We carried out an announced comprehensive inspection on 12 November 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service provides private psychiatric and psychological treatments for people experiencing mental health problems.

Dr Adrian Winbow is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

We identified regulations that were not being met and the provider must:

• Ensure they have completed an environmental risk assessment to ensure the safety of their premises for patients, staff and those living at Orchard House.
• Ensure they use a recognised risk assessment tool to fully assess, monitor and mitigate patient risk consistently.
• Ensure clinical documentation is kept updated to reflect patients’ risks and action taken.
• Ensure risk management and crisis plans are specific to people’s individual needs or presenting risks.

• Ensure they have systems, policy and processes in place for reporting, investigating, sharing and learning from incidents.
• Ensure they have systems and process in place to ensure they can deliver, monitor, review improve care and treatment.
• Ensure they have a system in place to monitor and limit prescribing of medicines that have the potential to be misused.
• Ensure all staff providing care or treatment to patients including children and young adults are competent, skilled and experienced to do so safely. This includes identifying any required mandatory training for staff to complete and discuss with them their learning needs.
• Ensure they coordinate care and communicate with the community mental health teams where required.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review their policies, ensuring they are comprehensive, up-to-date and accessible to all staff.
• Review and operate a robust system to highlight and manage vulnerable patients. This should include documentation on the patients’ care records.
• Review and operate systems for managing infection control, ensuring they have a policy in place and identify a lead at the service.
• Review and operate systems to ensure they engage with GPs with regards to patients’ ongoing physical health monitoring and ensuring they receive all test results requested.
• Review and operate systems and process to mitigate and review when patients decline consent to share information.
• Review and operate systems in respect of lone working.
• Review and operate systems that ensure covering consultants have up-to-date access to all patient records receiving care and treatment at the service.
• Review and operate systems to monitor the number of patients on their caseloads to ensure they can respond to patients’ changing needs and prioritise urgent contact with patients where required.
• Review and operate systems to ensure they assess and monitor patients’ physical health needs, and liaise with all appropriate health professionals needed. Assessments and care records should reflect this.
• Review and ensure assessments are holistic and consider patients’ social and emotional needs.
• Review patients’ crisis/contingency plans and ensure they are individual to their needs, they understand what to do in a clinical emergency and records reflect this.
• Review and ensure all patient records are kept up-to-date and are an accurate reflection of discussions had and care and treatment provided.
• Review and ensure the consultants receive continued professional development to support knowledge when treating young people.

Dr Paul Lelliott

Deputy Chief Inspector of Hospitals (lead for mental health)

Patients we spoke with who used the service were full of praise for the care and treatment they had received. “I have had three episodes requiring care and I can’t speak highly enough of Dr (name)”, “very impressed” and “extremely helpful” were amongst the comments we received.

Patients had given their consent to treatment and to the sharing of information if necessary. One person said they had,” … a very full discussion” and that the doctor ” ensured I understood the implications”.

Staff had been properly recruited and were qualified, skilled and experienced to meet patient’s needs.

There were effective systems in place to monitor the quality of care provided to people.

There was an effective complaints system in place. Patients had been made aware of it.

Private Psychiatry Limited Liability Partnership is an association of three consultant psychiatrists and a consultant psychologist, all medically qualified. They conduct their consultations at medical establishments across the south east of England where they have practicing privileges. There is a small office that handles administration. We spoke with one consultant psychiatrist, four people who used the service and all three office staff.

People said that they were treated with dignity, their privacy was respected and they had choices in their treatment. Comments included, “yes 100% confidential” and “I have absolute trust”.

People felt professionals gave them the time necessary to explore their problems. They felt that their treatments had helped them to make progress in their lives. People said, “so kind makes you feel that you are the only person on his books” and “... provides me with a safety net”.

We saw that the qualified staff took care to ensure that people were protected from abuse. Training in safeguarding was up to date. We saw that the social services were informed about allegations or suspicions of abuse when appropriate.

Staff felt supported in their roles. Professionals kept up to date with developments in their field.

There were some systems in place to monitor and assess the quality of service. However other systems designed to protect people who used the service had not been operated effectively.