had been undertaken and were comprehensive and completed to a thorough and high standard. Records showed staff had completed regular and appropriate levels of observation of patients and had recorded these effectively.

We rated Woodbourne Priory as good because:

Staff worked well together to assess and plan for the needs of patients. There were a range of professionals available to meet patients’ needs. Staff provided patients with care and support to offer them the best chance of recovery. There were a range of therapies available to patients and patients told us they enjoyed the therapies on offer.
The service routinely sought patients’ ideas and feedback and consistently made changes to the way they ran the service because of this. The service delivered effective programmes of therapy and specialist rehabilitation for the different patient groups.
Staff completed patient-centred risk assessments and care plans on most wards. Patient records were comprehensive and in good order. Staff considered mental capacity and assessed those they believed to lack capacity. They advised patients of their rights under the Mental Health Act. Staff addressed physical healthcare needs of patients and supported them to manage their physical health.
The ward provided patients with a comfortable and homely environment. Wards were visibly clean and furnishings in good order. Patients were provided with high quality meals and had access to food and drink 24 hours a day. Patients were able to personalise their own space. The ward areas reflected the presence and personalisation of patients in recovery.
The service had recruited new managers and they demonstrated the skill and experience needed to drive forward further improvements. There were systems in place to allow managers to audit the quality of care. Supervision and annual performance reviews were routinely held between staff and managers and were most were up-to-date

However, we also found:

The service did not follow its own policy in privacy, dignity and mixed sex accommodation by not allocating male and female areas of Maple ward at different ends of the ward. Guidance on same-sex accommodation requires providers with patients on mixed wards to be grouped to achieve as much gender separation as possible (for example, women towards one end of the corridor, men towards the other).
Care plans and staff handovers on one ward were not written in a way which reflected patient views and used clinical terminology.
Dual signatures were missing on two controlled drugs records on two wards. This was not in accordance with the providers drug administration guidance and policy.

We inspected one ward that provided care and treatment to young people. We spoke with four young people aged twelve to seventeen years including people whose rights were restricted under the Mental Health Act.

Young people were supported to understand the care choices available to them. Where their rights were restricted under the Mental Health Act the appropriate forms were in place to authorise their treatment. People who were using the service on an 'informal' basis said they were involved with their treatment plans. One young person told us, "It's lovely here. Everyone is treated with the same respect."

Young people's capacity to consent to treatment was assessed when they were admitted. Where they did not have the capacity to consent, the provider acted in accordance with legal requirements. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Each risk presented by the person's needs or condition was identified a care plan put in place to manage and treat it.

People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines. The service worked closely with an external pharmacy supplier and a pharmacist visited regularly to provide advice and support.

The provider formally notified us of significant incidents concerning young people throughout the year and had made referrals to other authorities as appropriate.

During our inspection of this hospital we focused on and spoke with five young people on one ward at the service. Some had their rights restricted under the Mental Health Act. Each person knew about their care plans and was well informed about the aim of their care including their medication.

Young people told us that the ward provided a good, caring and supportive service. We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety. Risks presented by the person's complex conditions were identified, assessed and managed through an agreed plan.

People's treatment and progress was monitored by regular meetings of the professionals involved with their care. Parents said they had 'excellent involvement' with their child's principal practitioner and community services and they understood the strategy for managing their child's safe return home and into community provision.

Young people were protected against the risk of unlawful or excessive control or restraint by arrangements such as including them in agreeing safe ways for staff to intervene in order to prevent self harm.

Young people told us that there were enough staff to look after them during the day and at night. We found there were sufficient numbers of staff on duty with the right skills and experience to meet people's needs and further training was made available to them. People were made aware of and used the provider company's complaint system.

The purpose of this review was to ensure that medicines were prescribed and given to people safely. The review was completed by a pharmacist inspector. This visit was to follow up on previous concerns.

We found that improvements had been made which should ensure people using the hospital services received their medicines, as prescribed, safely. We found that the medicine management systems in place were well organised and under constant review to ensure a high level service was maintained.

This review followed an earlier review we completed on Mulberry Unit at the hospital. We visited hospital on the 25 and 26 August 2011. These visits included all the units at the hospital. We identified similar concerns with the quality of care to those we found on Mulberry Unit. We identified that the provider was responding to the issues identified in the earlier review. We discussed the wider concerns with the provider and an action plan was agreed. We accepted that we needed to give the hospital time to deliver the improvements required across the hospital.

The hospital provided us with a weekly update against the action plan agreed. This included evidence to demonstrate the changes made. This included a range of audits, example care plans and training information. We followed up on our concerns by visiting the hospital again on the 27 October 2011 to ensure that the improvements reflected in the information received was being put into practice.

When we visited on the 27 October 2011 people using the hospital services told us they were happy with the quality of care and treatment received which met their aspirations along their road to recovery. Comments made by people included, ''Beyond my expectations,'' ''It's excellent, wanted and waited for nothing, '' ''Team work is astonishing'' and ''Support is always there for people.''

A person described to us that when they came to the hospital they were shown around the ward area, their room and met staff. This person told us that information about the hospital and how to make complaints was also given to them.

Three people we spoke with told us that they were well aware of why they had to be in hospital. They said that staff speak with them often and explain what is happening and why. A person told us, ''They (staff) get you where you want to be''. Another person we spoke with told us about the therapy support they were receiving and commented '''.a hug when needed''.

This review followed an earlier review we completed on Mulberry Unit at the hospital. We visited hospital on the 25 and 26 August 2011. These visits included all the units at the hospital. We identified similar concerns with the quality of care to those we found on Mulberry Unit. We identified that the provider was responding to the issues identified in the earlier review. We discussed the wider concerns with the provider and an action plan was agreed. We accepted that we needed to give the hospital time to deliver the improvements required across the hospital.

The hospital provided us with a weekly update against the action plan agreed. This included evidence to demonstrate the changes made. This included a range of audits, example care plans and training information. We followed up on our concerns by visiting the hospital again on the 27 October 2011 to ensure that the improvements reflected in the information received was being put into practice.

When we visited on the 27 October 2011 people using the hospital services told us they were happy with the quality of care and treatment received which met their aspirations along their road to recovery. Comments made by people included, 'Beyond my expectations,' 'It's excellent, wanted and waited for nothing, ' 'Team work is astonishing' and 'Support is always there for people.'

A person described to us that when they came to the hospital they were shown around the ward area, their room and met staff. This person told us that information about the hospital and how to make complaints was also given to them.

Three people we spoke with told us that they were well aware of why they had to be in hospital. They said that staff speak with them often and explain what is happening and why. A person told us, 'They (staff) get you where you want to be'. Another person we spoke with told us about the therapy support they were receiving and commented '.a hug when needed'.

We could only speak with two people using the service on the day of our visit; this was due to people being involved in their treatment programmes throughout the day. The people we did speak with told us that they enjoyed staying at the hospital. They told us that they were able to use computers, that staff were friendly and that they had plenty of activities to keep them occupied.

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.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Woodbourne Priory Hospital

All Inspections

10 January 2023, 18 January 2023 and 25 January 2023

During a routine inspection

31 August and 1 September 2022

During an inspection looking at part of the service

5,6,11,13 May 2022

During an inspection looking at part of the service

3-4 April 2018

During a routine inspection

To Be Confirmed

During an inspection looking at part of the service

20-22 June 2017

During a routine inspection

16/02/2017

During a routine inspection

4 May 2016

During an inspection looking at part of the service

5 November 2015

During a routine inspection

13 February 2014

During a routine inspection

23 January 2013

During a routine inspection

27 October 2011

During an inspection looking at part of the service

27 October 2011

During an inspection looking at part of the service

27 October 2011

During a routine inspection

8 August 2011

During an inspection in response to concerns

Mental Health Act Commissioner reports

Reports under our old system of regulation