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

Priory Hospital Newbury

Overall: Outstanding read more about inspection ratings

Monks Lane, Newbury, Berkshire, RG14 7RN (01635) 277234

Provided and run by:
Priory Rehabilitation Services Limited

Important: The provider of this service changed - see old profile

All Inspections

07/11/2023 08/11/2023

During a routine inspection

Priory Hospital Newbury is a high dependency rehabilitation service for individuals with enduring mental illness working towards living life back in the community. It supports patients who require a high level of care and intensive therapeutic support.

Our rating of this location improved. We rated it as outstanding because:

  • Without exception, all staff were passionate, committed, put patients at the centre of all they did, strived for excellence and enjoyed working at the hospital. Morale was good, all were signed up to the values and vision of the hospital. Staff were well supported through regular supervision, reflective practice, and appraisal.

  • Without exception, all patients spoken with said they felt safe and enjoyed being cared for at the hospital. All spoken with said their lives had improved since coming to Priory Hospital Newbury. They described being given ‘another chance’, when others had given up on them, to live their best life. All had a good knowledge and understanding of their care/treatment plans, and all had a focus on being discharged and living in the community. Patients knew every member of the staff team, including the administration, cleaning, and catering staff.

  • Care and treatment were rehabilitation and recovery oriented in line with nationally recognised best practice. 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 cared for in a mental health rehabilitation hospital. Staff engaged in clinical audit to evaluate the quality of care they provided.

  • There were enough staff, with the right skills and experience to keep patients safe and provide high quality care. There was minimal use of agency staff and those that were used were regular agency staff. Staff were extremely skilled and provided a wide range of care, treatment, therapies, and activities to support patients with their rehabilitation and recovery journey. The clinical psychology and occupational therapy vacancies had been recruited to and appointees would start in January 2024 – this completed the multidisciplinary team.

  • There was a collaborative approach to care delivery – every member of staff was respected for their views and their contribution valued. All staff were welcome to join the morning huddles and detailed discussions took place to ensure everyone understood every aspect of the care that each patient required.

  • The multidisciplinary team (MDT) members worked well together, they respected each other and valued each other’s contribution. They constructively challenged each other and decisions about treatment and care were made collectively. Patients were considered partners in their care and involved in discussions and decisions made at the MDT meetings. Risk assessment and care plans were updated during the MDT meeting – what was written was agreed by all, including patients. All then followed the agreed care plan.

  • A quality improvement research project had been undertaken to ensure the consistency of risk assessment and care planning. This had resulted in safer, less restrictive care being delivered. Patients were fully involved in planning their care. Records were of a very high standard.

  • Quality improvement work had ensured the hospital could offer patients high quality physical health care. There was a physical healthcare nurse in post who worked closely with the specialist doctor. There were good relationships with the local GP surgery and with other physical health care specialist teams, e.g., community diabetes team.

  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

  • Good relationships had been developed with the local community and wider community which supported patients to access a wide range of activities and amenities. Patients were actively encouraged and supported to take up work opportunities, volunteering opportunities and join local clubs.

  • Medicines management was excellent. Prescribing was thoughtful and considered and the medical team actively worked to reduce the medicines patients were taking. The electronic medicines system supported good practice. Patients’ medicines records were audited monthly – all patient medicine records we reviewed were accurate and complete.

  • Staff used a positive behavioural support approach when patients experienced difficult or challenging behaviours. They took a least restrictive approach. Restraint and rapid tranquilisation were very rarely used.

  • Staff had developed a ‘leave/absent without leave’ folder for each patient. This provided staff with clear details of each patient’s current access to leave, their Mental Health Act status and other key information. It contained an individual flow chart of the process to follow for each patient and when and who to escalate to when the patient had failed to return from leave. Staff had worked closely with the local police to ensure an appropriate response. The security nurse on each shift was responsible for ensuring they recorded when patients went on leave, when they were due to return and for initiating the appropriate response if patients didn’t return from leave on time.

  • Staff were passionate about improvement and described that they were striving for excellence so they could deliver the best care possible to the patients. Quality improvement initiatives had resulted in improvements in care for patients. The hospital had a quality improvement group, an identified QI lead and plan of projects it planned to progress.

  • There were good relationships with commissioners and other stakeholders. Managers were working with commissioners to increase referrals which had fallen after a block contract had been discontinued in 2023.

  • All areas of the hospital were immaculately clean and well maintained. Patients had access to a large garden which provided good facilities. For example, a pool room, gazebo, BBQ, sporting facilities, seating areas, summer houses, a planting shed and small allotment plot.

  • The hospital was well led, and senior leaders were knowledgeable, skilled, and experienced. They provided positive, proactive, and professional leadership and staff and patients liked and respected them. They empowered staff and encouraged all staff to lead and make decisions in partnership, so actively promoting positive outcome for patients.

  • Governance systems and processes were robust and ensured the smooth running of the hospital.

However:

  • There were often issues with the Wi Fi. Access could be slow and frequently dropped out which meant staff sometimes lost work or work took more staff time than it should have done.
  • The hospital did not have a clear vision and strategy for its future and how it would attract more referrals to fill the empty beds and stay within budget. Some plans had been developed to reopen Birch ward to provide additional ‘step down’ facilities, to re-open Orchid ward (currently part of Rowan ward) as a five bedded High Dependency Unit and use Rowan ward to care for patients who no longer needed HDU care but were not yet ready for ‘step down’.
  • Lots of excellent work, including quality improvement projects, were taking place at the hospital but hospital leaders were not always good at describing, sharing, and promoting what they did.

25-26 April 2017

During a routine inspection

We rated The Cloisters as good because:

  • Wards were clean and well maintained and patients told us they felt safe. Emergency equipment and medicine were stored safely and medicine management followed National Institute for Health and Care Excellence guidance.
  • There was access to out of hours support for patients’ mental health and physical needs and emergency contingency plans in place. Patients’ risk assessments and care plans were person centred and updated regularly. The Cloister’s focus was on recovery and patients had access to an outreach service which supported them after their discharge.
  • The Cloisters offered a full occupational therapy programme and empowered patients to access external resources such as the local college and gym. The service had purchased a wheelchair accessible minibus and patients had access to a garden and allotment. There was a good choice of fresh food available; staff catered for patients’ dietary needs and offered nutritional training.
  • There was very good assessment, monitoring and care of patients’ physical health needs and an effective relationship between the service and a local general practitioner practice. Staff had been trained to provide physical health care and participated in a number of audits to monitor the effectiveness of services provided.
  • The multidisciplinary team was consistently and pro-actively involved in patient care. Staff from all disciplines were invited to clinical huddles, non-clinical huddles and brief meetings to discuss key issues. Staff enjoyed working at the Cloisters and felt valued, supported and able to raise their concerns with senior staff members who were accessible.
  • The staff were kind, caring and motivated. We saw good professional and respectful interactions between staff and patients during our inspection. Patients told us that staff involved them in their care and that changes had been made to their care because of their feedback.
  • There were enough suitably qualified and trained staff to provide care to a good standard. Over 75% of staff had received mandatory training and over 95% of staff had received an annual appraisal. Staff had received safeguarding training and there were three safeguarding leads across the unit.
  • Governance structures were clear, well documented, adhered to and reported accurately. These are controls put in place so that managers can assure themselves that the service delivered is effective and delivered to a good standard. There was a strong commitment towards continual improvement and innovation.
  • Since our last inspection in October 2015, the service had experienced a change of provider. Senior Cloisters staff attended regular meetings with the commissioners and their new provider and felt supported in the process.

However:

  • Regular safety checks for fire and water were not in date. However, the service had provided an action plan in response and were addressing these issues.
  • Although medicine incidents were reported, there were no reports of near misses.
  • Managers did not always provide staff supervision consistently. During the six months prior to our inspection, monthly staff supervision completion rates ranged from 46% to 80%. However staff had access to group supervision and reflective practice sessions.
  • Staff discussed and reviewed patients’ capacity to consent to treatment and finances during the monthly multi-disciplinary review meeting but this was not recorded.
  • Patients told us they received copies of their care plan but the signed copies were not uploaded onto the patient electronic care record.
  • There was no formal strategy between the commissioners and the service about where the service fitted into the rehabilitation care pathway. This meant that patients might not have a clear pathway to move on to, leading to unnecessarily long stays.