We carried out this inspection to follow up on non-compliance from our previous inspection on 31 October 2013.

At the previous inspection we found that there were issues of non-compliance with infection control standards in the kitchen. Food was not stored safely and cleaning schedules were not consistently implemented and recorded.

At this inspection we found that the provider had addressed this. The kitchen was clean, and food was stored correctly.

The service had robust systems for checking cleanliness and staff were confident in using these systems.

This was a joint inspection carried out with the Mental Health Act Commissioners. At this unannounced inspection we spoke with patients, staff and the registered manager. We also observed care practices and looked at records.

Patients we spoke with told us that staff were caring and thoughtful. We found that there was a mental health advocate service available to patients if they needed.

The patients that we spoke with told us that they thought the food at the hospital was good. We saw that patients had access to fresh food and drink throughout the day. Those patients that needed it were offered nutritional advice and support from staff.

On the day of our inspection we found that the overall cleanliness of the hospital was good. However there were some areas of the kitchen that needed a deep clean and none of the cleaning schedules in the kitchen were up to date.

We looked to see that staff had received all of the training appropriate to their roles and confirmed that this was the case. Staff that we spoke with told us that they always undertook training and that they felt supported.

There were effective systems in place to monitor complaints. Patients told us that if they wanted to make a complaint they would know how to. We saw that the hospital recorded all complaints and resolved them where they could to the patient’s satisfaction.

The people we spoke to were very complimentary about the care they received at the hospital. One person told us "My key worker is wonderful and has helped me to explore and deal with all the issues that I didn't know I had until I came here." Another person told us "This is my third visit and I feel very safe indeed here. My doctor is fantastic, but in fact you can go to anyone here and they will give you time and support." This was supported by our own observation that the staff appeared to know their patients well and went about their work in a friendly, calm and professional way.

The care records we reviewed were person centred and well maintained and there were procedures in place to keep records secure and confidential.

The provider had taken steps to protect people from abuse and to deal appropriately with concerns if they were raised. They had also taken steps to ensure that medicines were managed effectively and safely.

Staff working within the service were vetted and received induction training before starting work at the hospital. There were also systems in place to audit and monitor the quality of the services being provided.

People who used the service told us they were involved in the planning of their care; that the consultant psychiatrist discussed their support options and treatments with them and their family. They said that they were provided with the patient information booklet, (service user guide) and that staff respected and recognised their individuality and human rights.

One person told us they were very much involved in their care. For example, if they wanted to take their medication earlier or later within reason then that would be ok with the staff. They said they were able and were allowed to make choices.

Another person told us they have made the decision not to attend residents' meetings. Instead they said they spoke with their psychiatrist or their named nurse and if their nurse was not on duty they would speak with another nurse.

People told us their care needs were based on their individuality, such as mental health and medical condition, likes and dislikes, social and day time activities and to maintain relationships with their families.

People said their treatment included their total involvement in their care. They said the therapy sessions had helped them to open up and discuss their feelings. They told us they liked the support they received from their therapist, psychiatrist and nurses.

People told us they did not feel they needed an advocate as they were quite able to discuss issues of concerns with their therapist , nurse or consultant. People said they felt very safe at this service. This statement was supported in the satisfaction survey undertaken by the service for the fourth quarter of 2011 in which 94.74% of people said they always felt safe.

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We rated the Priory Hospital Woking as good because:

• There were sufficient, appropriately trained, staff working at the hospital to meet the needs of the patients.
• Staff were confident in recognising and responding to safeguarding concerns.
• Medicines were securely stored and staff safely managed the administration of patients’ medicines.
• Incidents were reported appropriately by staff using the hospitals electronic system and the lessons learned from investigating incidents were shared to all staff.
• Patients received a comprehensive assessment from a doctor and ongoing monitoring of their mental and physical health by the hospital’s clinical staff.
• Patients had access to a structured treatment programme that matched their needs.
• The hospital’s multi-disciplinary team was cohesive and met regularly to review patient needs.
• Staff used relevant tools to monitor patient progress and risks.
• Patients’ concerns and complaints were recorded and investigated within the hospital policy target times.
• The governance structure and processes were effective. There was a yearly schedule for clinical audit and plans in place for continuous improvement in the treatment programmes available to patients.

However

• The amount of staff who had completed the training for the prevention and management of violence and aggression was below the hospital target.
• The quality of patient care plans and risk assessments was variable and not all plans contained complete information.
• Staff individual supervision rates had fallen below the hospital target due to a vacancy at ward manager level.
• The administrative resource allocated to the Mental Health Act was insufficient for the amount of detained patients.