The Priory Hospital Hayes Grove

Updated 7 June 2021

The Priory Hospital Hayes Grove is an independent hospital that provides support and treatment for people with mental illness, eating disorders and people recovering from drug and alcohol addictions. It has 46 inpatient beds. It provides care and treatment for men and women aged between 18 and 65. The services provided are acute mental health inpatient care and treatment, addiction therapy, medically assisted withdrawal from drugs and alcohol and specialised inpatient care for people with eating disorders.

Lower Court is an acute admission ward for up to 17 men and women. Patients received treatment either for their mental health needs or through the specialist addictions programme.

Wickham ward opened during our inspection in April 2021. Wickham ward had two patients on the ward at the time of the inspection. Wickham ward is an acute admission ward for up to nine men. Patients are placed on the ward by a local NHS trust.

The eating disorders service had 20 beds across two wards. The acute ward and the progression and transition ward. Each ward has ten beds. Patients are admitted to the acute ward. Here they are assessed, medically stabilised and started on a re-feeding programme. Patients then transfer to the progression and transition ward. On this ward, patients take more responsibility for their recovery as discharge planning intensifies. Throughout admission, patients are offered individual and group therapy interventions.

The provider is registered to provide care for the following regulated activities:

• Accommodation for persons who require treatment for substance misuse

• Assessment or medical treatment for persons detained under the Mental Health Act 1983

• Diagnostic and screening procedures

• Treatment of disease, disorder or injury

The service had a registered manager in place at the time of this inspection.

This was an unannounced comprehensive inspection of the service. We used CQC’s interim methodology for monitoring services during the COVID-19 Pandemic.

The last comprehensive inspection of the provider was in October 2018. The overall rating for the provider was good. The domains of safe, effective, caring, responsive and well-led were rated good.

CQC conducted focused inspections at the hospital in January and September 2020. These inspections focused on Keston Unit, which was a ward for people with learning disabilities or autism. These inspections identified concerns regarding the quality of care provided on this ward. Following the inspection in September 2020, the provider took the decision to close the ward. The Keston Unit closed in February 2021

CQC chose to suspend the rating for the service following the inspection in September 2020.

We conducted this inspection to review the governance of all the services provided at the Priory Hospital Hayes Grove to check that the concerns that we identified in the Keston Unit were not repeated.

Updated 7 June 2021

The Priory Hospital Hayes Grove is an independent hospital that provides support and treatment for people with mental illness, eating disorders and people recovering from drug and alcohol addictions.

Our rating of this location stayed the same. We rated it as good because:

• The ward environments were safe and clean. The wards had enough nurses and doctors to deliver care to patients, although they continued to have vacancies. At the time of inspection, there were 18 nursing vacancies across the service. Most of the nursing vacancies were covered by staff who were employed via an agency, often on a longer-term block-booked basis. Staff minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.

• 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 and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.

• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

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

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Staff did not always manage patients physical healthcare needs well in the eating disorder service.

Updated 7 June 2021

Our rating of this service stayed the same. We rated it as good because:

• The ward environments were safe and clean. The wards had enough nurses and doctors, although they continued to have vacancies. The eating disorder service had eight nursing vacancies at the time of inspection. These vacancies were covered by agency staff, often on a longer-term block-booked basis. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.

• 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 and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.

• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

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

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.

• The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Staff did not always assess and record all risks accurately, although they did manage most risks well. For one patient with epilepsy whose records we reviewed, the care plan and risk assessment did not refer to their epilepsy, and in seven out of eight risk assessments we reviewed, the level of risk identified did not match the risk identified in the risk formulation.

We rated this service as good because it was effective, caring, responsive, and well led although safe requires improvement.

Updated 7 June 2021

Our rating of this service stayed the same. We rated it as good because:

• The service provided safe care. All ward environments were clean, well equipped, well furnished, well maintained and fit for purpose. The wards complied with guidance in relation to mixed sex accommodation. Work was being undertaken to further reduce the number of ligature points in individual bedrooms on Lower Court ward.

• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

• Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly.

• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and abuse and to provide the right care and treatment. Ward managers could adjust staffing levels dependent on the acuity of the ward. The service had a recruitment and retention action plan to address the high number of nurse vacancies which were being managed through locum agency staff.

• The service assessed, managed and reviewed individual patient risk appropriately. Patients were involved in managing risks to their care. They responded promptly to sudden deterioration in patients’ physical and mental health.

• Staff monitored patients’ symptoms of withdrawal using a nationally recognised assessment tool. When clients were admitted for alcohol or opiate detoxification, they were prescribed medicines from standard prescribing protocols. Staff made patients aware of harm minimisation and the risks of continued substance misuse. Safety planning was an integral part of recovery plans. The service provided a comprehensive range of group and individual therapy to support patient’s recovery.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• Staff had access to all electronic and paper information needed to deliver patient care. Records and care plans were individualised, clear, accurate, up to date and completed in a timely manner.

• The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medicines on each patient’s mental and physical health.

• The service had a good track record on safety. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Comprehensive mental and physical health assessments were completed on admission to the service. Care plans were personalised, holistic, included the patient’s views and were regularly reviewed and updated. Staff monitored patients’ physical healthcare, took appropriate action when needed and supported them to live healthier lives. Outcome measures were used to measure the effectiveness of treatment programmes.

• The service made sure staff were skilled and competent for their roles. Managers appraised staff’s work performance and held regular supervision meetings with them. The service provided mandatory and specialist training in key skills to all staff and made sure everyone completed it. Managers provided an induction programme for new staff.

• Staff from different disciplines worked together as a team to benefit patients. The service had effective relationships with relevant teams in the organisation and with external teams, professionals, and organisations.

• Staff cared for patients with compassion and kindness. Patients were partners in their care. Where appropriate families and carers were involved.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and wider service.

• The service had managers at all levels with the right skills and abilities to run the service effectively. Morale was high and staff were positive about their leadership. Staff were supported, felt valued and felt they could raise issues of concern and would be listened to by the management team.

• Managers operated effective governance processes, throughout the service. Robust performance management systems were in place to ensure the quality of the service was monitored and actions were in place to constantly drive improvement.

Updated 7 June 2021

Our rating of this service stayed the same. We rated it as good because:

• The service provided safe care. All ward environments were clean, well equipped, well furnished, well maintained and fit for purpose. The wards complied with guidance in relation to mixed sex accommodation. Work was being undertaken to further reduce the number of ligature points in individual bedrooms on Lower Court ward.

• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

• Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly.

• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and abuse and to provide the right care and treatment. Ward managers could adjust staffing levels dependent on the acuity of the ward. The service had a recruitment and retention action plan to address the high number of nurse vacancies which were being managed through locum agency staff.

• The service assessed, managed and reviewed individual patient risk appropriately. Patients were involved in managing risks to their care.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• Staff had access to all electronic and paper information needed to deliver patient care. Records and care plans were individualised, clear, accurate, up to date and completed in a timely manner.

• The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medicines on each patient’s mental and physical health.

• The service had a good track record on safety. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Comprehensive mental and physical health assessments were completed on admission to the service. Care plans were personalised, holistic, included the patient’s views and were regularly reviewed and updated. Staff monitored patients’ physical healthcare, took appropriate action when needed and supported them to live healthier lives. Outcome measures were used to measure the effectiveness of treatment programmes.

• The service made sure staff were skilled and competent for their roles. Managers appraised staff’s work performance and held regular supervision meetings with them. The service provided mandatory and specialist training in key skills to all staff and made sure everyone completed it. Managers provided an induction programme for new staff.

• Staff from different disciplines worked together as a team to benefit patients. The service had effective relationships with relevant teams in the organisation and with external teams, professionals, and organisations.

• Staff cared for patients with compassion and kindness. They respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and wider service.

• The service had managers at all levels with the right skills and abilities to run the service effectively. Morale was high and staff were positive about their leadership. Staff were supported, felt valued and felt they could raise issues of concern and would be listened to by the management team.

• Managers operated effective governance processes, throughout the service. Robust performance management systems were in place to ensure the quality of the service was monitored and actions were in place to constantly drive improvement.