The Priory Hospital North London Quality Report Grovelands House The Bourne Southgate London N14 6RA Tel: 020 8882 8191 Date of inspection visit: 30 April - 2 May 2018 Website: www.priorygroup.com Date of publication: 17/07/2018 This report describes our judgement of the quality of care at this location. It is based on a combination of what we found when we inspected and a review of all information available to CQC including information given to us from patients, the public and other organisations Ratings Overall rating for this location Requires improvement ––– Are services safe? Inadequate ––– Are services effective? Requires improvement ––– Are services caring? Requires improvement ––– Are services responsive? Good ––– Are services well-led? Requires improvement ––– Mental Health Act responsibilities and Mental Capacity Act and Deprivation of Liberty Safeguards We include our assessment of the provider’s compliance with the Mental Capacity Act and, where relevant, Mental Health Act in our overall inspection of the service. We do not give a rating for Mental Capacity Act or Mental Health Act, however we do use our findings to determine the overall rating for the service. 1 The Priory Hospital North London Quality Report 17/07/2018 Summary of findings Further information about findings in relation to the Mental Capacity Act and Mental Health Act can be found later in this report. Overall summary We rated The Priory Hospital North London as requires to one registered nurse on a shift. Young people did improvement because: not always receive one to one nursing sessions and their escorted leave was sometimes cancelled due to • At the previous inspection in May 2016 we found that staffing levels on the wards. ligature risks were present across the wards. At this inspection there were still many ligature risks, • Patients' risk assessments were not detailed and risk including high risk ligatures in bedrooms on the child management plans did not always identify how staff and adolescent wards. The pace of change following could minimise risks effectively. On the child and serious incidents on the child and adolescent wards adolescent wards, young peoples' risk assessments was not rapid enough to ensure that ligature risks did not include information about all areas were removed or minimised. Serious incidents had of potential risk, such as their physical health needs included a child who had died. They had used a or history of severe self harm. bedsheet and been found hanging from a ligature • Staff on the child and adolescent wards did not anchor point. always understand what constituted restraint. • There was a lack of clear leadership on the child and Restraints of young people were not always recorded adolescent wards. At the time of the inspection consistently on incident forms or within nursing neither ward had permanent ward managers notes. Care plans did not reflect how to support available. Acting ward managers were in place, but young people in the least restrictive way. they were unable to describe what actions were • On the child and adolescent wards emergency taken to ensure the safety of all young people on the alarms and call buttons were not always responded wards. to in a timely manner. The on-call doctor was on site, • On the child and adolescent wards, the governance but did not carry an alarm or pager. Staff may not and risk management systems and processes in have been able to contact the doctor in an place had not been effective. Potential risks to young emergency. people were not proactively addressed and • Physical health assessments of young people were minimised in a timely manner. The systems and not always fully completed on their admission to the processes in place to monitor care were not effective hospital. Staff did not complete the paediatric early on the child and adolescent wards. Audits were not warning system correctly. This meant staff may not effective in alerting staff or managers to areas where recognise a deterioration in a young person's there were concerns and improvements were physical health and report this to medical staff. needed. • Staff on the child and adolescent wards did not • At the previous inspection in May 2016 we found that ensure that medicines were managed safely. there was not a full complement of nursing staff. At Medicine administration records did not always this inspection we found that staffing levels for show clearly which route ’as required’ medicines nurses on the child and adolescent wards were not should be or had been administered. Staff did not safe. There were numerous shifts when the number record in daily records why ‘as required’ medicines of registered nurses fell below the established level were required or how effective they had been. • Clients having substance misuse treatment did not have early exit plans in case they left detoxification 2 The Priory Hospital North London Quality Report 17/07/2018 Summary of findings treatment early. Early exit plans would describe to • The provider did not ensure that complaints were clients how they could avoid such risks when leaving responded to within agreed time frames. treatment early, such as alcohol withdrawal seizures However, we also found the following areas of good or overdose. practice: • Clients having alcohol detoxification treatment were • Chronotherapy was used to treat patients’ monitored using a validated withdrawal tool for two depressive symptoms. Chronotherapy involves a days. Serious complications from alcohol withdrawal variety of strategies to control exposure to treatment can occur after the first two days of environmental factors which may influence alcohol detoxification. depressive symptoms. This treatment is not widely • On all of the wards, patients and young peoples’ care available in the United Kingdom, but has a strong plans did not always reflect their needs. Care plans international evidence base. were not always personalised, holistic or • On the adult ward, staffing levels had improved and recovery-orientated. On the child and adolescent the minimum staffing levels were consistently met or wards, young people were not involved in producing exceeded. Staff on the adult ward received regular their own care plans. Staff did not always understand one-to-one supervision, and had access to regular the needs of the young people. Most patients on the group supervision. This had improved since the last adult ward did not have a copy of their care plan. inspection. • Young people on the child and adolescent wards • Patients, young people and carers had the told us that some staff did not treat them with opportunity to provide feedback to the service in respect and dignity. They found some staff various ways. This included community meetings patronising and unsympathetic. and periodic surveys. Young people on the child and • On the child and adolescent wards, staff had not adolescent wards were involved in the recruitment of attended specialist training required to carry out staff. their role effectively. They had not had training in • Staff were supported following serious incidents. epilepsy or autism, and did not have a good Staff were given the opportunity to reflect on knowledge of the Mental Capacity Act 2005. incidents and identify changes that could be made • On all of the wards, there was no clear record to the service to prevent similar incidents that informal patients were told that if they were re-occurring. Learning was identified following informal, they had the right to leave at any time. On incidents and complaints, and was used to improve the child and adolescent wards this applied to the service. informal young people over 16 years of age. This was • Clients having substance misuse detoxification were not in accordance with the Mental Health Act code of monitored using validated withdrawal tools. Staff practice. were knowledgeable regarding substance misuse • On the child and adolescent wards, information was and had received specific training. not available in an 'easy read' format for young • On the child and adolescent wards, the staff team people with learning disabilities or difficulties. provided a weekly programme consisting of • There was no system to indicate to staff when education, therapy and activity-based groups. equipment needed replacing or recalibrating. • All patients and young people received a welcome Physical health equipment, such as blood glucose pack when they were admitted to the hospital. monitoring equipment, could become inaccurate if it Families of young people also received a welcome was not maintained properly. Only an adult blood pack. This included information on how to make a pressure cuff was available on one of the child and complaint. Carers had access to a monthly carers adolescent wards, and some equipment was not group. They could meet other carers and discuss any clean or within it's expiry date. issues or concerns that they may have. 3 The Priory Hospital North London Quality Report 17/07/2018 Summary of findings • Adult patients having acute mental health or possible staff gave other opportunities such as substance misuse treatment reported that staff had attending by conference call. Staff encouraged positive attitudes and treated them with respect. young people to maintain relationships with people Staff worked hard to meet the individual needs of that mattered to them. patients, and supported them with areas such as • Staff found that the senior staff team were religion and gender identity. supportive and visible. Following a recent serious • On the child and adolescent wards, young people incident staff had received counselling and were expected to attend education that was additional support. provided on the ward. Staff supported young people During and following this inspection, we provided to be reintegrated back into their local school or feedback to the provider regarding our concerns, and college provision. specifically our serious concerns regarding young • Staff supported young people to maintain contact peoples' safety on the child and adolescent wards.