Archived: The Priory Hospital Potters Bar

We carried out an unannounced inspection of The Priory Hospital Potters Bar, and focused on the areas of safe and effective in relation to staffing levels, care plans, risk assessments and observations levels. We did not rate the provider on this inspection. We did not look at the whole domains of safe and effective and focused only on specific issues.

We found:

• Physical health monitoring was being completed but not consistently recorded. Staff did not evidence how concerns about patients blood pressure or physical health was being managed effectively.
• Where physical health checks identified a physical health concern for example diabetes and high blood pressure, care plans were not in place.
• Patients had pre-leave risk assessments forms in place however these were not completed with the time due in or actual time back in.
• There were discrepancies in patients risk levels from the patient information board to those indicated in the patients risk assessment. However, risk levels and patients risk behaviours had been identified.
• Sleep charts and observation record sheets were not fully completed in line with the hospitals’ policies. The observation sheets did not describe the patients mental state which is required as part of the observation and engagement policy.
• There was a high use of qualified agency nurses on both Crystal and Ruby ward on a daily basis.
• Care plans were not holistic or in the patient voice and not comprehensive.
• Care plans did not reflect the risks that had been identified in the risk assessments. Some care plans were in place and had been written for risks that had not been identified.

However:

• All patients were assessed by a qualified nurse and doctor within 24 hours of admission and were physically examined.
• The hospital had a staffing matrix in place and the staffing rotas we saw met the numbers required. There was a clear handover of patient information between shifts..
• Staff had policies in place that gave guidance on the Care Programme Approach, risk assessments, observations and engagement and the monitoring of physical health of inpatients. The provider had completed an audit on both wards that identified care plans that were due to be reviewed.

We rated The Priory Hospital, Potters Bar overall as good because:

• Each ward was purpose built and designed for safe and effective staff observation of patients. Patients told us they felt safe and well supported by staff.
• Staff had mandatory training in those areas identified by their provider, including de-escalation and diversionary techniques. This is where staff learnt to calm and manage difficult patient behaviour through talking.
• Patient care and treatment plans were comprehensive and completed in a timely manner. The occupational therapist and their team provided a good range of daily programmes and activities. A wide range of staff from different specialties took part in every ward round and involved the patient wherever possible.
• Staff had received training in, and had a good understanding of, the Mental Health Act 1983, the Code of Practice and the Mental Capacity Act 2005. Staff had assessed and documented patients’ mental capacity and ability to consent to their treatment and care.
• Patients told us that they had effective and supportive meetings with their named nurse and the clinical notes supported this. Individual care and treatment records were up-to-date and relevant. Patients had access to independent advocacy services and the provider displayed information about these services across the wards.
• The hospital received patients from all over the UK, when NHS hospitals did not have enough beds available. This sometimes resulted in short-term admissions. The provider reported good joint working with NHS trusts around arrangements for transferring patients in and out of the service.
• The hospital had a robust patient complaints process.
• The hospital had a ‘lessons learnt’ group, which provided information and guidance to senior managers and each ward. Staff told us that senior managers visited their area and were accessible if they had any concerns. Frontline staff took part in clinical audits and used the findings to improve services for patients. Frontline staff spoke of having good morale on all wards. There was a low level of staff sickness.

However:

• Seven patients out of 36 said that staff had not given them a copy of their care plan and had not involved them in developing it.
• Nursing staff expressed frustration over the amount of paperwork they needed to complete, which they felt did not give them enough time with patients to deliver care and treatment.