We looked at the care records of people who used the service and found people experienced care, treatment and support which was centred on people's individual needs. Where people were detained under the Mental Health Act (1983) we saw that mental health section paperwork was completed fully and fulfilled legal requirements.

We saw that care plans had been completed with people to ensure staff understood how to support people with their care and treatment needs. Care plans were reviewed regularly.

We spoke with people who used the service who told us that staff were very caring and that they were happy with the care and treatment they were provided with. One person said: "I feel really involved in my day to day care." Another person said: "I help make decisions about my goals."

During the course of our inspection we saw that people were supported to express their views and choices by whatever means they were able. Staff clearly understood each person's behaviours and their individual care and treatment needs. We saw that people were comfortable with staff and others at The Priory Hospital Chelmsford and that there was a relaxed atmosphere.

We toured the premises and found all areas decorated in a comfortable style and maintained to a high standard. The provider had effective systems in place to monitor the quality and safety of service that people received.

We spoke with four people who used the service who told us that they were happy with the service they were provided with. One person said, “I would not be where I am now if it was not for the support I have had here.” Another person said, “This place has been wonderful and the care is brilliant.”

People told us that they were consulted about their care and treatment. One person said, “They asked me what I needed and for my views on the treatment.” Another person said, “The doctor does a ward round and (doctor) talks about my treatment and keeps me updated.” Another said, “They let me know my rights and go through it again with me,” and, "They always take time to listen to me." People also told us that they were provided with choices in their daily living, such as the support groups and therapy that they participated in.

People told us that the staff treated them with respect. One person said, "I have shouted at them (staff), but they have been there all the way.” We asked another person if they felt that the staff treated them with respect and they said, "Utterly. They are always there with a comforting smile."

We looked at the care records of five people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service.

People with whom we spoke confirmed that they were listened to and respected by staff. People reported that they had good access to different therapies and treatments and felt involved in their care. Good links were reported by individuals with families and other carers where appropriate for example through family therapy sessions.

People with whom we spoke confirmed that they actively participated in their own care and treatment programmes for example they had regular meetings with their responsible clinician, lead therapist and nursing key worker and were involved in the drawing up and implementation of their care plans. They confirmed that staff explained individual treatments to them and answered any questions that they may have.

People with whom we spoke confirmed that they were generally satisfied with the care and treatment provided by staff and felt safe in the hospital. They felt able to approach staff if they had any concerns and were confident that these would be addressed appropriately.

People with whom we spoke were generally complimentary about the environment and the facilities available in this hospital.

We rated the Priory Hospital Chelmsford overall as ‘requires improvement’ because:

• The provider’s governance systems were not fully effective in monitoring the service provided. Two issues related to ligature assessment and management and male visitors to Chelmer ward.

• Some ward environments required improvement. The children and adolescent mental health services (CAMHS) ward did not meet the standards outlined in the (QNIC) Quality Network for Inpatient CAMHS, the Royal College of Psychiatrist’s peer review 2017. Managers identified some improvements required, but did not set timescales for completion.

• The provider had not fully complied with eliminating mixed sex accommodation as ward staff had allocated a bedroom in the male area of Danbury ward to a female patient, which affected their dignity and privacy. Bedrooms on the ground floor did not have privacy screening on windows. Danbury ward’s fence in the women’s garden posed an absconsion risk as patients could potentially climb over. Staff told us that some patients had absconded from the external gardens. Chelmer and Springfield ward staff had not completed personal emergency evacuation plans for patients.

• The provider had not ensured that all staff were receiving supervision as per their standard of 90%. The provider’s recruitment and human resources processes were not fully effective as there were several nursing staff vacancies, which managers said was one of their challenges. Wards used a notable level of agency staff, particularly on the CAMHS ward that were not regular and managers were not regularly reviewing their training. Staff had not covered 33 nursing shifts from September to January 2018.

• Managers had not ensured that all staff had access to report incidents in a timely way. They were not fully reviewing those incidents reported to check the quality and identify risks and areas for improvements.

• Staff on Chelmer and Danbury wards had not fully completed initial assessments in six patients’ records. They had not always recorded their observation of patients.

• Chelmer staff had not recorded if blood borne virus testing was offered to patients being treated for addictions and had not documented if they had a history of intravenous drug usage.

• The provider had not given clear information to informal patients on Danbury and Chelmer wards as to when they could have community leave. Eight patient’s records did not have information about discharge planning. The Lodge residential rehabilitation service for patients receiving treatment for addictions was not fully open. This meant that patients who had finished detoxification on Chelmer ward did not move to the service.

• Staff’s practice concerning management of medicine on Chelmer and Danbury ward’s needed improvement, for example, we found gaps in records.

However:

• Patients told us that staff were caring, treated them with dignity and respect and gave them support. Most patients said they were involved in their care and treatment. Carers said that staff contacted them to gain their views.

• The provider held daily ‘flash’ meetings with staff and completed ‘quality walk rounds’ by senior staff, patients and staff to record the quality of the hospital.

• The provider had a system for investigating and responding to complaints. The provider had received 38 compliments about its service.

• Most staff reported effective team working, support and good morale. Staff had received mandatory training for their role. Managers had completed 100% of appraisals with staff.

• The provider had employed more doctors, including a specialist in working with patients with addictions.

• The provider had taken action to ensure patients with addictions had drug testing and appropriate assessments to establish withdrawal and inform treatment for detoxification.

• The provider could offer a range of therapies recommended by the National institute for health and care excellence. This included cognitive behavioural therapy and dialectical behavioural therapy.