Archived: Orchard House

Updated 11 November 2019

Orchard House is a stand-alone service for private, fee-paying patients run by Private Psychiatry Limited Liability Partnership.

The service is run by Dr Adrian Winbow who has over 30 years’ experience as a general adult consultant psychiatrist within the NHS and private sectors. He specialises in treatment for a range of disorders including anxiety and phobias, alcohol misuse and addictions, eating disorders and psychotic and personality disorders. The service is now provided for adults only. Prior to the inspection, the service also included care and treatment for young people over the age of 16 years old. Following the inspection, Dr Winbow took the decision to stop treating anyone under the age of 18 years old. The overall objective of the service is to offer psychiatric and psychological treatments to people with mental health conditions in Kent, London and Surrey. Therapies are delivered on a one-to-one basis.

Working in partnership with Dr Winbow, is Professor Anthony Hale. Professor Hale is a general adult and forensic consultant psychiatrist with over 30 years’ experience working in the NHS, including as medical director for two trusts. Professor Hale is also a lecturer at one of the local universities.

The staff team is supported by three medical secretaries, a practice manager and a marketing manager.

The consultant psychiatrist carries out an initial assessment of all patients and a treatment plan is developed in consultation with the patient. All treatments provided by the service are evidence-based and include medication and psycho-social interventions such as mindfulness and cognitive behavioural therapy.

The service also takes on medico legal work for people who require assessments for mental capacity and occupational health assessments as well as expert witness services. However, these services were exempt from registration by CQC. Therefore, we did not inspect or report on these particular services.

The service address is:

Orchard House, High Street, Leigh, Tonbridge, Kent, TN11 8RH.

The opening hours for the service are mostly Monday to Friday 9am to 5pm with some additional clinics held as needed, for example, on Saturdays. The service offers appointments at several locations in Kent, London and Surrey and clinic times vary. During the inspection, we visited Orchard House and Lombard House, both in Kent. The consultant lead for the service told us they also offered evening and weekend appointments to suit the needs of the patients.

How we inspected this service

Prior to the inspection, we gathered and reviewed information submitted by the provider including notifications submitted to the Care Quality Commission and data included as part of the Provider Information Request (PIR). The Care Quality Commission sends PIRs to all providers when a comprehensive inspection is due to take place.

During our inspection visit we:

• reviewed eight patients’ care records
• looked at the environment at Orchard House and visited one of the other clinic locations, Lombard House
• spoke with four staff including the two consultants and two administrators
• reviewed staff training records, governance documents, such as clinical governance meeting minutes, safeguarding information and serious incident logs and clinical audits
• looked at policies, procedures and other documents relating to the running of the service.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 11 November 2019

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Orchard House on 3 and 4 July 2019 as part of our inspection programme and to follow up on breaches of regulations from a previous inspection. The inspection in July 2019 was carried out using our independent doctor methodology and was the first time Orchard House had been rated. Prior to this, the service had been inspected using our community mental health methodology.

The service provides private psychiatry and psychological treatments for people experiencing mental health problems and who require specialist treatments. The service now only treats people over the age of 18 years.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Orchard House also support medico-legal work for people who require assessments for mental capacity, occupational health assessments and expert witness services, which are not within CQC scope of registration. Therefore, we did not inspect or report on these services.

Dr Adrian Winbow is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission previously inspected the service on 12 November 2018. We identified regulations that were not being met and issued the provider with a warning notice for Regulation 12, Safe care and treatment. We told the provider they must:

• Ensure they have completed an environmental risk assessment to ensure the safety of their premises for patients, staff and those living at Orchard House.

• Ensure they use a recognised risk assessment tool to fully assess, monitor and mitigate patient risk consistently.

• Ensure clinical documentation is kept updated to reflect patients’ risks and action taken.

• Ensure risk management and crisis plans are specific to people’s individual needs or presenting risks.

• Ensure they have systems, policy and processes in place for reporting, investigating, sharing and learning from incidents.
• Ensure they have systems and process in place to ensure they can deliver, monitor, review improve care and treatment.
• Ensure they have a system in place to monitor and limit prescribing of medicines that have the potential to be misused.
• Ensure all staff providing care or treatment to patients including children and young adults are competent, skilled and experienced to do so safely. This includes identifying any required mandatory training for staff to complete and discuss with them their learning needs.
• Ensure they coordinate care and communicate with the community mental health teams where required.

We checked these areas as part of this comprehensive inspection and found the service had improved and these issues had all been resolved.

Our key findings were:

• The service provided safe care. Clinical premises where patients were seen were safe and clean. The service had enough staff who knew the patients and received basic training to keep patients safe from avoidable harm. Staff assessed and managed risk well and followed good practice with respect to safeguarding. Staff followed good personal safety protocols. The service had systems to ensure medicines were safely prescribed and recorded. The doctors regularly reviewed the effects of medicines on patients’ health.
• The service had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Incidents were investigated and lessons learnt and shared with all the staff.
• Staff developed recovery-oriented treatment plans informed by a comprehensive assessment and in collaboration with the patients. Staff listened to patients’ views and wishes and adjusted treatment to suit their personal experiences and needs. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff kept detailed records of patients’ care and treatment. Records were clear, up to date and easily available to all staff providing care. Staff engaged in clinical audit to evaluate the quality of care they provided.
• Staff received training, supervision and appraisal to support their skills and ongoing development. All staff worked well together as a team and with relevant services outside the organisation, where relevant, to provide holistic, safe care and treatment.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively and appropriately involved patients and families and carers in care decisions.
• The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude patients who would have benefitted from care.
• Our findings from the other key questions demonstrated that the service had made improvements since our last inspection in November 2018. Both doctors had the skills, knowledge and experience to perform their roles. Governance processes operated effectively, and performance and risk were managed well by all staff.

Dr Kevin Cleary

Deputy Chief Inspector of Hospitals (Hospitals - Mental Health)