The Priory Ticehurst House

Updated 16 June 2021

The Priory Ticehurst House is situated in Wadhurst, East Sussex. It is an independent hospital which provides inpatient mental health treatment to adults and young people.

There were two child and adolescent mental health (CAMHS) wards for young people ages 12-18 years. Keystone is a 12-bed mixed sex, purpose built psychiatric intensive care unit. Upper Court is a 13-bed female only ward which is a general CAMHS ward that provides assessment and treatment for children and young people with emotional, behavioural or mental health difficulties. There was an Ofsted-registered school on site which supports young people with educational needs. At the time of the inspection, the service had voluntarily paused admissions due to medical staff shortages.

There were three acute wards for adults of working age. Newington Court 1 and 2 is a combined 21-bed female only ward. Newington Court 2 is a step-down ward where patients on Newington Court 1 move to. Garden Court is a 13-bed, male only ward. Highlands ward is a 9-bed ward for private paying patients only.

The Priory Ticehurst House is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983.
• Treatment of disease, disorder or injury.

There is a registered manager at the service.

The child and adolescent mental health wards were last inspected in December 2020. This was an unannounced, focused inspection and we specifically looked at some aspects of the key questions, are services safe, effective and well-led. In September 2019, we had rated the key question safe and well led as inadequate and still had some concerns because of information we had received from young people and parents about whether services were safe. Following the December 2020 inspection, we told the provider to ensure that young people were involved in the decision making about the use of closed-circuit television in their bedrooms and that consent was sought appropriately. We also told the provider to ensure that there was effective governance and oversight of the use of closed-circuit television in young people’s bedrooms and that Priory policies were adhered to. We did not rerate the service following the December 2020 inspection as we only looked at specific key lines of enquiry in the key questions are services safe, effective and well-led. Therefore, the previous rating of inadequate remained in place. We found that some elements of these requirements were met during the comprehensive inspection carried out in April 2021.

The adult acute psychiatric service was last inspected as a full comprehensive inspection of the location in April 2018. The service was rated as good overall and good in each domain.

What people who use the service say

People who use the acute adult service were largely positive about their experiences at the hospital. Most of the patients we spoke with reported feeling safe and felt that the staff took a genuine interest in their care and wellbeing. Patients told us that most of the time there were enough staff on the wards and that they had the opportunity to participate in a range of activities. Patients told us that the wards were clean, the quality of the food was good, and that staff were always available. Most of the patients said that they were able to seek advice and support from staff about their physical health.

We also received positive feedback from the families we spoke with, in particular, about the quality of care their family members received from staff.

However, some patients felt that they have not been adequately involved in their care planning and that they would like more information and support around healthy eating and exercise. Some patients also told us that some repairs were needed on the wards.

Young people, relatives and carers were overwhelmingly positive about staff and the quality of care they received. Young people said staff were engaged with them with appropriate humour which they liked. They said staff were caring and supportive and they felt truly respected, involved and empowered to make decisions as individuals in the therapies and treatments offered to them. Some young people were keen to tell us about specific members of staff they felt had provided outstanding care and support to them. Relatives and carers told us they felt staff knew the young people very well. They felt involved in contributing to their relatives’ care and treatment and were invited to attend meetings to discuss their care and were aware of plans and goals for discharge. Relatives and carers said that staff communicated well with them and they were kept well informed of every aspect of their relatives’ care and treatment. They told us that they felt staff listened to and respected their views and they felt the support received from staff to be invaluable.

Updated 16 June 2021

The Priory Ticehurst House is an independent hospital which provides inpatient mental health treatment to adults and young people.

We undertook an unannounced comprehensive inspection to determine if the service was providing safe and good care to patients and young people and to check if the service had made improvements, we told them they must make.

Since this inspection, the provider decided to close the two child and adolescent mental health wards of the hospital. This was because the provider was experiencing issues recruiting enough nursing and medical staff for this service. This decision was not related to our inspection activity.

The acute wards for adults of working age remain open.

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

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. 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. However, on the adult wards, some of the patients’ care plans were more basic and generic than others. Staff provided a range of treatments suitable to the needs of the patients and young people 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. The ward staff worked well together as a multidisciplinary team and had effective working relationships with external teams and organisations. Most staff told us they felt supported and could speak with their manager when they needed to.
• Staff treated patients and young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients and young people. They actively involved patients and families and carers in care decisions. Staff on the children and adolescent wards interacted with young people in a way that appealed to their age group and empowered young people to be partners in their care.
• 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 mostly ensured that ward procedures ran smoothly.

However:

Staff did not understand or discharge their roles and responsibilities under the Mental Capacity Act 2005. Capacity to consent assessments and recording was not always in line with current legislation. Staff did not document their rationales for the decisions they made, and they did not support people who lacked capacity through best interest decisions.

Updated 16 June 2021

Our rating of this service improved. We rated it as good because:

• The service provided safe care. The service had enough nursing and medical staff and received basic training to keep young people safe from avoidable harm. Staff assessed and managed risks to young people and themselves well. Staff understood how to protect young people from abuse. Managers investigated incidents and shared lessons learned.
• Staff assessed the physical and mental health of all young people and managed medicines safely. They developed individual care plans, which they reviewed and updated regularly. Managers made sure they had staff with a range of skills needed to provide high quality care. Staff from different disciplines worked together as a team to benefit young people.
• Young people were truly respected and valued as individuals and were empowered by staff as partners in their care. Feedback about the way staff treat young people was highly positive. Staff recognised and respected the totality of people’s needs and were motivated and inspired to deliver the best care. Staff valued their relationships with young people.
• Staff planned and managed discharge well. The ward environments supported young peoples’ treatment needs and privacy and dignity. Staff facilitated young people’s access to high quality education throughout their time on the ward. The service treated concerns and complaints seriously.
• Staff felt respected, supported and valued. Ward teams had access to the information they needed to provide safe and effective care and used that information to good effect. Most governance processes operated effectively, and performance and risk were managed well.

However:

• Staff did not always support young people to make decisions on their care for themselves. Staff did not always assess and record consent and capacity or competence clearly for young people who might have impaired mental capacity or competence. Staff did not clearly record their reasons for the decisions they made on behalf of young people.
• Governance processes specific to the oversight of the Mental Capacity Act were not always effective and did not identify the concerns we found during the inspection.

Updated 16 June 2021

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

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well and they minimised the use of restrictive practices.
• Staff managed medicines safely and followed good practice with respect to safeguarding. The service treated concerns and complaints seriously.
• Staff developed recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received appropriate training. The ward staff worked well together as a multidisciplinary team.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983.
• Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients in care decisions and kept families informed about their loved one’s care. All staff interactions that we observed with patients were caring and respectful and most patients spoke positively about staff.
• The service managed beds well and patients were discharged promptly once their condition warranted this.
• The service was well-led and most of the governance processes ensured that ward procedures ran smoothly.

However:

• We observed that some ward areas needed repairs and redecoration.
• Staff did not always receive regular clinical and managerial supervisions.
• Staff did not always understand the provider’s policy on the Mental Capacity Act 2005 and did not record capacity clearly for patients who might have impaired mental capacity.
• Governance processes specific to the oversight of the Mental Capacity Act were not always effective and did not identify the concerns we found during the inspection.