Priory Barnt Green is an independent mental health hospital provided by the Priory Group. The hospital had one ward open at the time of our inspection. Bittell ward was a ten bed Psychiatric Intensive Care unit for female patients aged 18 and over. The hospital planned to open an acute mental health ward and a private ward but could not do this until they had recruited staff. The provider had submitted an application to increase the number of wards as this had been limited at the time of registration.
We carried out an inspection of the hospital on 28 and 20 June 2021. Following the inspection, we informed the provider of our immediate serious concerns and warned them of possible urgent enforcement action. The provider was told to submit two action plans. The first within three hours that described how it was going to immediately address CQC concerns. The second within two working days with more information about how it would continue to address those concerns. After submitting the first action plan the provider decided to close the hospital for a period of time as they did not feel they could keep patients safe if they stayed open. The provider then submitted their second action plan and informed us of further patient safety incidents that had taken place. We decided to use our powers under Section 31 of the Health and Social Care Act 2008 to take immediate enforcement action. We imposed additional conditions on the provider’s registration in the form of a Notice of Decision. The conditions were to restrict the provider from admitting any new patients to Priory Barnt Green without the prior written agreement of the Care Quality Commission and to ensure they updated us daily about the discharge of existing patients.
The hospital communicated with families after we had completed our inspection that they had decided to close the hospital.
This was the first time we rated this service. We rated it as inadequate because:
- The service did not have a good track record on safety. Staff did not always keep patients safe from avoidable harm. Patients had been able to harm themselves when staff should have been keeping them safe.
- The service did not have enough nursing staff and relied on agency staff. There were occasions where there were not enough nurses on shift. Patients and staff had concerns about the way agency staff treated patients and worked. Agency staff did not have access to the clinical records system, this meant it was hard for them to access information
- Not all areas of the seclusion room where patients were placed for safety were visible to staff.
- Not all staff had the right experience or skills for their roles. Most support staff had not worked in a mental health setting previously. Staff turnover and performance issues were high. Staff did not receive regular supervision and a number of staff had not received training to keep themselves and patients safe in a timely way. Staff assessed risks to patients but did not always manage risks to patients well. Staff sometimes struggled to manage patients’ challenging behaviour.
- There was not a full range of treatment and care plans for patients based on national guidance and best practice. Patients did not have access to enough individualised activity or psychological interventions.
- Staff did not always complete and record physical health observations of patients. The physical health of patients was not monitored regularly. Physical observations were not always completed or recorded after incidents of patients receiving rapid tranquillisation or patients head banging.
- Staff did not report all incidents and there had been delays in reporting, reviewing and investigating incidents. The service did not always manage incidents well and did not consistently learn from incidents to stop them reoccurring.
- Governance processes did not operate well, and this affected how the service managed risk and engaged with staff. The service had not always notified the CQC of incidents that they were required to. Record keeping was not consistent and there were gaps in documentation, including handover records, and Mental Health Act paperwork where information was missing or incorrect. Audits were not effective and staff meetings did not take place regularly.
- Not all patients felt staff always treated them kindly or respected their privacy and dignity. Not all patients felt all staff supported them with their care. Patients did not have discharge plans and did not have regular one to one sessions with their named nurse. The service had not ensured that patients could access independent advocates. Carers did not feel well informed.
The Chief Inspector of Hospitals is placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.