This inspection was carried out to see if improvements had been made following our inspection of 13 and 14 November 2013.

During this inspection, we spoke with seven patients and seven members of staff. We also reviewed seven patients’ care and treatment records.

Care and treatment was not always planned and delivered in a way that was intended to ensure patient's safety and welfare. Patient’s needs and risks had been assessed and care plans were in place. However, some care plans lacked detail so as to enable staff to support patients in an individual manner.

There were a sufficient number of staff on duty to meet the needs of patients using the service. A recruitment and retention plan was in place to ensure that safe staffing levels were achieved and maintained.

Patients were not always cared for by staff who were supported and trained to deliver care and treatment safely and to an appropriate standard. Formal support systems for staff were poor. Training records detailed that 57% of staff had attended mandatory training.

There was not an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients who used the service and others. Whilst some audits were carried out, they were not reviewed and repeated within their time frames. Staff views were not sought about the service provision.

Notifications of incidents, such as police involvement, serious injury and safeguarding, were not being sent to the CQC.

We reviewed all the information we held about this provider before we visited the hospital. This included information from other agencies and the provider’s records. We also looked at information from a recent visit by the Care Quality Commission Mental Health Act commissioner.

During the visit we spoke in private with four patients and chatted informally to other patients. We looked at records, including five personal care plans, we spoke to the managers and staff who were supporting patients, and we observed how they provided that support.

We saw patients were supported to make choices and decisions and they were treated with dignity and respect. They were encouraged to share their views about the services they received.

In general we saw that patients were supported by a knowledgeable care team, and they received the care and support they wanted and needed. Staff demonstrated a good understanding of their roles within the hospital. However they were not appropriately supported to carry out those roles.

We saw that there were areas where the provider needed to make improvements to the service that patients received. We identified issues with seclusion arrangements, staff support and care planning.

We spoke with three people who use the services. One person was clearly very happy with the support he received and told us “I’ve been really well since being here. I know about the help I need to stay well.” Another person said “I see the Doctor and he keeps me right.”

We also spoke with some relatives and were told “It’s been the best place for my relative. He has been so much better and they bring him to see me” and “The staff are lovely and very supportive.”

Patients told us that they are satisfied with the support and treatment they receive at the hospital, and there are a lot of activities for them to do. They said that they feel listened to and they are encouraged to take part in the development of the services.

They said that they can use an independent advocacy service when they want to, and they feel happy to make a complaint if they have a need.

Patients told us that the hospital is kept clean and nice for them, and they can help to keep their own rooms tidy. They said that they think staff are properly trained, and they know what they are doing.

We rated Priory Hospital Lincolnshire as good because:

• Patients had access to evidence based, high quality psychological therapy, with once or twice weekly one to one sessions, group therapy and drop in sessions to supplement the structured therapy program. The range of activities available to patients, was extensive, and of high quality. Staff designed activities to promote recovery.
• Leaders were strong, consistent, and well respected by the staff and patients we spoke with. We saw evidence that managers were implementing the information and action plans, that they had shared with us through the provider engagement meetings, into the culture and practice at the hospital. Staff commented positively about how the providers vision and values were embedded into practice at the hospital. The vision and values were based on promoting a culture of family, support for each other, belonging and ownership.
• There were robust systems in place for reporting and recording incidents. There were systems and procedures to ensure that wards were safe and clean. Managers were carrying out regular environmental audits and acting on the findings when needed. The provider had implemented a successful recruitment drive for permanent staff, and improved staff engagement had reduced the number of staff leavers. The service adhered to the requirements of the Mental Health Act and Mental Capacity Act.
• Staff undertook risk assessments of patients upon admission. Staff updated risk assessments during patient review meetings or following an incident. Staff completed comprehensive assessments of patients upon admission. Staff used the information gathered during the assessment to create holistic and personalised care plans. Patients were involved in, and took part in the planning of their care. We reviewed twelve patient care records which showed that staff discussed care plans with patients and recorded their views.
• The hospital was clean, well maintained and safe. All patients had their own en-suite bedrooms with patient call alarms. There was adequate space for a variety of activities to be happening at the same time. There were enough skilled staff to meet patients’ needs and give all the necessary clinical and physical interventions needed. Clinics were clean tidy and well managed. Staff stored medication in locked cupboards within the clinic room. We checked 14 medication records for patients, staff had completed all records correctly.

However:

• The systems for recording and capturing supervision conversations were not clear or robust. Staff doubted the accuracy of the supervision data provided. Supervision records were not readily available and staff appeared to have lost some records. Although, prior to inspection, the registered manager had identified this as a problem and had started to put in place systems to ensure that staff recorded and stored supervision records appropriately.
• One patient who had complained of blurred vision, had been waiting several months for staff to arrange an optician’s appointment for him. Staff explained the reasons for the delay and before the inspection finished, staff had made the patient an opticians appointment at the hospital.
• Lancaster wards’ compliance with mandatory training was significantly lower than Scampton ward. We did not consider this a breach, because the providers overall training compliance was reasonable at 92%, however, the provider should address this discrepancy.
• Staff training in Mental Health Act and Mental Capacity Act was below the providers expected target.