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

Priory Hospital Dorking

Overall: Good read more about inspection ratings

Harrowlands Park, South Terrace, Dorking, Surrey, RH4 2RA (01306) 644100

Provided and run by:
Partnerships in Care Limited

All Inspections

18 July 2023

During a routine inspection

Priory Dorking Hospital provides Acute care for adults of working age.

This was the service’s first inspection. We rated it as good because:

  • Staff assessed and managed patients’ risks well. They minimised the use of restrictive practices 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 including nurses, doctors, a clinical psychologist, a psychology assistant, an occupational therapist, and occupational therapy assistants. 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.
  • All patients said that the care and treatment they received was good and that staff behaved kindly towards them.
  • The service managed access to beds well and discharged patients promptly once their condition warranted this.
  • The service was well-led.
  • Staff felt respected, supported, and valued. They said the service promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

However:

  • The provider did not manage ligature risks well. The tools and audits used by the provider did not adequately assess and manage potential ligature anchor points. A ligature point is anything which could be used to attach a cord, rope, or other material for the purpose of hanging or strangulation. There were multiple ligature points in parts of the ward which the provider had not sufficiently mitigated. The provider did not have a robust ligature risk assessment in place at the time of our inspection to remove all ligature risks. The provider did not have governance processes in place to enable the systematic review and management of environmental ligature risks. We were concerned that the governance around how ligature risks were systematically audited, reviewed, and actions carried out were not evident or documented. Due to the nature of the concerns, we escalated our concerns to the management team, and the provider gave us immediate assurance of how they were going to mitigate the ligature risks and provided a robust action plan immediately after our inspection visit.
  • Leaders did not always have oversight of the safety of the ward.
  • Staff did not always ensure patients’ medicines were managed safely. We checked medicines and found that several medicines including tablets, liquid, and creams were out of date. We ensured the provider had removed the out-of-date medicines from the cupboard during our inspection.
  • We identified that some medical equipment was out of date such as back up pads for a defibrillator and some syringes which were out-of-date. We ensured the provider had removed the out-of-date equipment from the cupboard during our inspection.
  • Staff did not always review and record the effects of intramuscular rapid tranquilisation on the patients’ physical health including regular checking of their vital observations. Therefore, staff could not potentially detect any harmful physical health deterioration of the patients to mitigate against or reduce the risk of harm.
  • We identified gaps in the National Early Warning Signs (NEWS2) records because staff stored NEWS2 information on both paper record and electronically. Staff could not frequently total NEWS2 scores so staff could not quickly escalate any serious concerns to the clinical team.
  • Not all ward areas were clean, well maintained and fit for purpose. Most parts of the ward looked very ‘tired’ and needed maintenance and redecorating. We found damaged doors, flaking paintwork and holes in walls on the ward.
  • The service did not have enough permanent registered nurses but was in the process of recruiting to vacancies.
  • The occupational therapy team did not provide enough therapeutic activities for the patients during the weekend.

30 - 31 October 2018

During a routine inspection

We rated Pelham Woods as good because:

  • Both wards were safe and clean and received daily cleaning from domestic staff. Furnishings were well maintained and this included a recently renovated patient lounge area which was bright and welcoming. Convex mirrors had been installed in areas of the ward that had been identified as blind spots. Extra closed-circuit television cameras had been installed to cover areas of the garden which had been identified as difficult to observe continuously.
  • The service had carried out significant work to identify restrictive practices on the wards and the reason they may have been in place. Those restrictions that were necessary to maintain the safety of the wards were kept under regular review. This meant that the breach in regulation identified in the previous report had now been addressed.
  • The service had brought the staff and patients together to try to look at the way the wards were working and used the “Safewards” model which gives methods for reducing risk and coercion in inpatient wards. There were creative attempts to involve patients in all aspects of the service.
  • Patients had care plans which were up to date, personalised, holistic and recovery focused. The multidisciplinary team actively involved patients and their families or carers in all aspects of their care and treatment during weekly reviews. Staff undertook comprehensive physical health assessments for all patients. Patients were having dental and optician appointments and regular blood pressure and weight checks.
  • Patients had regular one-to-one time with staff and had access to groups such as walking, current affairs, gardening, goal setting and fitness with the support of technical instructors. They also provided recreational activities such as smoothie making and pampering sessions. Staff treated patients with dignity and respect and understood the needs of individual patients. Staff were proud of their work and the progress patients were making.
  • Patients had clear discharge plans and progress towards discharge was discussed during handovers, multidisciplinary meetings and patients’ reviews. There were no delayed discharges across the two wards.
  • There were sufficient staff to ensure that patients received the right care for them at the right time. The service considered the fluctuating needs of the patient group and ensured that ‘floating’ staff could dedicate their time where it was most required. During the time leading up to the inspection, the service had recruited a number of permanent staff so reducing its reliance on agency and bank staff. Nearly all staff (98%) had completed statutory and mandatory training. Staff were receiving regular supervision and all staff had received an appraisal.
  • The service demonstrated a commitment to achieving best practice and this was reflected in its performance and risk management systems and processes. Managers and staff worked in a systematic way to continually improve the quality of the services and to create an environment in which staff could provide high quality care. Managers reviewed governance arrangements in a proactive way to ensure that they reflected current best practice. The service was well led at ward level and by the hospital director with an inspiring shared purpose. The managers were striving to deliver and motivate staff to succeed with a great commitment towards continual improvement and innovation.
  • Managers and staff took a systematic approach to working with other organisations to improve care outcomes.
  • The staff were achieving consistently high levels of creative and constructive engagement with the patients, across all equality groups. Rigorous and constructive challenge from patients, the public and stakeholders was welcomed and seen as a vital way of holding the service to account.
  • Staff knew how to handle complaints appropriately and there were different options available to patients should they choose to make a complaint either informally or formally.
  • There was clear learning from incidents which was fed back to the staff and the patients. Learning was fed back from the managers to the staff when things went well which promoted training, research and innovation. Staff were open and honest to patients and carers when something went wrong.

26 and 27 April 2016

During a routine inspection

We rated Pelham Woods as good because:

  • Wards were clean and comfortable. Environmental risk audits had identified risks and action taken to alleviate these. Patients were safe because there was adequate staff. All staff had completed the required mandatory training.
  • Patients we spoke with told us staff were respectful and polite. They felt staff were caring and interested in their well-being. Staff interacted with patients positively and in a kind and caring way.
  • There was a clear admission process. On admission each patient had a physical health assessment and records showed patients continued to have physical health checks.All patients had documented risk assessments and risk management plans. Patients had access to psychological therapies and national institute for health and care excellence (NICE) guidance was evident in care planning. Each patient had a personal timetable of activities.Records we reviewed showed staff assessed patients’ needs and delivered care based on their individual care plans. On admission each patient had a physical health assessment and records showed patients continued to have physical health checks.
  • The hospital kept detailed recordings of incidents when patients needed to be restrained and the governance group monitored the trends and action plans. The safeguarding and incident reporting processes included monitoring trends and fed back lessons learnt to staff.

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  • Patients told us they had access to good advocacy services. The hospital involved patients in developing and improving services through patient representatives who told us the hospital listened to them and responded to requests. Staff listened to patients’ preferences and patients could personalise their bedrooms.Patients had access to mobile telephone provided they had no internet access or cameras, could make hot drinks and snacks throughout the day dependent on risk assessment, and had access to a garden.
  • All staff said they experienced good leadership at ward and organisational level. All staff had received regular support and managers made themselves available to staff. Staff we spoke with said senior managers were visible in the hospital and told us morale was good.
  • We saw a clear structure of clinical governance at Pelham Woods through to a regional and national level.We saw good examples of a commitment to improve the quality of service provided. For example there had been a recent change in policy and procedure regarding patient monies following a review to ensure that patient money was recorded and kept appropriately.

However:

  • Patients complained about restrictive practices, such as the difficulties in leaving the building as an airlock prevented informal patients from leaving the building easily. Patients could not have mobile telephones with internet access or cameras on the ward and patients had restricted access to the internet. There were rooms that patients could not freely access such as the toilets in the main area. There was no free access to outside space. These restrictive practices were not in response to current recorded patient risk. There was no record that the impact of the blanket restrictions on each patient had been considered and documented in the patient’s records in accordance with the Mental Health Act Code of Practice.
  • The unit had ligature risk assessments completed in December 2015 which identified ligature risks but did not include specific actions to mitigate all risks.

5 August 2013

During a routine inspection

We spoke to several patients during our visit about their views on the care and treatment they received. They told us they felt well cared for and that the staff were kind and supportive. We saw many examples of positive interactions between patients and staff and we observed patients were relaxed and at ease.

Two Mental Health Commissioners spoke privately with five patients. The expert by experience spoke with several patients and concluded that patients generally felt satisfied with the care and treatment they received. They also felt that staff treated them kindly and were respectful.

Patients told us that they liked the food and that the chef listened to their views and suggestions. They told us that the food was good and that healthy options were available if they requested this.

Patients told us they knew their rights and they felt safe. They told us that if they had a problem or concern they knew who to talk to. Staff told us they had undertaken their safeguarding training and they would not hesitate to report any concerns or issues to their line manager.

People were supported by staff who received appropriate professional development.

The provider had systems in place to monitor the quality and safety of the hospital.

24 January 2013

During a routine inspection

People we spoke to told us that they were happy with all aspects of their care and treatment at Pelham Wood. They told us that the staff were caring and kind and helped them with their rehabilitation programme.

They had good comments regarding the quality and variety of food offered. They said that the chef provided a healthy option if they requested this and that they had an input with the menu planning.

People told us that they had been involved it their treatment plan and were able to discuss this with their primary nurse and at meetings.

People told us that there was always some activity taking place that kept them occupied.

We were told that staff were polite and always treated people with respect.

14 March and 12 April 2011

During a routine inspection

All the people who used the service were content with their treatment at Pelham Woods and had no complaints about any aspect of the service they received. They said the food was plentiful, varied and of a good quality with plenty of choices. They were particularly complementary about the chef. Most said that they had an input into their care plans. People who used the service were fulsome in their praise of the staff whom they described as caring, helpful and kind. Some people who use the service would like to see more in the way of occupational therapies and Pelham Woods has plans to increase the space available for this. One carer expressed concerns about the weight that her daughter had gained whist a patient at two mental hospitals, one of which was Pelham Woods.

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.