The Care Quality Commission (CQC) has rated The Priory Hospital Woking requires improvement and has said that it must make immediate and ongoing improvements, or conditions would be imposed on the provider’s registration.
The Priory Hospital Woking provides an acute inpatient treatment programme for a range of conditions, including depression and anxiety. It also provides a treatment for patients with substance or behaviour addiction issues. It cares for up to 35 adults.
The hospital was previously rated good overall and good for being safe, effective, caring, responsive and well-led after. Following an inspection in June, the overall rating dropped to requires improvement. The ratings for safe and well-led also went down to requires improvement. Effective, caring and responsive remain good.
Karen Bennet-Wilson, CQC’s head of hospital inspection for mental health, said:
“During our inspection of The Priory Hospital Woking, we found a number of areas of concern. When we last inspected the hospital in April 2019, we told the provider that they must undertake an assessment of potential ligature risks in the hospital, which could lead to people harming themselves. However, we found that ligature risks are still present in some of the wards, and in corridors in the hospital, and there was a lack of robust management of these risks in place. This is not acceptable when caring for people who may be at risk of harming themselves.
“We were also concerned about the management of risk when allocating bedrooms to patients. We saw that a patient who had recently been admitted after attempting to harm themselves by strangulation, had been allocated a standard room, rather than a safe room. This needs to be addressed urgently and guidance put in place to minimise the risk to patients.
“We also pointed out that people could be exposed to risk of harm after patients told us that they were not appropriately searched or drug tested when being admitted to the hospital or returning from leave.
“However, patients did tell us that they felt safe and comfortable in the hospital and that staff were kind, respectful and polite and they genuinely cared about the wellbeing of patients. Patients said they were involved in their care decisions, although they were not given copies of their care plans.
“We wrote to the provider outlining our concerns and told them that we would take urgent action if they could not provide assurance that they will make the required improvements urgently. The provider has now provided us with an action plan outlining the actions it is taking to address our concerns and it has already started to put the plan in place and make improvements. We will continue to monitor the service closely to ensure that the required improvements are made.”
Inspectors found the following areas of concern:
- The management of ligature risks across the hospital was not robust and not all wards were safe for all patients
- Staff did not have written guidance, which included patients’ risks of self-harm and suicidality, to determine whether a patient would be allocated to a standard room, a safe room, or a safer one. There was no guidance available for staff if a patient's risk changed when they were in a standard bedroom
- The older part of the hospital had some areas with significant ligature risks in corridors with a closed door. All patients could have access to these areas
- Staff did not record the rationale for decreasing observation levels or risk assessments for deciding which type of room a patient would be allocated to. The governance processes needed to be strengthened to provide assurance that all the measures needed to maintain patient safety were in place
- Staff did not safely manage the searching of patients on return from leave or admission. At a community meeting that inspectors observed, patients told ward staff that they had items such as lighters and illicit substances within their possession. Patients told us that searching was inconsistently applied when returning to the hospital grounds
- Personalised care plans were in place for all patients, but patients did not receive a copy of their care plan
- Staff and patients told us that, due to the COVID-19 pandemic, patients were not allowed visitors on site, unless there were exceptional circumstances. Staff told us that this was a Priory wide policy.
However:
- Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for patients and staff. Staff were complimentary when speaking about the hospital director and director of clinical services and said they were approachable and listened to feedback regarding the service
- Staff felt respected and valued. They said the provider promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear
- Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition
- The ward teams included, or had access to, the full range of specialists required to meet the needs of patients on the wards. Managers made sure they had staff with the range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff
- 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 followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme
- The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately
- Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support
- Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
Full details of the inspection are given in the report published on our website.
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