The Priory Hospital Bristol

Updated 28 July 2021

The Priory Hospital Bristol is an independent hospital registered to provide care and treatment for up to 85 people with mental health conditions. The hospital is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983

• Treatment of disease, disorder or injury.

Patients detained under the Mental Health Act 1983 were admitted and were provided care and treatment in the

following core services:

• Long stay/rehabilitation wards

• Acute inpatient units and a psychiatric intensive care unit (PICU)

• Eating disorder service

The long stay and rehabilitation wards for working age adults comprised:

• Hillside Ward: mixed gender ward for people who required mental health rehabilitative care.

• Oak Lodge Ward: Male ward for people with dementia or Huntington’s disease and complex care needs. This ward

accepted admissions for working age men as well as older men if the patient was appropriate for the care environment.

Acute inpatient units and a psychiatric intensive care unit (PICU): Acute wards comprise:

• Redcliffe Ward all male ward,

• Blackwell Ward

• Walter Ward (a mixed gender ward)

• Purdown (all male PICU) Acute mental health inpatient units.

Eating disorder service.

• Lotus ward:10-bed ward for men and women who required treatment for eating disorders.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the previous focussed inspection in September 2020 we took enforcement action under Section 31 of the Health and Social Care Act 2008 and placed conditions on the providers registration.

During the current inspection we saw that the provider had made enough improvements and so we invited the provider to apply to have the conditions removed. The provider was successful with their application to remove conditions on their registration. These were removed on 15 June 2021.

All requirement notices, which identify the improvements the provider must make to meet legal requirements, from the previous focussed inspection had been met and related to Regulation 9 (Person-centred care), 12 (Safe care and treatment), 15 (Premises and equipment), the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

What people who use the service say

Two of the three patients we spoke with in acute wards described the criteria for their admission and the conditions which referred to their detention. They praised staff that were working permanently at the hospital and told us the staff understood their conditions. They said the staff helped them make informed decisions. One patient gave us an example of the kindness from staff to support a smooth transition to the hospital.

Patients in long stay and rehabilitation wards said staff treated them well and behaved appropriately towards them.

Patients said staff treated them with dignity and respect and they listened to them. Patients said staff responded well to them with the right care at the right time. Patients said they ‘couldn’t fault staff’ and that they were ‘brilliant’. Patients said that staff explained things to them when they did not understand and helped them fill out forms. Patients said staff were always interested and involved in their care.

Patients in the eating disorder wards told us they felt safe and found it a supportive atmosphere. Patients said they were involved in their care planning and had a copy shared with them.

Patients in the eating disorder ward told us they received therapy which was effective and meaningful for them.

Patients in long stay and rehabilitation wards told us that there were regular staff, which improved consistency and patient experience. However, patients felt the night staff were not always familiar to them. All the patients we spoke with, told us the dietician that supports them is extremely personable, approachable and has had a profound effect on their recovery.

Patients told us that staff explored their goals and they felt the service was passionate about supporting them to achieve these

Updated 28 July 2021

The Priory Hospital Bristol is an independent hospital registered to provide care and treatment for up to 85 people with mental health conditions.

Our rating of this location stayed the same. We rated it as good because:

• All of the ward teams included or had access to a range of specialists. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

• Generally, the hospital provided a range of care and treatments suitable to the needs of the patients and in line with national guidance about best practice.

• The hospital generally provided safe care and patient areas in all wards were clean.

• 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.

• Patients told us that staff explored their goals and they felt that staff were passionate about supporting them to achieve these.

• Staff said they felt valued by the organisation. They felt able to give feedback and senior managers were visible in wards.

• We found improvements in the management of safeguarding procedures. A safeguarding lead was appointed creating full oversight. 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.

• 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 felt respected, supported and valued. They said the hospital promoted equality and diversity in daily work and provided opportunities for development and career progression.

However,

• Audits about the cleaning of the clinical rooms were not robust in identifying shortfalls. Clinic rooms needed cleaning

and were poorly organised. Checks on emergency equipment were not being completed and key items, such as defibrillations pads were missing for the emergency bags and some emergency medicine were missing.

• There were outstanding maintenance issues in the long stay and rehabilitation wards. For example, broken viewing panel in a bedroom, two bedrooms used for storage and broken automatic door stops.

• Patients in all acute and long stay wards had limited opportunities for occupational therapies due to occupational therapist (OT) vacancies.

• Registered nurse vacancies were currently at 60% across the hospital. Although recruitment for substantive staff was ongoing this resulted in difficulties covering shifts of registered nurses. Despite attempts at securing bank and agency staff to cover vacancies the number of registered nurses on each ward could not always be maintained and addition health care assistants were used to cover gaps to support patient care. We were told agency staff didn’t have access to patient’s electronic care records.

• A range of patient records were not always comprehensive or updated regularly. This included risk assessments, care plans and mental capacity assessment records. Risk assessments or care plans in the psychiatric intensive care unit (PICU) lacked detail on how staff were to de-escalate or the least restrictive measures to take when patients behaviours placed them and others at risk of harm. Care plans in acute, PICU, long stay and rehabilitations wards did not always include meaningful discharge plans. In addition, they were not always personalised and in the rehabilitation wards goal setting was not always clear and in progress towards recovery was not always evident.

Updated 28 July 2021

• The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk 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 cared for in a mental health rehabilitation ward 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 a range of specialists required to meet the needs of patients on the wards. 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.

• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

• The service worked to a recognised model of mental health rehabilitation. It was well led, and the governance processes ensured that ward procedures ran smoothly.

However,

• Audits about the cleaning of the clinical rooms were not robust in identifying shortfalls. Clinic rooms needed cleaning and were poorly organised. Checks on emergency equipment were not being completed and key items were missing for the emergency bags and some emergency medicine were missing.

Updated 28 July 2021

Our rating of this service stayed the same. We rated it good:

• The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk 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 cared for in a mental health rehabilitation ward 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 a range of specialists required to meet the needs of patients on the wards. 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.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service worked to a recognised model of mental health rehabilitation. It was well led, and the governance processes ensured that ward procedures ran smoothly.

However,

• Audits about the cleaning of the clinical rooms were not robust in identifying shortfalls. Clinic rooms needed cleaning and were poorly organised. Checks on emergency equipment were not being completed and key items were missing for the emergency bags and some emergency medicine were missing.

Updated 28 July 2021

Our rating of this service went up. We rated it as good

• The service provided safe care. The patient areas were safe and clean. Staff minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• Generally, the hospital provided a range of care and treatments suitable to the needs of the patients and in line with national guidance about best practice.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff undertook robust risk assessments and assessments of needs.
• The ward teams included or had access to a range specialist. 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 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 decision.
• Staff felt respected, supported and valued. They knew and understood the provider’s vision and values and how they applied to the work of their team.
• Our findings from this inspection demonstrated there were improvements in governance processes which generally operated effectively at team level.

However,

• Audits about the cleaning of the clinical rooms were not robust in identifying shortfalls. Clinic rooms needed cleaning and were poorly organised. Checks on emergency equipment were not being completed and key items, such as defibrillations pads, were missing for the emergency bags and some emergency medicine were missing.
• The recruitment for substantive registered staff was an ongoing challenge resulting in difficulties covering shifts of registered nurses. Resulted in the loss of a number of regular registered nurse agency staff meaning that health care supporter workers were often used to cover for registered nurses; wards that required two registered nurses were often left with only one registered nurse. This resulted in the registered nurse not having time to complete documentation robustly and the lack of therapeutic activities.
• Some patients told us that there was a lack of therapeutic activities on the wards and they sometimes did not get their Section 17 leave. We saw that there was a lack of a structured programme of activities on a day to day basis.
• Patients' legal status was not always listed in their care records. A record of when patients were informed of their section 132 rights under the Mental Health Act (MHA) should be maintained.
• The service did not develop care plans which included meaningful discharge planning. Goal setting and documentation of progress made towards recovery was not documented or that patients had received a copy of their care plan.
• Risk assessments or care plans lacked detail on how staff were to de-escalate or the least restrictive measures to take when patients behaviours placed them and others at risk of harm.
• The records for patients assessed as lacking capacity did not demonstrate consultations, as part of best interest decisions, were reached with the patient, decision makers or professionals.
• Notices telling informal patients they were free to leave the ward were not on display in all acute wards.