Priory Hospital Dorking

Updated 28 September 2023

The Priory Hospital Dorking is an independent hospital and is part of the Priory Group (Partnerships in Care). The service supports males of working age, experiencing an acute mental health episode, providing the necessary levels of care required during crises.

The focus of their service is to stabilise and support patients on a pathway to community discharge as soon as possible, with the appropriate aftercare in place.

This new service has not previously had an inspection since changing name and its service provision to acute wards.

Priory Dorking is registered with CQC to provide the regulated activities of assessment or medical treatment for persons detained under the Mental Health Act 1983, Diagnostic and screening procedures and Treatment of disease, disorder, or injury.

We undertook an unannounced comprehensive inspection to determine if the service was providing safe care to males of working age, experiencing an acute mental health episode.

The service was previously registered with CQC as Pelham Woods and provided rehabilitation services for females with Emotionally Unstable Personality Disorder (EUPD). The service re-registered with CQC as Priory Dorking in December 2021 as an 18-bedded acute mental health service. At the time of inspection, there were 14 detained and 4 informal patients.

CQC inspected the service under the previous provider on 31 October 2018 and rated the service good over all with outstanding in well-led.

The service did not have a registered manager in post at the time of this inspection.

Updated 28 September 2023

Priory Dorking Hospital provides Acute care for adults of working age.

This was the service’s first inspection. We rated it as good because:

• Staff assessed and managed patients’ risks well. They minimised the use of restrictive practices 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 including nurses, doctors, a clinical psychologist, a psychology assistant, an occupational therapist, and occupational therapy assistants. 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.
• All patients said that the care and treatment they received was good and that staff behaved kindly towards them.
• The service managed access to beds well and discharged patients promptly once their condition warranted this.
• The service was well-led.
• Staff felt respected, supported, and valued. They said the service promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

However:

• The provider did not manage ligature risks well. The tools and audits used by the provider did not adequately assess and manage potential ligature anchor points. A ligature point is anything which could be used to attach a cord, rope, or other material for the purpose of hanging or strangulation. There were multiple ligature points in parts of the ward which the provider had not sufficiently mitigated. The provider did not have a robust ligature risk assessment in place at the time of our inspection to remove all ligature risks. The provider did not have governance processes in place to enable the systematic review and management of environmental ligature risks. We were concerned that the governance around how ligature risks were systematically audited, reviewed, and actions carried out were not evident or documented. Due to the nature of the concerns, we escalated our concerns to the management team, and the provider gave us immediate assurance of how they were going to mitigate the ligature risks and provided a robust action plan immediately after our inspection visit.
• Leaders did not always have oversight of the safety of the ward.

• Staff did not always ensure patients’ medicines were managed safely. We checked medicines and found that several medicines including tablets, liquid, and creams were out of date. We ensured the provider had removed the out-of-date medicines from the cupboard during our inspection.
• We identified that some medical equipment was out of date such as back up pads for a defibrillator and some syringes which were out-of-date. We ensured the provider had removed the out-of-date equipment from the cupboard during our inspection.
• Staff did not always review and record the effects of intramuscular rapid tranquilisation on the patients’ physical health including regular checking of their vital observations. Therefore, staff could not potentially detect any harmful physical health deterioration of the patients to mitigate against or reduce the risk of harm.
• We identified gaps in the National Early Warning Signs (NEWS2) records because staff stored NEWS2 information on both paper record and electronically. Staff could not frequently total NEWS2 scores so staff could not quickly escalate any serious concerns to the clinical team.
• Not all ward areas were clean, well maintained and fit for purpose. Most parts of the ward looked very ‘tired’ and needed maintenance and redecorating. We found damaged doors, flaking paintwork and holes in walls on the ward.
• The service did not have enough permanent registered nurses but was in the process of recruiting to vacancies.
• The occupational therapy team did not provide enough therapeutic activities for the patients during the weekend.

Updated 6 September 2016

Updated 28 September 2023