We rated Priory Hospital Preston as good because:

• There were appropriate measures in place to safely manage the ward layout and environmental risks. This included the use of closed circuit television and the use of mirrors.

• Staffing levels were adequate and could be increased when needed. There were few vacancies and patients had regular one to one time with nurses. There were effective systems in place to ensure that all staff received appropriate mandatory training this ensured that staff were up to date with the correct training.

• Comprehensive care plans and risk assessments were fully completed and up to date. Care plans and risk assessments were reviewed regularly as part of a multi-disciplinary discussion. Patients were encouraged to be involved in their care plans and patient views were clearly documented within care plans.

• The electronic care record system was easy to navigate and locate patient documents. This meant that staff could work efficiently and access patient information without delay.

• There was good psychological provision on Bartle ward that was specific to eating disorders. This meant that patients were receiving holistic care as recommended by national guidance. There were structured patient activity programmes on each ward that were specific to meet patient needs. Patients met to discuss which activities they would prefer and suggestions were implemented where possible.

• Staff demonstrated kind and caring attitudes towards patients. Patients described staff as approachable and helpful. The values and behaviours of the hospital were embedded throughout the service. Staff were aware of the values and behaviours expected of them and were rewarded for demonstrating them in practice. Staff morale was high. Staff enjoyed their work and strived to achieve the best for patients. There were positive results from the staff engagement survey.

• There were many ways patients could give feedback about the service. We saw evidence of patient suggestions being considered and acted upon. There was a robust complaints procedure for staff to follow. Complaints were fully investigated and information shared with staff and other appropriate people.

• The service aimed to provide patients with continuity of care. The service had agreements with local NHS providers that patients admitted to the hospital would remain there until their inpatient treatment was complete. There was effective multi-disciplinary working on both wards. A range of staff disciplines met regularly to decide care and treatment options for patients.

• The food was described by patients as high quality. Patients gave very positive feedback about the food and choices available.

• The service was beginning to implement the safe wards programme. Staff were using positive words and relaxation boxes were available for patients.

However:

• There was no female only lounge on Bartle ward.

• Physical health assessments on admission to the hospital had been omitted and not followed up for two patients. This meant that staff were unaware of any potential physical health issues and unable to initiate treatment.

• Staff had a limited understanding of how to conduct a capacity assessment and implement the best interest’s checklist.

• Staff had not received regular managerial supervision. This was not in line with the providers policy.

• As required medication was not being reviewed in accordance to the national guidance.

We rated Priory Hospital Preston as good because we were assured about the safety of patients being cared for in the hospital.

We inspected the safe domain following notifications received by CQC about absent without leave incidents. These had involved patients leaving the hospital through windows and doors. We were assured that the provider had taken appropriate actions to address these issues to avoid recurrence.

• We rated the Priory Hospital Preston as good.

Systems were in place to monitor and manage patient risk. Staff carried out comprehensive assessments in a timely manner and regularly reviewed these. Assessments of ligature risk (the risk created by places to which patients intent on self-harm might tie something to strangle themselves) were in place, along with policies to support the management of this risk. The hospital had embedded safeguarding throughout. Staff were aware of their responsibilities to report and raise any incidents and safeguarding issues. Staff had received up-to-date mandatory training. Managers assessed and reviewed staffing levels to keep patients safe.

Patients’ care and treatment was planned, delivered and reviewed regularly, in line with best practice guidance. Staff routinely collected and monitored information about patient outcomes. There were systems in place to ensure adherence to the Mental Health Act (MHA) 1983, the MHA Code of Practice, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Patients had access to psychological therapies. Plans were in place to review the provision and quality of these therapies.

Feedback from patients, carers and relatives at the hospital was positive. We observed staff treating patients in a respectful manner, and with a caring and empathetic approach. Staff involved patients in their own care. Managers regularly evaluated feedback from patients to improve inpatient care and treatment at the hospital.

The hospital planned services to meet the needs of patients. Patients were provided with continuity of care, with staff liaising with outside agencies when patients were discharged from the hospital. Managers ensured there were continuous environmental improvements to ensure patients received care in well-maintained ward environments.

Patients had access to the complaints process. Managers listened to complaints and concerns from patients and made improvements when required.

Senior managers were visible and proactively engaged staff in the vision and values of the organisation. Staff felt supported and consulted about their roles. Staff told us they were confident in approaching their line manager. There were good governance structures with individualised and group audits in place to support and deliver safe care and to monitor the performance of the hospital.

However, there were some issues the managers needed to continue to address. These included reviewing and monitoring the quality of the psychological therapies to ensure it met patients’ needs; recruiting to the nursing staffing vacancies on Bartle ward and the maintenance of the perimeter fence.

We spoke with six patients during our inspection. A number of the patients we spoke with had used the service on a long term basis.

The feedback we received from people was generally very positive and people expressed satisfaction with their care and treatment. People told us they felt safe at the Priory and that their needs were well met. Their comments included:

‘’The staff here are excellent.’’

‘’My wishes are considered and my requests are always met. They are a great lot of staff.’’

‘’Managers are brilliant and go over and above what is their duty.’’

Some patients we spoke with did feel that improvements could be made in relation to the number of agency staff used on their unit. One patient told us that agency staff were always ‘very nice’ but said it would be better to have permanent staff on duty at all times.

During this inspection we looked at how the care needs of people were met and how their welfare was promoted. We assessed a number of areas relating to staffing, including recruitment, staffing levels, training and support. We also assessed systems for monitoring the safety and quality of care that people received. The service was found to be compliant in all the areas we inspected.

During our visit we had the opportunity to speak with some patients. People that we spoke with were very positive about the care and treatment they had received at The Priory. Comments included:

‘’There are very little demands on me, which means I can concentrate on getting well.’’

‘’They have looked after me here and now I am so much better, I will be leaving soon.’’

‘’Most staff are lovely. They listen to you and they don’t make you feel bad like some places I’ve been before.’’

We viewed communal areas and some patients’ rooms. We saw that the surroundings were pleasant and comfortable and that patients’ rooms were nicely personalised with pictures, photographs and other such treasured possessions.

We also noted that there was a good amount of information posted about the hospital for the benefit of patients. We saw leaflets and posters giving information about the role of the Care Quality Commission, making complaints and advice on how to access local advocacy services, for example. We also noted that there was information aimed at patients’ relatives about how they could access support or therapy for themselves.

During the inspection we looked at standards relating to how the patients’ wellbeing was promoted and how people were protected from harm. We also looked at staff training and support and how the quality of services was monitored. We found that the service was compliant in all the areas we assessed.

We spoke to a range of people about the service. They included, patients, staff, and some external agencies in order to gain a balanced overview of what people experience. All comments were very positive.

People using the service told us staff were respectful and provided them with all the information they needed about any treatment or tests they were going to receive.

One person said, “Everything has been as they said it would be its been a good experience for me”.

One person told us, "I have a care plan in my room, which was compiled by me and I generally agree to my treatment programme".

"I don’t have time to get bored, as I have an intense daily treatment programme and regular group meetings, which are important to help me in my recovery".

"They come round in the evening and ask what we would like for lunch and dinner the next day and we always get what we order"