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Priory Hospital Lincolnshire Good

Inspection Summary


Overall summary & rating

Good

Updated 15 March 2019

We rated Priory Hospital Lincolnshire as good because:

  • Patients had access to evidence based, high quality psychological therapy, with once or twice weekly one to one sessions, group therapy and drop in sessions to supplement the structured therapy program. The range of activities available to patients, was extensive, and of high quality. Staff designed activities to promote recovery.
  • Leaders were strong, consistent, and well respected by the staff and patients we spoke with. We saw evidence that managers were implementing the information and action plans, that they had shared with us through the provider engagement meetings, into the culture and practice at the hospital. Staff commented positively about how the providers vision and values were embedded into practice at the hospital. The vision and values were based on promoting a culture of family, support for each other, belonging and ownership.
  • There were robust systems in place for reporting and recording incidents. There were systems and procedures to ensure that wards were safe and clean. Managers were carrying out regular environmental audits and acting on the findings when needed. The provider had implemented a successful recruitment drive for permanent staff, and improved staff engagement had reduced the number of staff leavers. The service adhered to the requirements of the Mental Health Act and Mental Capacity Act.
  • Staff undertook risk assessments of patients upon admission. Staff updated risk assessments during patient review meetings or following an incident. Staff completed comprehensive assessments of patients upon admission. Staff used the information gathered during the assessment to create holistic and personalised care plans. Patients were involved in, and took part in the planning of their care. We reviewed twelve patient care records which showed that staff discussed care plans with patients and recorded their views.
  • The hospital was clean, well maintained and safe. All patients had their own en-suite bedrooms with patient call alarms. There was adequate space for a variety of activities to be happening at the same time. There were enough skilled staff to meet patients’ needs and give all the necessary clinical and physical interventions needed. Clinics were clean tidy and well managed. Staff stored medication in locked cupboards within the clinic room. We checked 14 medication records for patients, staff had completed all records correctly.

However:

  • The systems for recording and capturing supervision conversations were not clear or robust. Staff doubted the accuracy of the supervision data provided. Supervision records were not readily available and staff appeared to have lost some records. Although, prior to inspection, the registered manager had identified this as a problem and had started to put in place systems to ensure that staff recorded and stored supervision records appropriately.
  • One patient who had complained of blurred vision, had been waiting several months for staff to arrange an optician’s appointment for him. Staff explained the reasons for the delay and before the inspection finished, staff had made the patient an opticians appointment at the hospital.
  • Lancaster wards’ compliance with mandatory training was significantly lower than Scampton ward. We did not consider this a breach, because the providers overall training compliance was reasonable at 92%, however, the provider should address this discrepancy.
  • Staff training in Mental Health Act and Mental Capacity Act was below the providers expected target.
Inspection areas

Safe

Good

Updated 15 March 2019

We rated safe as good because:

  • Staff carried out regular risk assessments of the care environment. There was a complete and comprehensive ligature audit and assessment.
  • All areas of the hospital were clean and tidy, furniture was maintained to high standard and cleaning records were up to date and showed that staff cleaned the ward regularly.
  • The provider had a fully equipped clinic room with accessible resuscitation equipment and emergency drugs that staff checked regularly. We reviewed 14 medication charts and found staff followed good practice in medicines management.
  • The provider staffed wards safely. We checked duty rotas and the provider filled shifts with right numbers of staff.
  • Staff used recognised risk assessments and completed comprehensive risk assessments on all patients at the time of admission.
  • Data showed that 96% of staff had trained in safeguarding vulnerable adults and 96% of staff had trained in safeguarding children. The provider had a good track record for safety. Managers recorded and investigated all incidents fully and made changes based on the learning from those incidents.

However:

  • We could not determine the providers compliance with, or quality of staff supervision. Supervision records were not readily available, staff appeared to have lost some records. Staff doubted the accuracy of the data provided, and told us they did have frequent, good quality supervision that allowed them to feel confident in their jobs. Although prior to inspection, the registered manager had identified this as a problem and had started to put in place systems to ensure staff recorded and stored supervision records correctly.

Effective

Good

Updated 15 March 2019

We rated effective as good because:

  • We reviewed 12 care records, all care records showed that staff had completed comprehensive mental health assessments at the time of admission. Assessments included patients physical, emotional and mental health needs, and when necessary staff carried out other specialist assessments.
  • Staff and patients developed joint care plans that met the identified needs of the patient. Care plans had been cross referenced to evidence based practice. Staff reviewed care plans with patients at regular intervals and patients could check their own progress using “My five green goals”.
  • Staff provided care and treatment in line with guidance recommended by the National Institute for Health Care Excellence. Activities were recovery focussed and available throughout the week and weekends. The range and quality of therapies and activities available to patients, was extensive and of high quality.
  • Patients had access to high quality psychology, with once or twice weekly one to one sessions, group therapy and drop in sessions to supplement the structured therapy program available.
  • The provider employed a full range of staff from different disciplines. Staff had the experience and qualifications to perform their roles and meet the needs of the patient group. The multidisciplinary team worked well together to provide cohesive treatment and care for patients. Managers ensured that staff had regular access to team meetings and reflective learning opportunities.
  • The experienced Mental Health Act administrator ensured that the service maintained compliance with the Mental Health Act and Mental Capacity Act code of practice.

However:

  • One patient who had complained of blurred vision, had been waiting about four months for staff to arrange an optician’s appointment for him. Although staff explained the reasons for the delay, the inspection team felt this delay was not acceptable. Before the inspection finished the nurse in charge told us that they had found an optician and the patient had an optician’s appointment.
  • Lancaster wards compliance with mandatory training was significantly lower than Scampton ward, and we did not see enough evidence to show staff had addressed this effectively. We did not consider this a breach, because the providers overall training compliance was reasonable at 92%, however, the provider should address this discrepancy.
  • Staff training in Mental Health Act and Mental Capacity Act was below the providers expected target. Though we did not see any impact of this on practice.

Caring

Good

Updated 15 March 2019

We rated caring as good because:

  • We saw how staff were kind and caring towards patients. Staff understood patients’ needs and treated them with dignity and respect, engaging with patients in ways that were meaningful to them.
  • Patients took part in the care planning process. We reviewed 12 patient records which showed that staff encouraged patients to take an active part in the care planning process. Staff supported patients to understand and manage their care, treatment or condition.
  • Patients had access to advocacy. We spoke to an advocate and they informed us they helped patients to engage with meetings, care planning, safeguarding and the patient forum. Patients could give feedback on the service they received through the patient forum or during mealtimes, when staff sat with patients and they ate together.
  • Both carers we spoke with felt involved in their relatives’ care and were happy with the support and communication they received from staff and managers.
  • Staff directed patients to other services when appropriate and, if needed, supported them to access those services.

Responsive

Good

Updated 15 March 2019

We rated responsive as good because:

  • Patient discharges and transfers were well planned and supported.
  • The provider had a range of rooms and equipment to support patient care and treatment. This included a fully equipped clinic room, therapy and group activity rooms, a gym, quiet rooms and private visitor’s rooms. The hospital was in the grounds of an extensive woodland area that was accessible to patients.
  • The provider offered patients paid real work opportunities at the hospital and supported patients to access voluntary work and education opportunities in the community.
  • The provider had a range of accessible information about local organisations, patient rights, confidentiality and how to make a complaint.
  • Patients told us the food was good and there was a good choice. Hot and cold drinks and snacks were available throughout the day. We saw evidence that the food options provided by kitchen staff, supported cultural and religious dietary requirements.
  • The provider had a robust complaints procedure. The manager investigated complaints and shared lessons learned with staff. Carers we spoke with felt that the provider dealt with complaints swiftly.

Well-led

Good

Updated 15 March 2019

We rated well-led as good because:

  • Leaders had the skills, knowledge and experience to perform their roles effectively. Leaders had a good understanding of the services they managed and were visible on the wards and approachable for both staff and patients.
  • Staff were aware of the organisation’s visions and values. Staff told us how the values of the organisation, such as putting people first and being supportive of each other, underpinned the work they did. We saw staff behaviour reflecting the organisation’s values. Managers had incorporated the vision and values into the new Care Certificate workbooks for all healthcare support staff.
  • Staff felt respected, supported and valued. Managers had introduced staff wellbeing sessions, providing relaxation training, and complimentary therapies. The provider recognised staff success within the service through employee recognition events such as: employee of the month, team of the quarter, employee and team of the year. In addition to this, highly performing employees were nominated for the Priory’s national staff awards.
  • Staff had access to both a local and the organisational risk register. Staff concerns matched those on the risk register. Where cost improvements were taking place, they did not compromise patients care.
  • Managers had access to the feedback from patients, carers and staff and used the feedback to make improvements. Managers had introduced a solution box, to encourage staff to identify problems areas and offer a solution. All staff whose solutions were implemented received a gift voucher as a thank you.
  • Except for supervision processes, all other governance processes and systems were robust, and allowed managers to run an efficient and effective service. Managers had a formula for establishing staffing numbers based on patient’s complexity and needs. There were robust systems in place for reporting and recording incidents.

However:

  • Overarching governance and the systems for recording and capturing supervision conversations were not clear or robust. Although, we also noted that the hospital director had already, and prior to inspection, identified this as a problem and had started to put in place systems to address the issues we identified at the time of inspection.
Checks on specific services

Forensic inpatient or secure wards

Good

Updated 29 November 2016

Meadow View provides services for up  to 28 patients over two wards.