The Priory Hospital Chelmsford

We rated The Priory Hospital Chelmsford as requires improvement because:

• The provider had not ensured that they identified and mitigated all risks on the wards, including ligature risks, and prescribing errors. They did not have enough staff on the Children and Adolescent Mental health wards to keep young people safe. The Children and Adult Mental Health ward had experienced high levels of incident reports related to staffing levels, but the provider had not acted to resolve the issues.
• Pharmacy staff and Mental Health Act internal audits had highlighted issues with prescribing and administration of medicine, but staff had not resolved all of these issues. Managers had not acted to address issues with staff performance in these areas. We found issues with storage of medicines and record keeping on one ward.
• Staff on Springfield and Chelmer wards had not completed all their mandatory training.
• Staff did not assess the physical and mental health of all patients in an individualised way.
• The provider’s governance system was not robust enough to ensure the safe care and treatment of patients. Managers had not identified problems with risk assessments and medicines audits and did not keep appropriate records of agency staff work experience.

However:

• The hospital provided a full multidisciplinary team and treatments in line with national guidance and best practice.
• Staff completed and updated risk assessments for each patient and used them to formulate care plans to manage those risks. The service managed complaints and incidents well and learned from them through meetings and bulletins. Managers used lessons learned and introduced new ways to improve patient safety.
• Staff on the adult acute wards treated patients with compassion and kindness, respected their privacy and dignity and involved their family members in decisions about their care.
• The design, layout, and furnishings of the wards supported patients’ treatment, privacy and dignity.
• Patients were positive about the care and treatment they received at the hospital and staff supported them to maintain contact with the local community and their friends and relatives.

We rated the Priory Hospital Chelmsford as requires improvement because:

• The provider had completed ligature risk assessments for each room, which were rated, and in date. However, staff did not record items including soap and towel dispensers in one room as present. The provider did not identify other items including hangers in wardrobes, garden furniture, trees and some door closers on the ligature risk assessment or rated these as a low risk. Staff did not identify ligature points in “safer rooms” on some wards. The shower curtains were collapsible at a weight of 40-45kg. However, some patients on Springfield ward were of a lower weight than this making this a potential ligature point. The provider managed the risks from ligatures by individual risk assessments and staff observations of patients
• One patient in receipt of the addiction therapy programme and detoxification did not have a record of their dependency levels by drug testing prior to administration of treatment and to therefore, guide prescriptions for detoxification. Two records for patients receiving detoxification did not include all required assessment information to guide withdrawal management for individual patients and patients receiving detoxification treatment.
• The provider did not have a specialist consultant for the addictions treatment programme at the hospital. Training, specifically in addictions, was minimal and staff received training in addictions at induction only.
• Chelmer and Springfield ward had out of date bandages and defibrillator pads which would be required in an emergency. However, these were replaced on the second day of our inspection.
• The provider complied with same sex accommodation where patients’ male and female sleeping areas were segregated. However, male visitors entered the female corridor to visit female patients. When staff required bedroom doors to remain open, due to high levels of observations, male visitors would be able to see female patients in their bedrooms. This was a breach of the privacy and dignity of those patients.
• Chelmer ward, Springfield ward, the adolescent ward and the Lodge had blind spots where staff could not easily observe patients. However, this was mitigated by staff completing individualised risk assessments and observations.
• Staff left the doors separating Springfield ward from Chelmer ward open. It was unclear where each ward ended.
• Springfield ward rotas indicated the ward was understaffed on five occasions between November 2016 and December 2016. When we raised this with the ward manager, we were told that staff had probably been moved to other wards. However, we were unable to find a record of this on the rota.
• Records for Chelmer ward, Springfield ward and the Lodge showed risk assessments completed and updated, however, records were inconsistent between paper and electronic forms. Patient admission checklists on Chelmer ward were not always signed by staff as completed.
• Staff completed records of incidents of restraint. However, we did not always find accurate detail of staff involvement. The provider would not have access to accurate information should an incident require further investigation.
• Young people had safes in their bedrooms. However, these were not used to store young people’s personal possessions, but used by staff to store restricted items.

However:

• Wards had clinic rooms which were well equipped with emergency medication present.
• The provider was clean and had a homely feel. Staff completed risk assessments and fire safety checks. Staff dealt with maintenance issues in a timely manner.
• The provider reviewed serious incidents and made improvements to reduce the incidents such as additional training and improvements to the security and environment of the building.
• Staff completed assessments of patient needs on admission and physical health assessments with on-going monitoring of physical health problems. Patient care records mostly contained up to date, personalised and holistic care plans, which staff reviewed regularly.
• Psychological therapies were available to patients and patients undergoing the addictions programme completed the 12-step programme.
• Patients with eating disorders received treatment in accordance with the provider policy and the Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN) national guidance (Royal College of Psychiatrists, 2014).
• There was an effective system in place for checking Mental Health Act (MHA) documentation and staff had a good understanding of the MHA and the Code of Practice. Staff read patients their rights regularly. Staff had training in the Mental Capacity Act, 2005 (MCA) and generally demonstrated a good understanding of the MCA. No patients were subject to a Deprivation of Liberty Safeguards application during our inspection.
• Patients generally held positive views about the staff at the provider stating that staff were caring and attentive to their needs. Although patients on the adolescent ward said they felt unsafe due to recent incidents of absconsions from fire exits and verbal and physical aggression towards staff. The provider had taken action to address these incidents and to ensure the safety of young people.
• Patients with an eating disorder used an additional therapy room to eat their meals in private and young people had their own dining area for meal times.
• Systems were in place for managing and dealing with complaints with information provided to staff and patients. The provider shared learning from complaints with the staff team.
• The provider had good governance systems in place with dashboards to monitor quality objectives, a monthly learning outcome meeting and daily ‘flash meetings’ to review incidents and staffing issues. Staff had regular supervision and yearly appraisals.