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

Archived: The Priory Hospital Heathfield

Overall: Requires improvement read more about inspection ratings

Tottingworth Park, Broad Oak, Heathfield, East Sussex, TN21 8UN (01435) 864545

Provided and run by:
Priory Rehabilitation Services Limited

All Inspections

02 December 2020

During an inspection looking at part of the service

On 2 December 2020 the Care Quality Commission undertook an unannounced comprehensive inspection of The Priory Hospital Heathfield to look at the improvements made to the service following our previous inspection visits on 12 June, 14 July and 2 September 2020.

Previously, the Priory Hospital Heathfield was inspected in June 2018. At that time the hospital was registered as a care home, therefore it was inspected using our adult social care methodology. During the inspection in 2018, Priory Hospital Heathfield was rated good overall and good in all five domains.

Provider has now redesigned the service and is now operating it as a hospital. These ratings were suspended following the inspection we undertook on 14 July 2020, because the service was inspected under a different inspection methodology and were not a true reflection of the quality of care.

Our rating of the Priory Hospital Heathfield went down. We rated this service as requires improvement because:

• Staff did not always meet the communication needs of all patients. Staff were not using communication aids to support patients with communication difficulties.

• The hospital did not provide a range of treatments suitable to the needs of the patients cared for in mental health rehabilitation wards and in line with national guidance about best practice. We found limited evidence of individualised therapeutic input and rehabilitation focused care.

• Staff did not always ensure that care plans were personalised and that patients’ monitoring charts were completed thoroughly.

However:

• The service provided safe care. The hospital was clean and tidy and the wards were calm. There were enough nursing staff on both wards and they were spending time with the patients.

• There was a new leadership team in place at the hospital who had the experience, knowledge and skills to manage the service.

• Staff managed medicines safely and followed good practice with respect to safeguarding.

• Staff treated patients with compassion and kindness and respected their privacy and dignity. All staff interactions that we observed with patients were caring and respectful, and patients spoke mostly positively about staff.

• Staff access to paper-based and electronic clinical information had improved since our last inspection visit and these records had been kept up to date. Patients’ physical health and basic care monitoring forms and charts had been individualised and streamlined.

02 September 2020

During an inspection looking at part of the service

We carried out an unannounced focussed inspection at the Priory Hospital Heathfield, to look at the improvements made to the service following our previous inspection visits on 12 June and 14 July 2020. Following our visit in July 2020, we served the provider an urgent notice of decision under Section 31 of the Health and Social Care Act 2008, which imposed conditions on their registration. Section 31 of the Health and Social Care Act 2008 is an urgent procedure whereby the Care Quality Commission can vary any condition on a provider's registration in response to serious concerns. We took this urgent action as we believed that a person would or may have been exposed to the risk of harm if we did not do so.

During this inspection we identified that the service had taken a number of positive steps since our inspection visits in June and July 2020. However, we were concerned that the provider had not appropriately reviewed and monitored the patients’ records, in accordance with the conditions we imposed on their registration. Following our inspection visit we served the provider on 4 September 2020 an urgent notice of decision to impose new conditions on their registration under Section 31 of the Health and Social Care Act 2008. We took this urgent action as we believed that a person would or may be exposed to the risk of harm if we did not do so. We have imposed conditions on the provider to ensure that they address the concerns we found following our inspection.

We found:

  • The provider had not ensured that a suitably qualified professional had reviewed patients’ records in line with the conditions applied to the provider’s registration under the urgent notice of decision we served on 15 July 2020.
  • The service did not ensure that patients were protected from skin tissue breakdown. Staff had not completed the skin integrity risk assessments correctly and had not reviewed these within the timeframe set in the urgent notice of decision served on 15 July 2020. This put patients at an increased risk of developing pressure ulcers.
  • Staff did not evaluate the quality of care provided. All patients remained on food and fluid charts without an identified clinical reason. Information recorded on the food charts regarding the consistency of the food for some patients was different to the information recorded on the handover forms. This could increase the risk of patients chocking.
  • Staff did not accurately complete patients’ food and fluid charts.
  • Staff did not understand the individual needs of patients. The inspection team did not witness any staff supporting patients with communication difficulties to use their communication aids. We did not see any evidence that appropriate assessments had been carried out to determine the communication needs of the patients. This meant that patients may still not be able to communicate their needs to staff.
  • The leadership team at the hospital had not identified the new concerns found during the inspection and had not addressed some of the actions required by the urgent notice of decision served on 15 July 2020.

However:

  • Staff had reviewed all patients’ ability to summon assistance. Call bells had been put in place where appropriate and patients observation levels had been reviewed.
  • The hospital was clean and tidy and the wards were calm.
  • Patients were not left alone for long periods of time as we found at our last inspection.
  • There were enough nursing staff on both wards and they were spending time with the patients.

12 June to 14 July 2020

During an inspection looking at part of the service

On 12 June 2020 we undertook an unannounced focussed inspection at The Priory Hospital Heathfield. On 19 June 2020, following this inspection, we wrote to the provider under section 31 of the Health and Social Care Act 2008 about our serious concerns about the safety and patient care at The Priory Hospital Heathfield. Section 31 of the Health and Social Care Act 2008 Act is an urgent procedure whereby CQC can vary any condition on a provider's registration in response to serious concerns. The provider responded to our letter with an action plan on the 23 June 2020 that told us what action they were taking to address the concerns raised. We returned to the service on 14 July 2020 to review progress against the actions the provider told us they were taking to address the concerns in the Section 31 letter of intent.

On 15 July 2020, following our second visit, we served the provider an urgent notice of decision to impose conditions on their registration under Section 31 of the Health and Social Care Act 2008. Section 31 of the Health and Social Care Act 2008 Act is an urgent procedure whereby CQC can vary any condition on a provider's registration in response to serious concerns. We took this urgent action as we believed that a person would or may be exposed to the risk of harm if we did not do so. We have imposed conditions on the provider to ensure they address the concerns we found following both inspections. We suspended the hospitals rating following this inspection.

During the inspections we found:

  • The service did not provide safe care. Staff did not understand patients’ repositioning needs and there were inconsistencies in ensuring that patients with manual air mattresses had the settings correctly set. The Waterlow risk assessments were incorrectly completed in some cases. This put patients at an increased risks of developing pressure ulcers. Patients were not having their continence pads changed frequently enough

  • Staff did not assess and manage risk well and did not follow good practice with respect to safeguarding. Staff had not reported all safeguarding incidents appropriately to the local authority. Staff did not have the correct skills and competence to meet patients’ needs. For example, they did not know how to set manual air pressure mattresses or how to complete food and fluid charts accurately. Staff did not report all incidents in line with the provider’s policies. Information available to staff on the ward about patients was often out of date and incorrect.
  • Patients did not receive appropriate clinical intervention; patients did not receive regular input from clinical psychology, occupational therapy or physiotherapy and there was limited staff engagement with patients. The multi-disciplinary team did not demonstrate good team working to ensure there were no gaps in the patients care. Staff did not always record information correctly.

  • Staff did not always ensure the privacy and dignity of patients. Staff left patients undressed in their bedroom with the doors open. Staff did not always encourage patients and their relatives to be involved in planning their care.
  • The leadership team at the hospital had not recognised the concerns identified on the inspection and the governance systems they had in place had not identified them either.

  • There were no records of best interest decisions in relation to the taking of photographs of patient’s intimate areas when they had sustained wounds.
  • Staff did not undertake clinical audits to evaluate the quality of care provided. All patients were on food and fluid charts without an identified clinical reason. Food and fluid charts did not have target amounts recorded on them.
  • Staff did not understand the individual needs of patients. Staff did not use patients’ communication aids for communicating with patients that had communication difficulties.
  • Patients spent long periods of time in bed without interaction from staff. No activities were being offered.

However:

  • The hospital was clean and tidy.
  • The service had obtained training records and completed inductions for agency staff. Staff had received some relevant training since the first inspection visit.
  • Mental Capacity Act 2005 assessments were being completed in line with legislation following our second visit.
  • Staff had begun to complete do not attempt resuscitation forms correctly following our second visit.
  • On both wards staff had added detail about maintaining a patient’s privacy and dignity, in their care plans following our second visit.
  • Records on both wards showed that staff had maintained and cleaned equipment regularly.

25 June 2018

During a routine inspection

We inspected The Priory Hospital Heathfield on the 25 June 2018. This was an unannounced inspection.

The Priory Hospital Heathfield is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Priory Hospital Heathfield provides accommodation with personal and nursing care for up to 30 adults with an acquired brain injury. The service is divided into two units. Boyce unit provides long term nursing care and support for people who live with conditions such as Huntington’s Chorea. Holman unit is a unit for people with an acquired brain injury for specific behavioural rehabilitation. People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility. Some people on Holman unit were more independent and needed less support from staff. There were currently 12 people who lived at the service. People's accommodation and communal areas were provided on the ground floor.

The Priory Hospital Heathfield is owned by Priory Rehabilitation Services Limited.

At a comprehensive inspection in August 2016 the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). We undertook an inspection in March 2017 to see if the necessary improvements had been made. We found that significant improvements had been made and that the breaches of regulation had been met. We ascertained at that time that further time was needed to embed the improvements made in the safe and well led questions to ensure the improvements were sustained and that the overall rating was requires improvement.

This inspection found that the service had sustained the improvements necessary and achieved an overall rating of good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were content and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person said, "Very safe." Another said, "Excellent facility for me to get better." When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with an acquired brain injury, multiple sclerosis, Huntington’s Chorea, epilepsy, diabetes as well as specific mental health disorders, such as Korsakoff disease and dementia. They also received training in managing behaviours that challenge. Formal personal development plans, including two monthly supervisions and annual appraisals were in place. Staff were supported to become to undertake further training.

The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people could give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People chose how to spend their day. Activities were mixed and people could choose either group activities or one to one. People were encouraged to stay in touch with their families and receive visitors. The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns. The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

3 March 2017

During a routine inspection

We inspected Heathfield Neuro Rehabilitation service on the 03 and 06 March 2017. This was an unannounced inspection

Heathfield Neuro Rehabilitation Service provides accommodation with personal and nursing care for up to 24 adults with an acquired brain injury. The service is divided into two units. Boyce unit provides long term nursing care and support for people who live with conditions such as Huntington’s Chorea. Holman unit is a new unit for people with an acquired brain injury for specific behavioural rehabilitation. People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility. Some people on Holman unit were more independent and needed less support from staff. There were currently eleven people who lived at the service.

People's accommodation and communal areas were provided on the ground floor. This included a gym and an adapted daily living skills kitchen (a kitchen which was height adjustable). Outside there was an enclosed garden and grounds which people could access easily with walking aides and wheel chairs. There was also a hot tub which was used for therapeutic and relaxation techniques.

Heathfield Neuro Rehabilitation Service is owned by Priory Rehabilitation Services Limited.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At a comprehensive inspection in August 2016 the overall rating was Inadequate and the service was placed into special measures by the Care Quality Commission (CQC). Seven breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. People’s safety and well-being was being compromised in a number of areas. There were not enough suitably qualified or experienced staff at all times to meet people’s needs. People were not always treated with dignity or respect due to the lack of training. People had not always been consulted about their care and treatment and were not involved in developing their care plans. Care plans had not been accurately maintained and updated to reflect changes to people’s health. The provision of meaningful activities was poor and some people had very little engagement and were at risk of social isolation. Medicines were stored safely, however they were not always administered safely and records of administration were not completed accurately. There was no clear auditing system in place to monitor the quality of the service being delivered. Records were not in good order or always kept up to date. Records were not always stored securely to protect people’s confidentiality.

Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.

At this inspection many improvements had taken place since the last inspection and the breaches of regulations had been met. The service has been taken out of special measures. At the next inspection we will check to make sure the improvements are embedded and sustained. This is because we will need to see that as more people come to live at the service, the improvements are continued.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were protected against the risks of unsafe medicines management. The staff were following current and relevant medicines guidance. We found that previous issues with how medicines were managed and recorded had been monitored and improved. However the recording of prescribed creams still needed to be improved to reflect that staff have consistently applied the creams to prevent sore skin developing.

The completion of food and fluid records whilst improved still demonstrated that not all staff were recording correctly the amounts people ate and drank. New charts had been introduced but these were not always completed correctly and therefore did not always reflect the persons' actual intake. This had not ensured that staff always had a correct overview of peoples hydration and nutritional needs.

Care plans reflected people’s assessed level of care needs and were based on people's preferences. Care plans had been reviewed and there was acknowledgement from the management team that there was still work to be done to ensure that all reflected peoples personal preferences. There were plans to review the organisational documentation that would streamline peoples care plans to ensure that they were easy for staff to use and access. Staff handovers and communication systems had improved and were informative to care changes. Risk assessments that guided staff to promote people’s comfort, nutrition, skin integrity and the prevention of pressure damage were in place and accurate. There were behavioural management plans in place for those people who lived with behaviours that were challenging. Equipment used to prevent pressure damage was set correctly and people identified at risk from pressure damage had the necessary equipment in place to prevent skin damage.

Staffing deployment ensured people received the support required to ensure their health and social needs were met. There were arrangements for the supervision and appraisal of staff. Staff supervision took place to discuss specific concerns. Staff confirmed that they had regular supervision and yearly appraisals. People we spoke with were complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff were respectful to people and there was plenty of chat and laughter heard.

People were supported to eat and drink in a safe and dignified manner. The meal delivery ensured peoples nutritional and hydration needs had been met and offered a wide range of choice and variety of nutritious food.

The home was clean and well presented. Risks associated with the cleanliness of the environment and equipment had been identified and managed effectively. Emergency procedures were in place in the event of fire or evacuation.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health. There was a multi-disciplinary team that met regularly to ensure all aspects of care delivery was considered and was appropriate for the people who lived at Heathfield Neuro Rehabilitation Service.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses and health professionals employed by the service all had registration with the nursing midwifery council (NMC) and health and care professional council (HCPC)which were up to date.

4 August 2016

During a routine inspection

This inspection took place on 4 and 8 August 2016 and was unannounced.

Heathfield Neuro Rehabilitation Service provides accommodation with personal and nursing care for up to 24 adults with an acquired brain injury. The service is divided into two units. Boyce unit provides long term nursing care and support for people who live with conditions such as Huntington’s Chorea. Holman unit is a new unit for people with an acquired brain injury for long and short term specific rehabilitation. People were living with a range of care and nursing needs, many people needed support with all of their personal care, and some with eating, drinking and mobility. Some people on Holman unit were more independent and needed less support from staff.

People's accommodation and communal areas were provided on the ground floor. This included a gym and an adapted daily living skills kitchen (a kitchen which was height adjustable). Outside there was an enclosed garden and grounds which people could access easily with walking aides and wheel chairs. There was also a hot tub which was used for therapeutic and relaxation techniques.

Heathfield Neuro Rehabilitation Service is owned by Priory Rehabilitation Services Limited. We have received whistle blowing concerns in regard to inadequate staffing levels and lack of support and training. Due to the nature of concerns we brought the scheduled inspection forward.

There was no registered manager in post but a manager had been recruited and we were told they would be starting employment 15 August 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The clinical lead had taken on the role of acting manager and had been in this current post for three weeks. They were present on the days of the inspection.

People told us that they felt safe, but we found people’s safety was being compromised in a number of areas. There were not enough suitably qualified or experienced staff at all times to meet people’s needs. Not all staff had received the necessary training to meet people’s specific needs and some training was out of date. Staff told us they had received supervision but it had not been regular. There were no systems in place to support staff to develop skills, identify their development needs or to check they had learnt from the training. Staff did not always treat people with dignity or respect due to the lack of training.

People were not always consulted about their care and treatment and were not involved in developing their care plans. Care plans were not always accurately maintained and updated to reflect changes to people’s health. People could not rely on care being delivered in a consistent and appropriate way. Where assessments of people’s needs were required they had not always been undertaken. The provision of meaningful activities was poor and some people had very little engagement and were at risk of social isolation. Medicines were stored safely, however they were not always administered safely. There were no protocols in place for as required medicines (PRN). The provider had a policy in place but staff had not consistently adhered to this.

Staff were concerned about the quality of the service being delivered. Staff told us they did not feel supported or valued by the management and were not clear about what was expected of them or of their role. Job descriptions for new roles within the service were not in place and had not been discussed with staff.

There was no clear auditing system in place to monitor the quality of the service being delivered. Records were not in good order or always kept up to date. Records were not always stored securely to protect people’s confidentiality.

However there were some areas of appropriate support for people. The provider had a policy in place which gave guidance on how to handle complaints and complaints were handled appropriately.

The provider was meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were completed in line with legal requirements. Deprivation of Liberty Safeguards had been requested for those that required them.

People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.

The service had notified the Care Quality Commission (CQC) of all significant events which had occurred in line with their legal obligations.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Heathfield Neuro Rehabilitation Service and agency nurses all had registration with the nursing midwifery council (NMC), which were up to date.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

30 October 2013

During a routine inspection

During our visit we spoke with two patients, five members of staff including the clinical services manager, human resources administrator and hospital director. We looked at computerised care records for patients who used the service, the service's policies and procedures, four sets of personnel files and a selection of patient feedback questionnaires.

Staff were able to demonstrate a good understanding of the needs of the patients who were accommodated at The Priory Hospital, Heathfield. They were able to show us that they received the training and support they needed. They prioritised the privacy and dignity of people, and supported people to be independent. We spent time observing the care provided to people and saw that staff had a good rapport with patients, understood their needs and spent time talking and listening to them. There was a friendly, happy atmosphere in the hospital.

Patients told us that they felt staff treated them with respect and dignity and were given clear information regarding their care and treatment and they told us that they had a relationship of trust with care and clinical staff.

We found that patient needs were fully assessed, risks identified and managed. Care plans were well written, reviewed and continuously updated. Patients were involved in decisions about their care with advocates available when appropriate.

We found that the food was prepared to a high standard with initiatives to continually improve the service. The chef told us, "Homemade soup is now a firm favourite with patients and staff alike as we only cook with the freshest ingredients and pride ourselves on the quality of our meals." One person said 'My lunch is delicious.'

The service had clear safeguarding policy and procedures in place, supported by a range of appropriate and innovative staff training. People told us, "I do feel safe here and I trust the staff."

20 November 2012

During a routine inspection

During our visit spoke with members of staff who were able to demonstrate a good understanding of the needs of the people who lived at The Priory Grange, Heathfield. They were able to show us that they received the training and support they needed. They prioritised the privacy and dignity of people, and supported people to be independent. We spent time observing the care provided to people and saw that staff had a good rapport with people, and spent time talking and listening to them. Staff understood people's needs well. There was a friendly, happy atmosphere in the hospital.

People told us that they felt staff treated them with respect and dignity. We were told that staff were "kind, efficient and some had a great sense of humour". One person told us 'staff try very hard to make life fun and help us to do the things we want and enjoy. Another said 'this is our home and people need to feel safe, secure, happy and respected'.

We asked people if they were given clear information regarding their care and treatment and they told us that they had a relationship of trust with care and clinical staff. We were told by one person that 'this is such a nice place to live, everyone is so kind, they don't pretend to care, they really do care. I feel important here'.

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.