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Archived: Priory Hospital High Wycombe Inadequate

Action is being taken against the provider of this service. Find out more

  • We have served a fixed penalty notice on Priory Healthcare Limited for failing to comply with the Care Quality Commission’s (Registration) Regulations 2009 at Priory Hospital High Wycombe on 3 July 2019. Fines totalling £1250 have been paid as an alternative to prosecution.

Inspection Summary


Overall summary & rating

Inadequate

Updated 13 February 2019

We rated Priory Hospital High Wycombe as inadequate because:

  • Staff did not have sufficient experience or training to care for young people with learning disabilities and/or autism.
  • The ward environment was not well adapted for young people with autism.
  • There were very few specialist assessments for young people with a learning disability or autism.
  • There was insufficient provision of psychological therapies.
  • Where individual needs had been identified these were not always appropriately addressed. For example, care plans were not always in an accessible format where needed and there were not individual programmes for therapeutic activities.
  • Young people did not have positive behaviour support plans in place.
  • Physical health observations were not always recorded.
  • Access to parts of the ward were restricted without clear reasons for this. This meant that some young people could not independently access the toilet or help themselves to a drink.
  • Young people were routinely searched when returning from leave, rather than this being based on their individual needs.
  • Compliance with mandatory training was very low and supervision was not always recorded.
  • Staff had a lack of understanding of Gillick competence.
  • Some relatives told us that communication at the hospital was poor and that they struggled to obtain copies of care plans and meeting minutes.
  • Staff did not always use appropriate language to describe young people’s behaviour.

However:

  • All young people had up to date risk assessments in place.
  • The provider had good links with a local GP who visited the hospital weekly.
  • The hospital supported young people with their discharges and a few had already moved on to other services.
  • A young person told us they felt safe and comfortable on the ward.
  • Young people were able to personalise their bedrooms which they appreciated.

Following the inspection enforcement action was taken and the hospital was served with two warning notices in relation to Regulation 9 HSCA (RA) Person-centred care and Regulation 18 HSCA (RA) Staffing.

Following the inspection the provider made plans to transfer the young people from the hospital and applied to de-register the service with CQC.

Inspection areas

Safe

Inadequate

Updated 13 February 2019

We rated safe as inadequate because:

  • Compliance with mandatory training was very low. Less than half of staff had completed most of the required mandatory training courses. This included courses we consider essential when working with young people with complex needs such as safeguarding children (40%), basic life support (8%) and fire safety (30%).

  • Doors between bedrooms and communal areas in the female section of the ward were kept locked with no clear rationale. This meant that a female young person using the lounge had to ask staff if they wanted to leave the area, get a drink of water or use the toilet.

  • Young people were routinely searched on admission and on return from section 17 leave rather than this being based on their individual needs. Staff had not completed training in how to carry out searches.

  • Lessons learned from incidents were rarely documented and when they were these were very brief and not well formulated.

  • Relatives told us that section 17 leave was often cancelled due to a lack of staff, especially on weekends.

However:

  • There were good ligature risk management processes in place.

  • Up to date risk assessments were in place for all young people.

  • Staff followed best practice when storing, dispensing and recording the use of medicines.

Effective

Inadequate

Updated 13 February 2019

We rated effective as inadequate because:

  • Most staff working at the service did not have any experience working with people with learning disabilities or autism and no specialist training had been provided to them.

  • Care plans were generic and not recovery focused.

  • Ongoing physical healthcare checks were not always documented and one young person with a physical health condition did not have a plan in place to meet their individual needs.

  • Young people did not have positive behaviour support plans in place.

  • Young people did not have access to any psychological therapies.

  • Few specialist assessments had been completed by the members of the multi-disciplinary team working in the hospital.

  • Where specialist assessments had been completed, these were by staff who had a lack of experience of working with young people with learning disabilities and/or autism, and therefore struggled to communicate with the young people they were assessing.

  • Managers were unable to provide supervision records for permanent members of staff.

  • Only 33% of staff had completed training in the Mental Health Act and 25% in the Mental Capacity Act.

  • Many staff had a lack of understanding of Gillick competence.

However:

  • Records for all eight young people who were detained under the Mental Health Act were completed appropriately.

  • Staff were using a recognised rating scale to monitor severity of symptoms and outcomes.

  • The provider had good links with a local GP who visited the hospital weekly to review physical healthcare needs.

Caring

Requires improvement

Updated 13 February 2019

We rated caring as requires improvement because:

  • Staff used negative language when referring to young people’s behaviour, both verbally and in clinical documentation.

  • Relatives felt communication at the hospital was very poor. They had to request copies of care plans and meeting minutes several times before these were sent to them.

  • Regular community meetings did not take place and there were limited opportunities for young people and their relatives to give feedback to staff.

However:

  • We carried out an observation in a communal area using the short observational framework for inspection (SOFI 2) and observed a high number of positive interactions between staff and young people.

  • A young person told us they felt safe and comfortable on the ward.

  • Relatives told us they found senior medical staff to be professional and courteous.

Responsive

Requires improvement

Updated 13 February 2019

We rated responsive as requires improvement because:

  • The layout of the ward was disorientating and there were lots of loud noises, meaning the environment was not best suited for young people with autism.

  • It had been identified that one young person needed an easy-read version of their care plan but this had not been provided.

  • Relatives told us that section 17 leave was rarely offered and when it was, this was often just going outside to the car park or a short drive to a local supermarket. They were concerned about a lack of physical exercise and exposure to life in the community.

  • Whilst therapeutic activities took place there were not individual programmes in place to meet each person’s individual needs.

  • The education team suggested communication aids that staff members could use to communicate with young people with learning disabilities but staff did not use these.

  • Managers did not keep a central log of complaints.

However:

  • Young people were encouraged to personalise their bedrooms which they appreciated.

  • The chef met with young people weekly to plan menu options and a young person we spoke with gave positive feedback about the food at the hospital.

Well-led

Inadequate

Updated 13 February 2019

We rated well-led as inadequate because:

  • The hospital was not adequately equipped to care for the young people with complex needs who were admitted there.

  • Robust governance processes were not embedded at the hospital.

  • Records were not always complete or accurate. Inconsistent observation levels were recorded in half of care notes.

  • Some staff were unaware of the organisation’s vision and values.

  • Staff did not have a suitable forum to feedback ideas about service improvement to managers.

  • There was no regular audit programme in place to assure quality at the hospital.

However:

  • Instances of inappropriate staff behaviour had been dealt with promptly.

  • Members of the senior executive team regularly visited the ward.

Checks on specific services

Child and adolescent mental health wards

Inadequate

Updated 13 February 2019