Report evidence summary
Stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised. 26
Care Quality Commission Incorporate ward staffing levels and skill mix into ongoing provider monitoring and the next inspection.
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Care Quality Commission Conduct a joint unannounced inspection assessing medicines management and staffing compliance actions.
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Care Quality Commission Deliver a thematic programme on experiences and outcomes during mental-health crises and publish a national report.
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Care Quality Commission Include ward layout and its impact on patient care in planning and execution of the next hospital inspection.
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Care Quality Commission Conduct an unannounced follow-up inspection assessing emergency procedures, observation policies, staff training and completion of earlier compliance actions.
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Care Quality Commission Conduct an unannounced joint compliance inspection of The Priory Hospital Roehampton and require remedial action for identified non-compliance.
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Care Quality Commission Work with key partners in developing the Mental Health Crisis Care Concordat.
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Care Quality Commission Include information held on deaths in psychiatric detention in all future annual reports.
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Care Quality Commission Assess observation training and continue monitoring observation information and policy implementation to inform future inspections.
View source
Care Quality Commission Test the new mental-health inspection methodology through Wave 1 inspections and use learning to strengthen regulatory responses.
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Care Quality Commission Publish a specialised mental-health inspection and regulatory approach incorporating integrated regulation, Mental Health Act monitoring and specialist inspection arrangements.
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Care Quality Commission Use information about alleged nursing-record falsification to inform planning and delivery of the next inspection.
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Care Quality Commission Work with partners to develop a method for using death information to improve intelligence, shared learning and preventative action.
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Care Quality Commission Undertake an unannounced inspection within four months covering reported concerns, additional regulatory concerns and new intelligence, coordinated with Mental Health Act monitoring.
View source
Priory Group Continue monitoring ward staffing levels and skill mixes to ensure they remain appropriate.
View source
Priory Group Conduct weekly four-week-cycle Quality Walk Rounds, including checks of patient observations and care plans, with results reviewed through clinical governance.
View source
Priory Group Operate a rolling programme of detailed internal compliance inspections through a dedicated team of experienced compliance inspectors.
View source
Priory Group Establish a local Roehampton Human Resources function with trained staff to support staff-management responsibilities.
View source
Priory Group Review the Priory Healthcare Division Observation and Engagement Policy.
View source
Priory Group Separate Garden Wing into two wards with dedicated managers, nursing teams, therapists and activity coordinators.
View source
Priory Group Strengthen supervision and appraisal arrangements to identify and manage authority-related issues more rapidly.
View source
Priory Group Improve registration and monitoring of patients attending ward therapy groups.
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Priory Group Introduce weekday morning flash meetings involving ward, medical and management representatives to review activity and plan the next 24 hours.
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Priory Group Embed daily hospital monitoring visits to wards to check patient care and address immediate staff concerns.
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Priory Group Change the Roehampton staff induction programme to improve compliance with patient observations.
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Priory Group Hold monthly staff meetings with hospital management to exchange feedback on safety, quality and compliance.
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× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure of staff to accept the authority of the nurse in charge
Wider context from the report “(2) I heard evidence that indicated an enduring situation where the ward frequently had inadequate numbers of staff with an inappropriate skill mix and with an inappropriate layout over two floors. There was a lack of discipline with staff failing to accept a nurse in charge’s authority authority . Management was informed of some issues but failed to listen or act.
” Is this part of a recurring concern? No recurring-concern membership is currently published.
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Deliberate falsification of nursing records
Wider context from the report “(3) There was a deliberate falsification of the nursing record .
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to perform basic nursing observations
Wider context from the report “(1) There were repeated failures to perform basic nursing observations
” Is this part of a recurring concern? Yes — Unreliable patient observation arrangements .
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Inappropriate ward layout over two floors
Wider context from the report “(2) I heard evidence that indicated an enduring situation where the ward frequently had inadequate numbers of staff with an inappropriate skill mix and with an inappropriate layout over two floors . There was a lack of discipline with staff failing to accept a nurse in charge’s authority authority. Management was informed of some issues but failed to listen or act.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Inadequate staffing numbers and inappropriate staff skill mix
Wider context from the report “(2) I heard evidence that indicated an enduring situation where the ward frequently had inadequate numbers of staff with an inappropriate skill mix and with an inappropriate layout over two floors. There was a lack of discipline with staff failing to accept a nurse in charge’s authority authority. Management was informed of some issues but failed to listen or act.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure of management to listen or act on reported issues
Wider context from the report “(2) I heard evidence that indicated an enduring situation where the ward frequently had inadequate numbers of staff with an inappropriate skill mix and with an inappropriate layout over two floors. There was a lack of discipline with staff failing to accept a nurse in charge’s authority authority. Management was informed of some issues but failed to listen or act .
” Is this part of a recurring concern? No recurring-concern membership is currently published.
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Incorporate ward staffing levels and skill mix into ongoing provider monitoring and the next inspection.
Verbatim wording from the response “• A Mental Health Act Commissioner made a further visit to the ward, where Mr Carter was a patient, on 19 March 2014. They found safe staffing levels were in place on that occasion. However, the Commission intends that ward staffing levels and, in particular, the skill-mix of staff be incorporated within our monitoring of the provider, as well as in the planning and focus of our next inspection of The Priory Hospital Roehampton.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct a joint unannounced inspection assessing medicines management and staffing compliance actions.
Verbatim wording from the response “3. 12 March 2014: The Commission carried out a joint unannounced inspection comprising a compliance inspector, a Mental Health Act Commissioner and a pharmacy inspector. The inspection focused on assessment against outcomes 9 and 13 to consider whether the compliance actions that were required following the inspections on 25 June and 3 July 2013 had been satisfactorily completed. We summarise the findings below:” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Deliver a thematic programme on experiences and outcomes during mental-health crises and publish a national report.
Verbatim wording from the response “This will focus attention on the issues that have been highlighted around emergency mental health care. The Commission has committed to delivering a thematic programme around the experiences and outcomes of people experiencing a mental health crisis, and will take this forward over the course of 2014 with the intention of publishing a national report in the autumn.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Include ward layout and its impact on patient care in planning and execution of the next hospital inspection.
Verbatim wording from the response “• The appropriateness of the ward layout over two floors and its impact on patient care has not been specifically looked at by the Commission to date in its inspections since the death of Mr Carter. Within the Commission’s regulatory methodology this concern relates to outcome 10 dealing with the safety and suitability of premises. Outcome 10 corresponds to regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We are grateful that this concern has been brought to our attention and we intend to incorporate the outcome specifically into the planning and execution of our next inspection of the hospital.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct an unannounced follow-up inspection assessing emergency procedures, observation policies, staff training and completion of earlier compliance actions.
Verbatim wording from the response “2. 24 October 2013: The Commission undertook a joint unannounced inspection in direct response to information that was received following a death of a patient at the hospital in September 2013. The inspection was conducted by compliance inspectors and a Mental Health Act Commissioner. The inspection focussed on outcome areas that related to some of the concerns raised including emergency procedures, observation policies and staff training and also assessed whether the actions required to achieve compliance with Outcomes 1 and 10, following the inspection on 25 June and 3 July 2013, had been completed. The Priory Hospital Roehampton was found to be compliant with all outcomes that were assessed. We set out a summary of those findings below:” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct an unannounced joint compliance inspection of The Priory Hospital Roehampton and require remedial action for identified non-compliance.
Verbatim wording from the response “Since June 2013 the Commission have carried out the following compliance inspections of The Priory Hospital Roehampton:” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with key partners in developing the Mental Health Crisis Care Concordat.
Verbatim wording from the response “The Commission has also identified five key areas of action. These are in line with, and complement, our strategic intentions including recognising that people in the care of specialist mental health services are a high risk group for suicide and unidentified, poorly treated or preventable physical ill-health. We are concerned about how services respond to, review and report on deaths, so we are committing to include the information we hold on deaths in psychiatric detention in all future annual reports. We will work with partners, including NHS England and the National Confidential Inquiry into suicide and homicide by people with mental illness, to look at how we can do this in a way that offers better intelligence and opportunities for shared learning and preventative action. The Commission will also work with key partners in developing the Mental Health Crisis Care Concordat.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Include information held on deaths in psychiatric detention in all future annual reports.
Verbatim wording from the response “The Commission has also identified five key areas of action. These are in line with, and complement, our strategic intentions including recognising that people in the care of specialist mental health services are a high risk group for suicide and unidentified, poorly treated or preventable physical ill-health. We are concerned about how services respond to, review and report on deaths, so we are committing to include the information we hold on deaths in psychiatric detention in all future annual reports. We will work with partners, including NHS England and the National Confidential Inquiry into suicide and homicide by people with mental illness, to look at how we can do this in a way that offers better intelligence and opportunities for shared learning and preventative action. The Commission will also work with key partners in developing the Mental Health Crisis Care Concordat.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Assess observation training and continue monitoring observation information and policy implementation to inform future inspections.
Verbatim wording from the response “One of the steps that the Commission has undertaken in response to this has been to consider observation training as part of the follow-up inspection of staffing standards on 12 March 2014. The inspection on 12 March comprised a joint unannounced inspection comprising a compliance inspector, a Mental Health Act Commissioner and a pharmacy inspector. The inspection on 12 March focused on assessment against outcomes 9 (Medicines Management) and 13 (Staffing) to consider whether the compliance actions that were required following the inspections on 25 June and 3 July 2013 had been satisfactorily completed. During the inspection of 14 March the Commission found training on how to carry out” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Test the new mental-health inspection methodology through Wave 1 inspections and use learning to strengthen regulatory responses.
Verbatim wording from the response “It is hoped that the proposed changes will help identify poor mental health care and point to interventions when things need to be put right. We are testing out our new methodology with “Wave 1” inspections of NHS mental health trusts occurring during this financial year. We hope to learn from these inspections to ensure our regulatory responses are robust, proportionate and sustainable.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Publish a specialised mental-health inspection and regulatory approach incorporating integrated regulation, Mental Health Act monitoring and specialist inspection arrangements.
Verbatim wording from the response “The Commission’s proposed future regulatory response across Mental Health Services” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Use information about alleged nursing-record falsification to inform planning and delivery of the next inspection.
Verbatim wording from the response “The Commission has seen no evidence of deliberate falsification during the course of our inspections. It is extremely worrying that such evidence was presented. It is also a very difficult thing for the Commission to identify either in regular monitoring or at an inspection visit unless it had been brought to our attention by staff, patients or relatives. Nevertheless, this information will inform the planning and delivery of the next inspection visit of The Priory Hospital Roehampton.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with partners to develop a method for using death information to improve intelligence, shared learning and preventative action.
Verbatim wording from the response “The Commission has also identified five key areas of action. These are in line with, and complement, our strategic intentions including recognising that people in the care of specialist mental health services are a high risk group for suicide and unidentified, poorly treated or preventable physical ill-health. We are concerned about how services respond to, review and report on deaths, so we are committing to include the information we hold on deaths in psychiatric detention in all future annual reports. We will work with partners, including NHS England and the National Confidential Inquiry into suicide and homicide by people with mental illness, to look at how we can do this in a way that offers better intelligence and opportunities for shared learning and preventative action. The Commission will also work with key partners in developing the Mental Health Crisis Care Concordat.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Undertake an unannounced inspection within four months covering reported concerns, additional regulatory concerns and new intelligence, coordinated with Mental Health Act monitoring.
Verbatim wording from the response “The Commission plans to undertake the next inspection visit of The Priory Hospital Roehampton within the next four months. The precise date of the inspection has not been set and it is to be unannounced. It is also intended that that visit would consider not only the specific areas of concern highlighted in this report but also those highlighted in a separate Regulation 28 report that was addressed to the Commission following the inquest into the death of another service user at The Priory Hospital Roehampton. That visit would also take account of any further intelligence that is gathered or brought to the Commission’s attention before that inspection. The planning of that inspection is also being coordinated with the Mental Health Act Commissioners’ monitoring of the provider for the same purposes.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue monitoring ward staffing levels and skill mixes to ensure they remain appropriate.
Verbatim wording from the response “I am informed that following Mr Carter's death, Garden Wing was separated into two distinct wards. Each ward has its own ward manager and nursing team together with therapists and activity co-ordinators. I am informed by the hospital that the two smaller wards are sufficiently staffed and that the managers and nursing staff of the wards are sufficiently skilled and experienced. The wards are supervised by the Roehampton Hospital Director and additional clinical support is provided by the Clinical Services Manager. They will continue to monitor staffing levels and skill mixes to ensure they are appropriate.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct weekly four-week-cycle Quality Walk Rounds, including checks of patient observations and care plans, with results reviewed through clinical governance.
Verbatim wording from the response “To support compliance, standards across Roehampton Hospital are also monitored internally through the use of Healthcare Division ‘Quality Walk Rounds’ which are undertaken on a weekly basis and operate to a set four-week rolling programme of monitoring. For example, week one involves an assessment of the environment and week two involves an assessment of patient care which includes a review of the completion of patient observations and care plans.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate a rolling programme of detailed internal compliance inspections through a dedicated team of experienced compliance inspectors.
Verbatim wording from the response “In addition to the issues you have raised, I would also like to advise you that the Priory Group has a dedicated team of experienced compliance inspectors who undertake a rolling programme of detailed compliance inspections. The compliance inspections audit standards over and above those standards audited by external regulators. These internal inspections act as an early warning system to inform divisional and hospital management if improvements or adjustments are needed to be taken in relation to patient care.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Establish a local Roehampton Human Resources function with trained staff to support staff-management responsibilities.
Verbatim wording from the response “Further, I understand there is now a local Human Resources function at Roehampton Hospital with trained staff who can provide faster support and advice to those with staff management responsibilities who may feel their authority is being challenged.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review the Priory Healthcare Division Observation and Engagement Policy.
Verbatim wording from the response “We recognise, however, that we should strive to improve compliance with observations and the documentation of those observations in accordance with the risk assessments undertaken. In respect of staff carrying out patient observations, I am informed that these improvements have included changes to the staff induction programme at Roehampton and better registration and monitoring of patients at ward therapy groups. There has also been a review of the overarching Priory Group Healthcare Division Observation and Engagement Policy.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Separate Garden Wing into two wards with dedicated managers, nursing teams, therapists and activity coordinators.
Verbatim wording from the response “I am informed that following Mr Carter's death, Garden Wing was separated into two distinct wards. Each ward has its own ward manager and nursing team together with therapists and activity co-ordinators. I am informed by the hospital that the two smaller wards are sufficiently staffed and that the managers and nursing staff of the wards are sufficiently skilled and experienced. The wards are supervised by the Roehampton Hospital Director and additional clinical support is provided by the Clinical Services Manager. They will continue to monitor staffing levels and skill mixes to ensure they are appropriate.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Strengthen supervision and appraisal arrangements to identify and manage authority-related issues more rapidly.
Verbatim wording from the response “You also are concerned that: ‘There was a lack of discipline with staff failing to accept a nurse in charge’s authority’. I understand this arose from the experience of one nurse giving evidence at Mr Carter's inquest, who had found that the individuals had not respected her more senior role. We of course accept that such a situation is unacceptable and whilst there may be differences of opinion between members of staff, I am informed there is now much more emphasis at Roehampton Hospital on there being an effective framework of supervision and appraisals so that the risk of issues in relation to authority can be identified more rapidly and managed.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Improve registration and monitoring of patients attending ward therapy groups.
Verbatim wording from the response “We recognise, however, that we should strive to improve compliance with observations and the documentation of those observations in accordance with the risk assessments undertaken. In respect of staff carrying out patient observations, I am informed that these improvements have included changes to the staff induction programme at Roehampton and better registration and monitoring of patients at ward therapy groups. There has also been a review of the overarching Priory Group Healthcare Division Observation and Engagement Policy.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Introduce weekday morning flash meetings involving ward, medical and management representatives to review activity and plan the next 24 hours.
Verbatim wording from the response “• The introduction of a daily ‘flash’ meeting which is held every weekday morning attended by the nurse in charge from each ward, the hospital duty doctor and members of the hospital management team. The purpose of the meeting is to understand ward and hospital activity during the previous 24 hours/weekend and to plan for the forthcoming 24 hours/weekend.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Embed daily hospital monitoring visits to wards to check patient care and address immediate staff concerns.
Verbatim wording from the response “You also state that: ‘Management was informed of some issues but failed to listen or act’. In order to facilitate communications between management and staff, I am informed the following are now in place at Roehampton Hospital:” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Change the Roehampton staff induction programme to improve compliance with patient observations.
Verbatim wording from the response “We recognise, however, that we should strive to improve compliance with observations and the documentation of those observations in accordance with the risk assessments undertaken. In respect of staff carrying out patient observations, I am informed that these improvements have included changes to the staff induction programme at Roehampton and better registration and monitoring of patients at ward therapy groups. There has also been a review of the overarching Priory Group Healthcare Division Observation and Engagement Policy.” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Hold monthly staff meetings with hospital management to exchange feedback on safety, quality and compliance.
Verbatim wording from the response “You also state that: ‘Management was informed of some issues but failed to listen or act’. In order to facilitate communications between management and staff, I am informed the following are now in place at Roehampton Hospital:” Source location 2014-0103-Response-by-Priory-Group
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation No evidence of deliberate nursing-record falsification was identified during inspections.
Verbatim wording from the response “The Commission has seen no evidence of deliberate falsification during the course of our inspections. It is extremely worrying that such evidence was presented. It is also a very difficult thing for the Commission to identify either in regular monitoring or at an inspection visit unless it had been brought to our attention by staff, patients or relatives. Nevertheless, this information will inform the planning and delivery of the next inspection visit of The Priory Hospital Roehampton.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Alleged deliberate record falsification may require referral to the relevant professional regulatory body, such as the NMC or GMC.
Verbatim wording from the response “The Commission would also respectfully suggest that if it has not been done so already this may be a matter which would require referral to the relevant professional regulatory body, whether NMC, GMC or otherwise.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Deliberate record falsification is difficult to identify through routine monitoring or inspections unless reported by staff, patients or relatives.
Verbatim wording from the response “The Commission has seen no evidence of deliberate falsification during the course of our inspections. It is extremely worrying that such evidence was presented. It is also a very difficult thing for the Commission to identify either in regular monitoring or at an inspection visit unless it had been brought to our attention by staff, patients or relatives. Nevertheless, this information will inform the planning and delivery of the next inspection visit of The Priory Hospital Roehampton.” Source location 2014-0103-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The two wards are sufficiently staffed and skilled, with separate management and ongoing monitoring of staffing levels and skill mix.
Verbatim wording from the response “I am informed that following Mr Carter's death, Garden Wing was separated into two distinct wards. Each ward has its own ward manager and nursing team together with therapists and activity co-ordinators. I am informed by the hospital that the two smaller wards are sufficiently staffed and that the managers and nursing staff of the wards are sufficiently skilled and experienced. The wards are supervised by the Roehampton Hospital Director and additional clinical support is provided by the Clinical Services Manager. They will continue to monitor staffing levels and skill mixes to ensure they are appropriate.” Source location 2014-0103-Response-by-Priory-Group
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