Priory Hospital Enfield

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this inspection, the rating has remained as good.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

Staff we spoke with could describe how and when to report an incident. They could describe recent incidents and changes that had been made as a result of learning. Staff reported serious incidents as required, following the provider’s policy. Incidents were logged on an electronic reporting database and reviewed by senior staff.

Staff met regularly to discuss incidents and learning from incidents. Each morning staff attended a meeting where all incidents from the previous 24 hours were discussed.

Staff were aware of the duty of candour. Staff reported being open and transparent, explaining things fully to patients and their families if things went wrong.

Staff said they were always involved in discussions about incidents. Staff were aware of recent incidents, could describe what happened and what actions were needed to ensure safety of specific patients following incidents that involved them.

The hospital received referrals and admissions from an NHS trust. The hospitals referral and admission processes ensured that all essential information about the patient was received to determine if the patient's needs could be safely met. The hospital gave examples where they had not accepted an admission as they would not have been able to safely meet the needs of the patient.

Staff involved any necessary healthcare and social care services to ensure patients had continuity of safe care, both within the hospital and post-discharge.

Staff worked to ensure patients weren’t in hospital any longer than needed. 10 of the twelve patients had been in the hospital for less than 6 weeks. 2 patients had been on the ward for over 2 months.

Staff ensured that patients were only discharged if they had a crisis plan and a safe discharge setting.

Staff had a clear understanding of safeguarding and their responsibilities around this. Staff knew how to identify adults and children at risk of, or suffering, significant harm and what procedures to follow to manage this. Information about safeguarding leads and processes was clearly available to staff throughout the ward.

Staff followed safe procedures for children visiting patients. This did not take place on the ward and there were facilities that could be used in another area of the hospital site, if needed.

Staff received training on how to recognise and report abuse, appropriate for their role. Staff received training in levels 1, 2 and 3 safeguarding training for adults and children and demonstrated that they knew how to identify adults or children at risk of or suffering from harm and worked with other agencies to ensure their protection. All staff were up to date with training, with a 100% compliance rate for levels 1 and 2 and 92.5% for level 3.

Staff could give examples of how they had identified and managed safeguarding concerns. Staff notified the local authority within an appropriate timeframe and worked with them to keep patients safe from harm.

We reviewed 4 patient care records on the ward. Records showed that staff completed comprehensive risk assessments, reviewed these regularly, fortnightly at ward rounds or after an incident, and updated them with relevant risk information. Staff completed risk assessments looking at the patient’s potential risk factors. Staff assessed patients for any individual risks relating to them. This included dysphasia, or a risk of choking.

At the daily multi-disciplinary meeting, staff discussed patient risk levels, including a review of recent incidents and concerns.

Staff received training in restrictive intervention and compliance was 81%. This was delivered through a 5-day course and encouraged all staff to engage in de-escalation techniques before moving to any restrictive interventions.

Staff did regular risk assessments of the care environment. This included assessments of ligature risks throughout the ward. Staff had access to this assessment and a map in the staffing office indicating high risk areas. There were three sets of ligature cutters available on the ward, and these were clearly labelled. There were ligature cutters available on both floors of the ward.

The ward was laid out over 2 floors which meant that staff could not observe all parts of the ward from a central space. Risks were managed through individual risk assessments, individual levels of observations, which balanced risk and privacy and dignity, CCTV in communal areas and convex mirrors in areas with blind spots or narrower spaces.

Staff had easy access to alarms and patients had easy access to nurse call alarms. Wall alarms were fitted in communal areas and in each patient bedroom. During the inspection, we saw staff respond to an alarm from a bedroom quickly and appropriately.

At the previous inspection in September 2021, we identified a breach of regulations around alarms and requested that the provider ensure that staff always identify and escalate instances of emergency alarms not working in a timely manner. During this inspection, staff confirmed that alarms were working well and there were clear processes for charging and checking them. Staff said there were no recent examples of alarms not working. The provider had successfully made improvements and there was no longer a breach of regulation in this area.

The ward did not have a seclusion room. The ward did not accept referrals of patients where there was an indication that the patient may need to be cared for in a seclusion room. If this level of care was needed, the service referred the patient to a more appropriate environment.

Staff had a clear understanding of the different levels of engagement and observations to manage patient risk. Staff could clearly describe how to carry out intermittent observations at random intervals, so that there was no predictable period of time that a patient was not being observed. Observation records showed staff carried out intermittent observations at random intervals, in line with provider policy.

Staff were aware of processes and policies around managing risks of patient accessing illicit substances whilst on leave.

As part of their routine safety checks, the maintenance team conducts scheduled fire alarm testing on site. The maintenance team announced when testing was in progress, ensuring all staff, visitors and patients were aware. Notices were displayed throughout the building advising staff of the scheduled day and approximate time the alarms will sound.

Managers had calculated the number and grade of nurses and health care assistants required to safely support the care and treatment of patients. Managers adjusted staffing levels according to the needs of the hospital. For example, when a patient was nursed on enhanced observations or there was high acuity on the ward.

Staff told us there were enough staff on shift to meet the needs of patients. This included facilitating leave and activities on and off the ward, regular patient engagement, enhanced observations and ensuring staff got appropriate breaks.

There was adequate medical cover day and night and a doctor could attend the ward quickly in an emergency.

Staff received an appropriate induction to the ward and refresher training where needed. Staff were required to complete mandatory training. The training was appropriate for the patient group using the hospital. All staff had completed basic life support or immediate life support training, depending on their role. All staff had completed training on Autism and learning disabilities.

Staff received monthly clinical and managerial supervision, where they could discuss safeguarding, audits, required learning, issues within the team and discuss patients they supported. Staff wellbeing, sickness figures and annual leave allowance would also be discussed during their supervision. Staff had a 100% completion rate for their monthly supervisions. The annual appraisal rate for 2024 was 100%, with 2025 annual appraisals at the time of inspection marked as ‘in review’ or ‘assigned’.

Most patients told us that they met with their named nurse often, however one patient said they would like to meet with their worker more often.

The hospital had a quality improvement project with the aim of reducing the use of agency mental health nurses and support workers within the service. In October 2024, the average use of agency staff was 12.9% and in September 2025, we observed this being 10.6%.

They had been successful in promoting their overseas and UK recruitment drive campaigns which had attracted a strong pool of local candidates, resulting in more permanent frontline staff.

Regular agency nurses and support workers on the ward had also chosen to transition into permanent roles on the ward. As a result, there was a significant reduction in agency usage, greater workforce stability, improved continuity of care for patients, stronger team dynamics and consistent handovers.

Ward areas were clean, had good furnishings and were well maintained. An external company carried out cleaning regularly and maintained their own cleaning records.

There was some signage on the wards that was not following infection prevention and control best practice principles as they were attached to the wall with tape. The service were aware of this and had ordered poster frames to address this.

Staff maintained equipment well and kept it clean. Clean stickers were visible on equipment, and in date.

Staff understood how to store and label food in the kitchen. We saw most food was labelled correctly, with the opening date and date of expiry, and who it belonged to. There were two items in the fridge that needed a label added, and we identified this to the staff at the time.

The hospital had systems in place to support safe medicines use. Staff used an electronic prescribing and medicines administration system (EPMA) to record what was given to patients. Staff had access to Mental Health Act (MHA) consent to treatment documents. Prescribing was in line with legal authorisations.

Medicines including controlled drugs (CDs) were stored securely in lockable cabinets. Staff completed daily checks of CDs and drugs liable for misuse (DLMs) and recorded these at each shift change. Staff used a digital system to record checks completed such as ambient room and fridge temperatures, quality control of blood glucose monitoring machines and checks of the emergency medicines bags.

Physical health monitoring was completed using the National Early Warning Score 2 (NEWS2) and other recognised tools. Staff completed electrocardiograms (ECGs) and blood tests when needed. A physical health nurse supported the ward with monitoring and advice.

Staff understood the need to use the least restrictive care options. For medicines, staff discussed and offered non-intrusive options first, such as oral medicines. If necessary, staff were trained to administer rapid tranquilisation (RT - the process of administering a medicine intramuscularly for rapid sedation in patients with acute agitation, aggression or distress). RT was used as a last resort. We observed post dose monitoring being completed.

Staff were also inconsistent in recording why PRN (as required) medicines were given or if they were effective. This meant we could not be assured that the use of these PRN medicines was justified and in line with the prescribers’ intentions.