The Priory Hospital Roehampton

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service supported patients to be safe. The wards were kept clean and cleaning records were maintained. The provider ensured staffing had improved since the last inspection. There were sufficient staff to support patients within the service. Mandatory training had also improved since the last inspection. Staff completed induction and mandatory training specific to supporting children and young people. Further work was needed to ensure that all carers were kept fully informed in relation to their relatives care and treatment. This was a breach of Regulation 9, person-centred care of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider has told us that since the inspection a range of measures have been introduced to improve engagement with parents and care givers and we will assess these when we carry out next inspection.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us that patients could provide feedback about the ward during community meetings. Staff demonstrated an understanding of patient needs. They used behaviour support plans that identified potential triggers and what to do if in crisis. Staf reported that there was a ‘Speak Up Guardian’ who they could report to. Managers told us the service had 5 Freedom to Speak Up Guardians across the hospital and each ward had access to one.

Staff knew what incidents to report and how to report them. Concerns, incidents and near misses were reported in line with provider policy. We reviewed 10 incidents and found 4 inconsistencies with the documentation. We found inconsistencies with 2 out of 10 incidents having no information on a staff debrief. Senior leaders we spoke to told us they were not always documented because the acuity was so high that debriefs were not taking place regularly. There were also inconsistencies with updating patient risk assessments and care plans following incidents. Two patients risk assessments were not reviewed or updated following incidents. The service had no never events on any wards. Patients provided feedback in weekly community meetings. Staff met to discuss feedback and look at improvements to patient areas. Staff had access to weekly reflective practice and governance meetings.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients we spoke to stated that they felt safe on the wards.

Staff had training on how to recognise and report abuse, appropriate to their role. Staff were up to date with their safeguarding training for both children and adults. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff gave clear examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew how to recognise patients at risk of or suffering harm and worked with other agencies to protect them. Managers took part in serious case reviews and made changes based on the outcomes. The service made very few safeguarding referrals.

Staff were caring towards patients.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Staff on both wards knew how to make a safeguarding referral. On both wards staff sent an email to the safeguarding team and included all relevant parties involved in the child’s care including safeguarding leads and social workers. Staff uploaded the information to the incident reporting systems within the service. Staff completed mandatory safeguarding training for both adults and children. At the time of our inspection, 97% of staff completed safeguarding training for children and 82% completed the combined safeguarding training for both adults and children.

On the last inspection we found staff did not always involve families and carers appropriately and did not provide them with support when needed. This was a breach of Regulation 9, person-centred care of the Health and Social Care Act 2008 (Regulated Activities), Regulation 14. We were told of improvements that had been made to the service since our last inspection. These included families and carers being sent weekly feedback forms, monthly meetings with a family therapist, invitations to attend CPA meetings and engage with care planning and opportunities to meet with the consultant psychiatrist. However, feedback from families and carers during this inspection was mixed and further improvement was needed. This was a breach of Regulation 9, person-centred care of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service must make further improvements to ensure staff involve families and carers appropriately and involve them in their children’s care, including inviting parents and carers to meetings and providing them support where needed. Three out of 5 parents we spoke to stated they did not feel involved with their child’s care. They told us communication was inconsistent. Some parents told us they were not invited to ward round meetings or given any information to support their child. Some parents told us they did not receive or have a copy of their child’s care plan. One parent told us they didn’t feel supported by the staff when they had requested additional support. However, 3 parents told us they received a phone call or email with updates following the ward round. Patients had access to independent advocates.

Staff we spoke to stated that they involved young people in their care by including them in ward rounds and care programme approach (CPA) meetings. Staff told us they met weekly with patients to discuss their care plans and risk assessments. Staff told us they encouraged patients to make their own choices about their care and treatment. We reviewed care plan records and found all patients had care plans; including keeping connected; keeping safe; keeping well; keeping healthy. All care plans included risk management plans for individual risks identified in the care plans. Staff involved patients in decisions about the service, when appropriate. For example, children and young people were involved in recruiting a new occupational therapist. Wards held regular weekly community meetings at which patients could give feedback about the ward. Staff we spoke to stated that during these meetings patients were able to give ideas on what activities they wanted to do on the ward whether that be attending school, baking, gym, go on walks, watch movies. Staff we spoke to stated that they involved families and carers. The service had feedback posters displayed in the reception area from carers. Staff we spoke to stated that they completed a 5-point risk assessment. Risk assessments were regularly reviewed on a weekly basis during multidisciplinary team meetings. Levels of observations were discussed and patients were part of these discussions within the meetings. Staff we spoke to could tell us about incidents and themes across the hospital site. For example, staff spoke about patients on other wards had concealed blades. Staff were able to tell us how they managed the incident. Staff told us they managed this by conducting room searches and checking patients’ belongings, as per their policy. Staff used metal detectors during personal searches. Staff told us that they would talk to young people and ask if they were concealing any items when they returned from leave.

We reviewed 2 patient records which had safety plans. There was evidence of patients’ voice and how they wished staff to respond. For example, when patients felt like their risk was increasing, they would want staff to engage them in an activity. We reviewed 2 observation records on lower court ward. Some staff used abbreviations and at times did not record when the patient had been on leave, therefore it appeared as if observations had not been completed. We shared this with the ward manager at the time of the inspection. Improvements were needed to the processes in place to review observation sheets to ensure they were accurately completed and used abbreviations that were understood by all staff. Children and young people were offered a range of treatment options which included mindfulness, healthy living style, art psychotherapy, sensory based group, dialectical behavioural therapy, and cognitive behavioural therapy, music therapy and education. Children and young people also had access to a trauma therapy programme which was developed by the multi-disciplinary team to support patients who had experienced trauma. The provider had a policy on searches on children and young people. Staff told us they informed patients before carrying out room searches and gained their consent. When patients refused to give permission, staff would contact the children and young people’s parents or carers.

Staff completed and regularly updated environmental risk assessments. Staff we spoke to stated that a manager completed walk arounds every month, where they looked at environmental checks and cleanliness. Staff we spoke to stated that they carried personal alarms with them which they could access in the office and that there were alarms all around the ward. On Lower court, the ward had CCTV which covered all communal areas of the ward. In areas where there was no CCTV staff carried out observations. On Richmond court there was no CCTV so staff would complete face to face observations. Staff knew about any potential ligature anchor points and mitigated the risks to keep patients safe. All ligature and blind spots were mapped on a floor plan of the ward in the nurse’s office. The hinges on the fire doors throughout the ward were identified as fixed ligature points. The ward manager stated that they were not permitted to remove these as it would be removing the safety feature of the fire door. However, the Richmond Court ward had modernised fire doors with no fixed hinges. This highlighted a disparity between the 2 wards which showed that young people had a potentially safer environment on Richmond Court. Ligature risks and blind spots were mitigated by the use of mirrors, CCTV and staff presence on the corridors. Staff followed recommendations from the 2023 annual ligature audit, which asked staff to follow local protocols. However, these protocols were not present in the file which meant new staff may not know what they were. Staff were aware of ligature audits and the action plan. Staff we spoke to stated that ligature audits were completed regularly, and each room was examined for ligature points.

We saw equipment, facilities and technology that supported the delivery of safe care. For example, fire doors, anti-ligature features, maintenance audits, security checks. All ward areas were clean, well maintained, well-furnished and fit for purpose. Cleaning of the wards was completed by an external company. The ward complied with guidance and there was no mixed sex accommodation. During our inspection there were only female patients on both wards. All bedrooms had en-suite facilities so in the event of the admission of a male patient, single sex accommodation guidelines could be followed.

Staff followed the services’ policies and procedures when they needed to search children and young people or their bedrooms to keep them safe from harm. Staff completed and regularly updated environmental risk assessments of all ward areas and removed or reduced any risks they identified. The ward had safety features such as the fire doors and anti-ligature features. Staff completed a maintenance audit, security checks and ligature audits. Staff had easy access to alarms and patients had easy access to nurse call systems. Nurse alarms were present throughout the wards, in each room and garden. We tested the alarms at the time of inspection to check they worked. The alarm sounded throughout the ward and to a screen in the nurse’s office which showed which room the alarm had been activated in. Staff made sure cleaning records were up-to-date and the premises were clean. Cleaning records for the day had showed that the wards had been cleaned. Although the location was clean and tidy, staff on the ward did not have access to the cleaning records and so did not know if the ward had been attended to.

The service had enough nursing and medical staff, who knew the patients. Staff we spoke to stated that there was enough staff. Since the last inspection there were more permanent staff, with less agency staff on the ward. Staff felt staffing could be increased when there were patients on the ward with complex needs. Young people we spoke to stated that they knew the staff and that there were enough to keep them safe. However, young people we spoke to stated that there was not enough female staff on shift at night. Managers told us staff within the service could work across different wards. This meant if Lower Court or Richmond court had fewer female staff, other staff members could be moved across wards to ensure a female staff was always present. Managers told us they requested bank staff familiar with the service. Managers made sure all bank staff had a full induction and understood the service before coming on the ward. The service had enough staff on each shift to carry out any physical interventions safely. Staff were aware of de-escalation and physical restraint. Staff could tell us how they would respond to an incident. Staff within the multi-disciplinary teams told us that they completed mandatory training which included, immediate life support, mental health act and mental capacity act. All staff within the patient’s multi-disciplinary team worked together and supported each other. For example, staff within the patient’s multi-disciplinary team were encouraged to join ward rounds. Staff had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation. Staff shared information with all parties involved within the young people’s care.

The provider calculated how many staff were required on shift based on how many patients were on the ward. They ensured they had enough staff to keep patients safe. During our inspection, there were the exact member of staff on shift as required. The service had low vacancy rates. On Lower court they had 1 vacancy for a nurse and 2 senior healthcare assistants. On Richmond court there were 4 nurse vacancies and 3 healthcare assistant vacancies. The service was actively recruiting to fill these vacancies. The ward manager could adjust staffing levels according to the needs of the patients. Managers stated that they were able to request extra staff to cover sickness or if the level of acuity on the ward increased. Staff completed and kept up to date with mandatory training. On Lower Court the compliance of mandatory training was 92%. On Richmond court the compliance of mandatory training was 100%. The training included training specific to children and adolescents in mental health services. Staff completed training in restraint, basic life support, safeguarding and professional boundaries. During our inspection the service had a full multi-disciplinary team which included an occupational therapist, family therapist, psychologist, and assistant psychologist. Both wards 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 training opportunities. Staff told us they received supervision monthly and regular clinical supervision. Managers provided an induction programme for new staff which had increased from a one-day programme to a one-week programme. Managers told us the feedback from this was positive.

Staff we spoke to stated that there was an infection prevention and control policy and staff knew how to retrieve the policy. Staff told us they use personal protective equipment where necessary and disposed of waste in the correct bins. Leaders we spoke told us they managed risk with regards to infection prevention and control through the cleanliness of the ward. Leaders told us the infection control compliance across the service was 82%.

During the inspection, we saw the wards were clean. We observed staff following the infection control policy, including handwashing. The service had an infection control policy which was in date and updated on a yearly basis. Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly. Staff on both wards had access to the following equipment, alcometer, body mass index (BMI) machine, examination couch, ligature cutters, weighing scales, height measure, blood pressure and vital signs. On both wards medication was stored securely. All medication was in date.

The service used an electronic system and had processes in place to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each patient’s mental and physical health through physical health monitoring and ward rounds.

We found on both wards’ medicines were stored securely. Medicines were clearly labelled for individual use. At the time of our inspection, the service had no medication errors. The electronic system was checked on a weekly basis for any errors. Staff followed systems and processes to prescribe and administer medicines safely. On both wards we found that medicines were locked away securely when not in use and clearly labelled. Medicines with a shelf life had a ‘date opened’ label and take-home medicines were stored securely and accounted for. Medication records were kept up to date. On both wards-controlled drugs were stored and checked correctly. Unused controlled drugs were disposed of appropriately. All prescriptions we reviewed were appropriate, signed and dated. We found that medicines were up to date, in date and that there were no excess medicines. Staff reviewed each patient’s medicines regularly and provided advice to patients and carers about their medicines. On both wards we reviewed 5 patients medicine records and saw that these were regularly reviewed by pharmacists and nurses.