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

Priory Hospital Lincolnshire

Overall: Good read more about inspection ratings

Dog Kennel Road, Gainsborough, Lincolnshire, DN21 5UD (01427) 666080

Provided and run by:
Partnerships in Care (Meadow View) Limited

All Inspections

During an assessment under our new approach

Located in Gainsborough, Lincolnshire, Priory Hospital Lincolnshire is a low secure unit for males with mental health conditions. It offers support to those who are detained under the Mental Health Act (MHA).

The service has the capacity to house 28 males split equally across two wards. Lancaster ward for adult males, who require support to decrease their levels of behaviours that challenge, and Scampton ward providing continuing care, with a focus on community reintegration and preparing the person to move further along the care pathway, or to community living.

The secure services offer comprehensive support to people with complex mental health needs. The service provision is modelled on the NHS secure service specification for medium and low secure services, ensuring patients are given the highest quality of care to enable quick and smooth transitions into local services, wherever possible. The service is committed to delivering clinically effective, evidence-based treatment programmes for individuals who require secure care, providing both psychological and physical security.

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and/or autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

The service was last rated as Good (published March 2019). This was an unannounced assessment, which means the provider was not told an assessment was going to be taking place beforehand. During this assessment, we looked at all quality statements across all 5 key questions. The current rating reflects the findings from this assessment. We rated this service as Good.

 

People’s experience

We spoke with 12 patients. Patient’s feedback was positive about the quality of care and treatment they received. They felt safe, supported, and cared for by staff, who were described as kind, caring and approachable. Staff were attentive to patient’s needs and supported them in a respectful, and dignified way, ensuring they felt listened to, involved, and valued throughout their care journey.

Patients told us that staff were always visible, available, and responsive to their needs by offering support, listening effectively, and responding promptly to meet the needs of the patient’s they cared for.

Patients, and their families, participated in developing care, and risk management plans. A collaborative approach ensured that care was person-centred, and treatment was amended to meet patient’s individual needs, preferences, circumstances, and expectations.

The service offered a comprehensive range of therapeutic activities which were well-attended by patient’s, helping to promote engagement, recovery, and inclusion. The activities supported patients recovery and rehabilitation, and provided a good daily structure, which offered meaningful engagement, and contributed positively to their physical, mental, and emotional well-being.

Patients were given support to raise complaints or concerns, and to share feedback, they felt listened to and empowered. Tthe food was of good quality, with a variety of options available to them which suited individual preferences, religious or cultural needs, and specific dietary requirements.

The service ensured that learning from incidents was identified, acted on, and shared effectively with staff to improve care, and the experience of the patient’s using the service. When incidents, for example, episodes of agitation or aggression occurred, staff responded promptly, reported them appropriately, and updated care and risk plans accurately. Following incidents, patients and staff had debrief meetings, the psychology team also facilitated individual or group reflective practice sessions and were also available on an ad hoc basis if required to provide support. Staff demonstrated a strong understanding of the duty of candour. If things went wrong, patients and their families were offered clear explanations, and given apologies when required. The service had a Freedom to Speak Up (FTSU) ambassador who was also available to offer support.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

100% of staff had received training and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Overall staff demonstrated a good understanding of these. Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. People had easy access to information about independent mental health advocacy.

Staff explained to people their rights under the Mental Health Act in a way that they understood, repeated it as required and recorded that they had done so. Staff were able to ensure that people were always able to take Section 17 leave (permission for people to leave hospital) when this had been agreed.

Staff requested an opinion from a second opinion appointed doctor when necessary. Staff stored copies of people’s detention papers and associated records (for example, Section 17 leave forms) correctly and so they were available to all staff that needed access to them.

Staff did regular audits to ensure the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

100% of staff of staff had received training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act, in particular the 5 statutory principles

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it. Staff knew where to get advice from within the service regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable people to make their own decisions. For people who might have impaired mental capacity, staff had assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When people lacked capacity, relatives and staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. The service had arrangements to monitor adherence to the Mental Capacity Act.

15-16 and 22 January 2019

During a routine inspection

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.

11 and 12 October 2016

During a routine inspection

We rated Meadow View as good because:

  • Patients told us they usually felt safe on the wards.
  • The hospital had a policy and procedure for carrying out observations. Staff kept up to date records of observations carried out.
  • We observed staff interacting with patients in a positive way; there was a variety of activities available seven days a week.
  • Senior managers held daily morning meetings to discuss any concerns or complaints and to address issues promptly.
  • Medicines were stored securely and in accordance with the provider policy and manufacturers’ guidelines.
  • Hot and cold drinks were available throughout the day and night.
  • Patients were able to personalise their bedrooms, and had a lockable cupboard to store their possessions.
  • Staff said there had been a lot of positive change over the last nine months and they felt valued.

However:

  • Escorted section 17 leave was cancelled on two occasions due to lack of staff.
  • The hospital used the company regional on call doctor service; staff said it could take over one hour for the doctor to reach the hospital. This meant that patients may not have been seen in a timely way; however the hospital had recently appointed a full time associate specialist doctor.

18 to 19 August 2015

During a routine inspection

We rated Meadow View as requires improvement because:

  • We received limited assurance about safety. Managers had identified ligature risks throughout the hospital. They had identified ways to minimise the risk to patients, however there was no date for the work to be completed and no plan in place to immediately address the risk. Staff did not check emergency medical equipment regularly.
  • Patients’ privacy was compromised when they were in seclusion. The seclusion room window had no blind so patients in the activity kitchen could see in to the seclusion room.
  • The service did not meet patient needs. They did not provide a range of activities for patients to take part in.
  • Managers did not monitor the quality of the service or the performance of staff to ensure good quality care. Managers did not provide regular supervision for staff and appraisals were not taking place. The new audit schedule to monitor care and treatment was not fully embedded.
  • Staff did not record discussions about consent with patients so it was not clear if people agreed to their treatment. There was limited evidence of patient involvement in their care.
  • Patients told us they did not receive consistent care because of high agency and bank staff usage. The vacancy rate was an average of 9% for the previous 12 months.
  • There was poor physical healthcare monitoring for patients.

However:

  • Staff assessed risk to patients by completing a comprehensive risk assessment. Staff updated records when patients’ risk level changed
  • Managers were visible on the wards and staff knew the directors.

25 November 2014

During an inspection looking at part of the service

This inspection was carried out to see if improvements had been made following our inspection of 13 and 14 November 2013.

During this inspection, we spoke with seven patients and seven members of staff. We also reviewed seven patients' care and treatment records.

Care and treatment was not always planned and delivered in a way that was intended to ensure patient's safety and welfare. Patient's needs and risks had been assessed and care plans were in place. However, some care plans lacked detail so as to enable staff to support patients in an individual manner.

There were a sufficient number of staff on duty to meet the needs of patients using the service. A recruitment and retention plan was in place to ensure that safe staffing levels were achieved and maintained.

Patients were not always cared for by staff who were supported and trained to deliver care and treatment safely and to an appropriate standard. Formal support systems for staff were poor. Training records detailed that 57% of staff had attended mandatory training.

There was not an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients who used the service and others. Whilst some audits were carried out, they were not reviewed and repeated within their time frames. Staff views were not sought about the service provision.

Notifications of incidents, such as police involvement, serious injury and safeguarding, were not being sent to the CQC.

13, 14 November 2013

During a routine inspection

Prior to our visit we had received concerning information about staff numbers and skill mix. The information stated that some patients were displaying challenging behaviour associated with their mental health and staff were unable to manage this.

We visited Meadow View Hospital over two days. During this time we spoke with twelve members of staff, the hospital director and the business performance manager. We considered information from five patients, which was shared with us by a colleague from the Middle England Specialist Commissioning Group who was visiting the hospital on the day of our inspection, (MESCG are responsible for assessing patients with a view to them being placed in specialist services.) We also spoke directly to three patients to establish their views on the quality of service provision.

We looked at some of the records held in the service including the support files for three patients. We observed the support patients received from staff and carried out a tour of the hospital.

The care manager from MESCG reported that all the patients they spoke with said they felt respected by the staff and any interventions they had experienced had been carried out appropriately. However, all five expressed concerns about staff numbers and one said, 'It would be much better if we could get out and about more.'

We found the staffing levels were not always adequate to ensure there were enough staff to meet the changing needs of patients using the service. Although some of the patients living at Meadow View were unable or unwilling to talk with us, one patient did tell us, 'I think there should be more staff. I can't go out sometimes.' Another patient indicated to us that they were unhappy on the ward where they were placed but felt better when they were able to spend time on the other ward. They said this was because they felt safer on the other ward, where it was quieter.

We found that complaints about the service were taken seriously, investigated and resolved and the outcome shared with the person raising the concerns

5 December 2012

During a routine inspection

We reviewed all the information we held about this provider before we visited the hospital. This included information from other agencies and the provider's records. We also looked at information from a recent visit by the Care Quality Commission Mental Health Act commissioner.

During the visit we spoke in private with four patients and chatted informally to other patients. We looked at records, including five personal care plans, we spoke to the managers and staff who were supporting patients, and we observed how they provided that support.

We saw patients were supported to make choices and decisions and they were treated with dignity and respect. They were encouraged to share their views about the services they received.

In general we saw that patients were supported by a knowledgeable care team, and they received the care and support they wanted and needed. Staff demonstrated a good understanding of their roles within the hospital. However they were not appropriately supported to carry out those roles.

We saw that there were areas where the provider needed to make improvements to the service that patients received. We identified issues with seclusion arrangements, staff support and care planning.

10 January 2012

During a routine inspection

We spoke with three people who use the services. One person was clearly very happy with the support he received and told us 'I've been really well since being here. I know about the help I need to stay well.' Another person said 'I see the Doctor and he keeps me right.'

We also spoke with some relatives and were told 'It's been the best place for my relative. He has been so much better and they bring him to see me' and 'The staff are lovely and very supportive.'

17 March 2011

During a routine inspection

Patients told us that they are satisfied with the support and treatment they receive at the hospital, and there are a lot of activities for them to do. They said that they feel listened to and they are encouraged to take part in the development of the services.

They said that they can use an independent advocacy service when they want to, and they feel happy to make a complaint if they have a need.

Patients told us that the hospital is kept clean and nice for them, and they can help to keep their own rooms tidy. They said that they think staff are properly trained, and they know what they are doing.

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.