Woodbourne Priory Hospital

Updated 28 June 2023

Woodbourne Priory Hospital is owned by Priory part of Median and is registered to provide care and treatment to children, young people and adults with mental health conditions, including those whose rights are restricted under the Mental Health Act.

The service is registered to provide the following regulated activities:

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

The service had a CQC registered manager in post at the time of the inspection.

The service comprises seven wards:

Acute wards for adults of working age and psychiatric intensive care units

• Maple, Beech and Acer wards are mixed gender acute wards and have 37 beds.
• Aspen Ward a male-only psychiatric intensive care unit and has 10 beds.

Child and Adolescent mental health wards:

• Mulberry Ward a mixed gender inpatient child and adolescent mental health ward with 14 beds.

Specialist mental health eating disorder services:

• Oak Ward a specialist eating disorder ward for adults of working age and has nine beds.

Substance Misuse Service:

• The Manor is a private adult mental health and addiction therapy ward and has nine beds. The Manor also offers an aftercare programme for patients who have completed the inpatient service.

The Care Quality Commission carried out a focussed inspection in May 2022 following the publication of a prevention of future deaths document that was created after the coroners hearing into the death of a service user at the service in September 2020. The overall rating for the service following the inspection was inadequate. The safe and well led domain was inadequate, effective caring and responsive domains were not inspected and remained rated as good. The service had received two requirement notices in relation to Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment and one in regard to Regulation 17 HSCA (RA) Regulations 2014 Good governance.

This inspection was a comprehensive inspection to see if the provider had met the requirement notices of the last inspection.

What people who use Acute wards for adults of working age and psychiatric intensive care units service say

We spoke with 12 patients and four carers who were positive about the service and described staff as experienced, knowledgeable and non-judgemental. They said that staff treated them with care and compassion and were empathetic to their personal circumstances.

Patients felt safe on the wards and said that staff were friendly and welcoming. They were explained their rights and legal status on admission and at regular intervals afterwards.

Patients were generally complimentary about the range of activities available to them. Some patients felt there could be more activities on weekends.

All patients and carers were aware of the complaints procedure and said staff dealt with complaints in a timely manner. Patients said they had regular one to one time with their named nurse. Patients told us told us that care and treatment were patient-led, personalised and that treatment targeted their individual needs.

Feedback from families and carers about communication was mixed. Some families told us they were unable to get through to the wards by telephone or that staff did not return their calls in a timely manner.

What people who use Child and Adolescent Mental health wards say

We spoke with 3 children and young people and 3 carers.

Not all children and young people we spoke with felt safe on the ward and staff did not carry out their enhanced observations properly which meant they were able to self-harm.

One young person told us staff were not managing prohibited items being brought onto the ward from leave and not effectively searching other young people. Some children and young people told us staff bring in and use restricted items on the ward such as their mobile phones.

Children and young people also told us that the food was not great.

Most children and young people told us regular staff were caring and understanding, the advocacy service had improved and the education provision was good. However, temporary staff did not understand their needs, engage with them and were not respectful or show empathy.

Carers did not always feel involved in their relative’s care or treatment.

What people who use the Substance Misuse services say

Clients gave very positive feedback about the staff. They said they were very supportive and keen to help them. Clients felt confident that they could approach members of staff at any time for help and support.

What people who use the Specialist Eating Disorder services say

We spoke with three patients and five carers during this inspection. All three patients were complimentary about staff and told us that they were kind, caring and available to support them when needed. Patients told us that they understood their care and treatment and had some involvement in creating their care plan, however one patient told us that they felt they could have had more meaningful involvement with this.

All three patients told us that the number of rooms for therapy and visits on the ward was limited. All patients spent a period of time in the lounge after mealtimes, so they could be supervised by staff. One patient told us that the lounge was small and felt cramped when all patents were in there. Two patients and one carer told us that the room that was used for visits was not private as staff sometimes walked through to get to other areas of the ward.

Both patients and carers raised concerns about the quality of the food on the ward. Three carers told us that they felt some meal options were unhealthy and not very nutritious. We saw that patients had also regularly raised concerns about food with staff during weekly community meetings.

All five carers we spoke with told us that they had been invited to attend meetings about their family member’s care and treatment. Three carers told us that they had experienced some issues with their level of involvement in these meetings but had been able to discuss their concerns directly with the ward manager, who they described as approachable and dedicated.

Updated 28 June 2023

• Governance processes were not always effective. Managers did not have oversight or take action in line with the providers policy in relation to environmental risk assessments, fire safety and evacuation procedures. We found there was no process in place for managers to ensure that physical health checks were carried out as per national guidance or that medical equipment and devices were in date calibrated and cleaned regularly.
• We found concerns relating to infection prevention and control management, and some of the ward furnishings were not properly maintained within the acute wards. Cleaning records had not been completed in line with the provider's policy. The treatment room on Mulberry Ward was not clean and the fridge used to store specimens was dirty. Clinic rooms were not checked for out of date items regularly.
• We were not assured that if males patients were admitted to the eating disorder service that the service would remain compliant with guidance on mixed sex accommodation. The allocated female lounge could, at times be used by families and carer to visit.
• Within the acute wards and the eating disorder service staff did not maintain the privacy and dignity of patients at all times. In one care plan out of 23 reviewed we found negative and derogatory language which did not promote the patient’s dignity. Nine out of ten bedrooms on Aspen ward did not have curtains to maintain patients privacy. Staff walked through patient visit areas which impacted on the privacy or patients and their visitors.
• Managers of the eating disorder service did not ensure that regular team meetings took place to or minutes meetings of the meeting shared in a timely way to discuss the outcomes of incidents or to provide staff with updates regarding ward processes.
• Not all children and young people’s care plans were personalised, holistic and recovery orientated. Staff did not always actively involve children and young people or their families and carers in care decisions. We spoke with some children and young people who said they did not feel safe on the ward and that they whilst they were on enhanced support they have managed to hurt themselves. We were concerned as staff did not always follow the providers policy and procedures on the use of enhanced support.
• Not all staff had the required training to ensure that they could meet the needs of the patients in their care.

However:

• The service provided safe care. The majority of the wards seen were safe and clean. The service had enough staff. Staff assessed and managed risk well and followed good practice with respect to safeguarding. They minimised the use of restrictive practices and followed best practice in anticipating, de-escalating and managing challenging behaviour. It was evident that staff prescribed, administered, recorded and store medicines safely.
• Leaders had a good understanding of the services they managed and could explain clearly how teams worked to provide high quality care. Leaders were visible in the service and approachable for patients and staff.
• 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.
• 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. Staff worked well together as a multidisciplinary team. Ward teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
• With the exception of the child and adolescent ward, staff had developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. They actively involved patients and families and carers in care decisions.

Updated 28 June 2023

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

• Governance processes were not always effective. Managers did not always ensure that environmental risk assessments were updated regularly in line with the provider’s policy.
• There was limited space on the ward for therapeutic activities and visits. The lounge area felt cramped when all patients were in this space and staff sometimes had to walk through visiting areas to get to other parts of the ward; impacting on the privacy of patients and their visitors.
• At the time of the inspection, the ward was all female. However, we were not assured that if males patients were admitted there would be a day lounge allocated to females only as per guidance on mixed sex accommodation.
• Whilst we noted that the ward was clean and tidy, there were not cleaning records completed in line with the provider's policy.
• Managers of the eating disorder service did not ensure that regular team meetings took place to or minutes meetings of the meeting shared in a timely way to discuss the outcomes of incidents or to provide staff with updates regarding ward processes.
• Newly employed staff had not completed training specific eating disorder training.

However:

• 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, 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.

Updated 28 June 2023

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

• Staff did not always manage risk well. Staff did not always follow the provider’s policy and procedures on the use of enhanced support when observing children and young people assessed as being at higher risk harm to themselves or others. Levels of restrictive interventions on Mulberry ward were varaible.
• The treatment room was not clean and the fridge used to store specimens was dirty. Clinic rooms were not checked for out of date items regularly.
• Not all children and young people’s care plans were personalised, holistic and recovery-orientated. Not all staff had access to training to meet the needs of children and young people they were supporting.
• Not all children and young people felt safe on the ward.
• Staff did not always treat children and young people with compassion and kindness, respect their privacy, or understand the individual needs of children and young people. They did not always actively involve children and young people or their families and carers in care decisions.
• The governance processes on the ward did not always operate effectively or provide the right assurances at a team level. Agency induction checklists were not always complete. Staff did not always score children and young people’s paediatric early warning score (PEWS) records correctly. Managers did not have sufficient and effective systems and processes to ensure that medical equipment and devices stored in the clinic room were kept in date, calibrated, or cleaned regularly.

However:

• The wards had enough nurses and doctors. They managed medicines safely and followed good practice with respect to safeguarding. Staff provided a range of treatments suitable to the needs of children 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 children and young people on the ward. 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. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
• Staff managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• Leaders had a good understanding of the needs of the children and young people and how to address these as well as a comprehensive understanding of the service they managed.

Updated 22 September 2022

Long stay or rehabilitation mental health wards for working age adults

• The Manor is a private adult mental health and addiction therapy ward and has nine beds. The Manor also offers an aftercare programme for patients who have completed the inpatient service.

Updated 28 June 2023

Our rating of services improved. We rated them as requires improvement because:

• The service did not ensure the privacy of patients. Nine out of ten bedrooms on Aspen ward did not have curtains. This was not subject to individual risk assessment or review.
• In one care plan we found negative and derogatory language which did not promote the patient’s dignity.
• Ward environments were not always clean. We found concerns relating to infection prevention and control management, and some of the ward furnishings were not properly maintained.
• We identified concerns with fire safety and evacuation procedures including generic personal emergency evacuation plans, and a lack of documentation available to staff in the event of an evacuation.
• The seclusion suite did not have a working intercom.
• The service had not made reasonable adjustments for a patient with a diagnosis of autism.
• We found that managers and leaders did not have oversight of concerns with ward environments and fire safety and evacuation procedures and had not taken action to address these.

However:

• Staff completed and regularly updated thorough risk assessments of all ward areas, and removed or reduced any risks they identified.
• The service had enough nursing and medical staff, who knew the patients and received basic training to keep people safe from avoidable harm.
• Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour.
• Staff followed policy when using restrictive interventions. We found that there was good oversight of the use of restrictive intervention by managers and leaders.
• 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.
• The service had effective systems and processes to safely prescribe, administer, record and store medicines.
• Care plans reflected patients’ assessed needs, and were personalised, holistic and recovery oriented.
• Ward teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
• There were effective bed management processes in place. Patients did not have to move wards unless it was for their benefit.
• 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.
• Leaders had a good understanding of the services they managed and could explain clearly how teams worked to provide high quality care. Leaders were visible in the service and approachable for patients and staff.

Updated 28 June 2023

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

• The service provided safe care. The clinical premises where clients were seen were safe and clean. The service had enough staff. Staff assessed and managed risk well 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 clients and in line with national guidance about best practice.
• The teams included or had access to the full range of specialists required to meet the needs of clients under their care. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team.
• Staff treated clients with compassion and kindness and understood the individual needs of clients. They actively involved clients in decisions and care planning.
• The service was easy to access. Staff planned and managed discharge well and had alternative pathways for people whose needs it could not meet.
• The service was well led, and the governance processes ensured that its procedures ran smoothly.

However:

• Staff did not always complete observations of physical health, during clients’ withdrawal from alcohol, at the frequency specified by the client’s consultant.