• The inspection of The Priory Altrincham was unannounced and was prompted by notification of an incident following which people using the service sustained serious injuries. This inspection was conducted to ensure that at the time of this inspection, patients were receiving safe care and were protected from avoidable harm. This inspection looked at the key questions relating to safe and well led and did not focus on the specific incident as this is subject to a separate additional investigation. We did not look at the key questions of caring, effective and responsive at this inspection. This inspection was not rated.

• The hospital followed national guidelines on cleaning standards and monitoring procedures to provide and maintain a clean and appropriate environment to prevent and control healthcare associated infection. Ongoing refurbishment plans had seen improvements to the ward environments. Regular environmental quality checks were conducted and patients could discuss and resolve environmental issues in community meetings.

• The ward environments were subject to constraints in observation. These were managed and risks mitigated with the use of observation and individual risk management planning.

• Accessible emergency equipment was available to staff and was maintained appropriately. Medicines were dispensed and stored securely and audits were undertaken to ensure safe practice.

• Staffing levels were determined using a staffing ladder model. Staffing was reviewed regularly to ensure there was enough staff with the relevant skills to deliver safe patient care. Patients were supported by a skilled multidisciplinary team of staff which included nursing, psychiatric, psychological, occupational and dietetic support. Staff were supported to deliver effective care and treatment they told us that they received meaningful and timely supervision and were supported to maintain their professional skills and experience.

• Safeguarding processes were in place which reflected national guidance, and understood by all staff. There was a clear structure of reporting and responsibility for safeguarding adults and children. Any concerns relating to adult and child protection were communicated to the relevant protection agencies.

• There was an established governance structure with a defined hierarchy of reporting and decision making within the service. There were clear systems of accountability and senior managers were actively involved in the operational delivery of the service. There was a clear statement of visions and values, staff knew and understood the vision, values and strategic goals of the service. Processes and systems of accountability and governance were in place and performance management and quality reporting was clearly set out. Risks were identified and monitored. Performance issues were escalated and discussed at relevant governance forums and action taken to resolve concerns.

• All staff we spoke with were positive about their roles and staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation. They told us that they felt valued, had input into the service and were consulted and involved in service quality developments.

• The service was committed to improving the services on offer and continually improving the quality of care provided to patients.

The Priory Altrincham provided care for patients who needed support with their mental health, specialising in the management and treatment of a wide range of mental health conditions and addictions. These include obsessive compulsive states, eating disorders, addiction treatments and all major acute psychiatric illnesses.

We found that care was provided in a clean, organised but relaxed environment.Treatment was provided in 48 single rooms on three units within the hospital. Individual bedrooms and public areas had fixtures and fittings that been appropriately risk assessed for ligature points.

Patients we observed were treated with dignity and respect and were able to share their views and comments with the staff.

Staff had access to detailed policy guidance in relation to both child protection and safeguarding vulnerable adults.

We found The Priory Altrincham had systems in place to ensure staff were safely and effectively recruited and employed.

We found robust systems in place to monitor the quality of the service provided. All policies and guidance were currently up to date and were reviewed on an annual basis.

We spoke to two patients who told us they were fully consulted on their care and were happy with the way they were being cared for.

We spoke with four members of staff who told us they felt supported and enjoyed their job within the hospital.

Patients told us; "I enjoy the group sessions it works for me". "I get the support I need and know I can always chat to someone at any time of the day or night which is a comfort".

The Priory had consent policies and procedures in place which reflected current guidance on informal and formal consent. This enabled patients, their relatives or representatives, to give appropriate consent to care and treatment.

Care plans were comprehensive and demonstrated clear assessment of the needs of individual patients. On admission a 72 hour initial care plan was implemented to allow a full assessment of need to be carried out, once the patient had the opportunity to adjust and settle into the ward.

We found that care was provided in a clean, organised but relaxed environment. Risks assessments had been undertaken for all aspects of health and safety. Individual bedrooms and public areas had fixtures and fittings that been appropriately risk assessed for ligature points. Patients had access to large gardens and external designated smoking areas.

Patients told us : “I feel safe and secure here, the staff are really trying to help me”, “Everything is explained, you don’t have to feel stupid, they make sure that you know what is happening and why”.

We rated The Priory Altrincham as good because:

Patients using the service told us that they were treated with dignity and respect and described the staff as caring and helpful. We observed that staff took time to communicate with patients in a respectful and compassionate manner and patients were empowered to become active participants in their care.

All patients underwent an assessment of need, care plans were holistic and recovery oriented and included physical health assessments, these were completed in collaboration with the patients, progress was regularly reviewed.

Regular multidisciplinary meetings were held and attendance by outside agencies was encouraged. Families and carers were involved in this process where appropriate. Advocacy services were accessible and available to support patients.

The hospital followed national guidelines on cleaning standards and monitoring procedures to provide and maintain a clean and appropriate environment to prevent and control healthcare associated infection. There was an established cleaning regime, wards were generally clean although refurbishment work was causing some disruption to the cleaning regime. Clinic rooms were fully equipped. Emergency equipment was accessible to all and was maintained appropriately. Medicines were dispensed and stored securely and audits undertaken to ensure safe practice.

The ward environments were effectively managed and risks mitigated with the use of observation and individual risk management planning. Regular environmental quality checks were conducted and patients could discuss and resolve environmental issues in community meetings.

Patients were supported by a skilled multidisciplinary team of staff which included nursing, psychiatric, psychological, occupational and dietetic support. Treatment practices were based on nationally recognised guidance.

Safeguarding processes were in place which reflected national guidance, and understood by all staff we spoke with. There was a clear structure of reporting and responsibility for safeguarding adults and children. Any concerns relating to adult and child protection were communicated to the relevant protection agencies.

Restrictive practices were reviewed regularly and patients were involved in the process. Regular patient surveys and community meetings informed improvements in patient care across the hospital.

Staff were trained in and had a good understanding of the Mental Health Act and Mental Capacity Act. Staff followed local procedures and support was available from a mental health act administrator. Patients were given information and support to ensure appropriate representation and aid understanding of their rights.

There was an established governance structure with a defined hierarchy of reporting and decision making within the service. There were clear systems of accountability and senior managers were actively involved in the operational delivery of the service. There was a clear statement of visions and values, staff knew and understood the vision, values and strategic goals of the service.

Staff we spoke with were positive about their roles and were positive about service development. Staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation. They told us that they felt valued, had input into the service and were consulted and involved in service quality developments.