The Care Quality Commission (CQC) has told leaders at Priory Hospital Arnold that they must make further improvements to the quality of services following an inspection in December.

CQC carried out an inspection of the hospital, which provides acute mental health services for men and women, to follow up on concerns from a previous inspection where the service was rated as inadequate and placed into special measures.

Following the latest inspection, the service has been rated inadequate overall. The ratings for safe and well-led remain inadequate, responsive and effective remain requires improvement. The rating for caring has moved up from requires improvement to good. Two warning notices were issued due to risks identified with safe care and treatment and good governance.

Craig Howarth, CQC’s head of hospital inspection for mental health and community services, said: “During our latest inspection of Priory Hospital Arnold, whilst we found staff were caring, kind and hard-working, improvements were still needed to ensure people were being cared for in a safe and secure environment.

“We remained concerned that procedures to minimise risks were not always followed which placed people at risk of harm. We heard a patient had come to harm as their risk assessment hadn’t been followed, leading to delays in staff carrying out observations.

“There had been another incident where a patient tried to harm themselves with a plastic bag which was a restricted item on the ward. Staff had not followed the patient’s risk assessment and did not search the patient on their return from a visit off the ward.

“It was also concerning that despite rotas showing enough staff were available across the hospital, staff gave examples of when a lack of staffing had impacted on patient care and safety. Also, the multidisciplinary team met each morning to discuss risk with some staff from the wards however, it wasn’t clear how this information was passed to all ward staff. Despite the measures in place, the risks to patients were not reduced and there was evidence of incidents of harm to patients.

“However, we were pleased to see the provider had made some progress in removing and addressing ligature risks and substantial work had been done to remove panelling and edges on doors and wardrobes in several rooms. Despite this, we found further ligature risks in patients ensuites which had not been identified by the provider.

“We will continue to monitor this service and if insufficient improvements are made, we will use our enforcement powers further to ensure people receive appropriate and safe care.”

Inspectors found: 

• The absence of any monitoring of the impact of known risks to patients’ mental and physical health could have led to serious harm.
• Staff did not always act to prevent or reduce risks to patients. The multidisciplinary team met each morning to discuss risk with some staff from the wards however it was not clear how this information was passed to all ward staff.
• Patients said there were sometimes not enough staff and this made them feel unsafe.
• Staff did not have easy access to clinical information, and it was not always easy for them to maintain high quality clinical records – whether paper-based or electronic

However, inspectors also found: 

• Patients said staff were polite, respectful and knocked on their bedroom door before entering. They said staff respected their dignity and privacy.
• 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.
• The provider had undertaken work to remove potential ligature anchor points. They removed wardrobe doors and completed work on panelling and corners of doors to remove potential ligature anchor points.
• Staff had completed and kept up to date with their mandatory training. The mandatory training programme was comprehensive and met the needs of patients and staff and additional training such as ligature risks and relational security had been added.

A spokesperson for the Priory Hospital Arnold said: “We are disappointed that the hospital remains in special measures, although the fact that five of the seven conditions placed on the hospital after the previous inspection have been removed shows that significant progress has been made.

“We are working closely with the CQC and others to make the other necessary improvements. We have reassessed our staff deployments to ensure the right staff are available whenever they are required. We are continually improving our risk identification and assessment policies, which in the main are working well.

“The ligature point referred to in the report was the result of maintenance work taking place to improve the site and has subsequently been removed. A nurse now inspects all maintenance work after completion for potential impact to patent safety to prevent this happening again.

“The CQC note in their report that we have recruited the psychologists needed to provide a full range of treatments, they started the week of the inspection. We are pleased that the regulators recognised the improvements made to achieve a ‘good’ rating in the ‘caring’ category.”

The report will be published on the CQC website on 15 March.