The Care Quality Commission
  • Mental Health
  • Independent mental health service

Cygnet Hospital Harrogate

Overall: Good read more about inspection ratings

23 Ripon Road, Harrogate, North Yorkshire, HG1 2JL (01423) 500599

Provided and run by:
Cygnet Health Care Limited

All Inspections

Wednesday 30 and Thursday 31 August 2023

During a routine inspection

Our rating of this location ​stayed the same​. We rated it as ​good​ because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.

  • Staff developed collaborative, holistic and recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.

  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

  • Feedback from patients about the care they received was consistently good and exceeded their expectations. Patients we spoke with said this was the best hospital they had been too and that all staff, including housekeepers and catering staff contributed to a positive inpatient stay.

  • The last patient satisfaction survey data indicated that 96% of 118 patients who completed the survey said staff were caring and supportive.

  • Patients were treated as individuals and different approaches were taken, when needed, to support them in the most appropriate way. Patient’s individual needs, cultures and backgrounds were supported by staff and adjustments were made to accommodate their needs.

  • The service managed beds well and patients were discharged promptly once their condition warranted this. The service had positive working relationships with commissioners, referring authorities and other external agencies.

  • The service was well led, and the governance processes ensured that ward procedures ran smoothly.

29 and 30 October 2019

During a routine inspection

We rated Cygnet Hospital Harrogate as good because:

  • The ward environments were safe and clean. The wards had enough nurses and doctors to meet patients’ needs. Staff assessed and managed risk well and followed good practice with respect to safeguarding. Use of physical restraint had reduced and was only used when other interventions had been unsuccessful.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audits to evaluate the quality of care they provided.
  • The ward teams included or had access to a range of specialists to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisals. The ward staff worked well together as a multidisciplinary team and with those external to the hospital who had a role in patients' aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff understood the individual needs of patients. Culture on the wards had improved and patients were mainly positive about staff approach. They supported patients to make informed decisions about their care and maintain relationships with families and carers.
  • The service managed beds responsively, making decisions based on the existing patient group to maintain a good ward dynamic for staff and patients. Patients were discharged promptly once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly. The managers had overseen significant improvements within the hospital.

However,

  • Staff on both wards did not manage medicines safely. Medicine cards demonstrated errors and omissions in prescribing, administering and documenting medicines. Physical health monitoring after rapid tranquilisation was not always carried out appropriately. Information from incidents, risk assessments and risk management plans were not always triangulated effectively, and level of harm was assessed inconsistently.
  • Care records were not always reflective of allied health professional input or actions that had been taken to monitor physical health care. Good practice in data management was not maintained; paper records did not clearly demonstrate when later amendments had been made, and agency staff made patient record entries using regular staff members' accounts. Paperwork processes were complex and time-consuming for staff.
  • Patients reported that some staff could be abrupt. Interventions took place in patients’ bedrooms as there was not a suitable alternative. Evidence of staff application of the Equality Act was not consistent.

3 and 4 July 2018

During a routine inspection

We rated Cygnet Hospital Harrogate as requires improvement because:

  • The hospital did not deliver safe care. Staffing levels on the wards were unsuitable for the acuity and number of patients and staff turnover was high. The hospital used a high number of agency staff and this had an adverse impact on the safety of patient care. Staff did not use an individual risk assessment as the basis for the decision about which observation level each patient should be on. They did not consistently carry out observations in a safe manner nor did they record these accurately. Staff did not carry out physical health monitoring appropriately after they had given rapid tranquilisation. Use of restraint was high and some members of staff expressed the view that restraint was used more often than necessary when there was low staffing levels on the wards. Insufficient action was taken following serious incidents to mitigate the risk posed. The on-call system was flawed and there were delays in patients receiving medical support from doctors. Patients’ bedrooms were not always placed according to gender. Blanket restrictions were in place. Staff did not always promptly ascertain what medicines patients were taking for physical health conditions, or whether they had allergies, when they were admitted.

  • Care was not consistently effective. The hospital did not have a multi-disciplinary team and care was not reflective of their statement of purpose. Patients could not access activities or therapies seven days a week. Documents such as section 17 leave forms were not correctly completed. Consent to care and treatment was not recorded in all patient files. Informal patients’ rights under the Mental Health Act were not upheld on admission as they could not leave the hospital unaccompanied.

  • Staff were not always caring. They could be “abrupt” to patients when the wards were busy. Staff were heard discussing patient confidential information at the nurses’ stations. Patients did not feel informed of or involved in risk assessment and medicines decisions. Carers were not involved in care decisions or routinely contacted. Because of the absence of appropriate rooms or an examination couch, staff had to hold one to one meetings with patients and undertake physical examinations in patients’ bedrooms.

  • The governance structures were not robust. The auditing processes were not always effective. Not all ligature risks had been recognised and paperwork errors were not identified. Staff morale was low and not all staff felt they could raise concerns with their line manager. Staff did not feel supported within clinical supervision. Mandatory training was not consistently enforced. The service was placed under financial restrictions that limited their ability to respond to concerns that they had identified.

However:

  • There was good team working and respect between teams. Staff had access to opportunities not expected of their role; such as a health care support worker leading the Safe Wards implementation. The managers had created a staff representative group where staff could raise concerns anonymously without managerial presence and evidenced actions following this. Staff were complimentary of the clinical and hospital manager. Staff had regular appraisals and managerial supervision; engaged in de-briefs following incidents and encouraged reflective practice regarding improvements. Poor performance was investigated and appropriate support put in place.

  • Shortly before the inspection, Sanctuary had implemented Safe Wards as an ongoing initiative to reduce restrictive practice. Patients were more complimentary of the staff approach on Sanctuary.

  • Care plans were personalised and reflected the patient’s voice and that the service was discharge and recovery focused. Patients had a comprehensive assessment on admission.

  • Duty of candour was embedded and patients were told when things had gone wrong. Patients felt safe to raise concerns; staff acted on patients’ concerns raised in complaints and community meetings. Patients had regular access to an independent mental health advocate who also assisted with social needs such as housing. The hospital was linked to an interpreter service for patients who required it and had good disabled access.

12 December 2016

During an inspection looking at part of the service

Following a comprehensive inspection of Cygnet Hospital Harrogate in June 2016, we rated the service as overall good. We rated the effective, caring, responsive, and well-led domain as good and rated the safe domain as requires improvement.

We issued one requirement notice, which related to a breach of Regulation 10 HSCA (Regulated Activities) Regulations 2014. Dignity and Respect. We told the hospital it must ensure it meets national guidelines for same-sex accommodation and provide a dedicated lounge that is always available solely for the use of female patients.

According to current national guidelines, where there are male and female patients on a ward, good practice requires a service to provide a day lounge for use by females only. Female-only environments are important because of the increased risk of sexual and physical abuse and risk of trauma for women who have had prior experience of such abuse.

We published the report from our comprehensive inspection in September 2016.

We inspected Cygnet Hospital Harrogate again on 12 December 2016. This was an unannounced, focused inspection to find out whether the hospital had made the required improvements since our last comprehensive inspection on the 14 and 15 June 2016.

Following this inspection we have rated the safe domain as requires improvement because:

  • The hospital had not acted sufficiently to meet the requirement notice we issued after our inspection in June 2016 to meet the requirements for same sex accommodation. The hospital provided only one dedicated female only lounge, which was available for female patients from all two of the mixed wards to use at any time. Female patients on Sanctuary ward rarely used the lounge. This could be because the one female only lounge provided by the hospital was situated on Haven Ward.

However;

  • On the day of our visit, the dedicated female only lounge was available for all female patients to use. Staff we spoke with were clear about the national guidelines for same sex accommodation on mixed wards and the need for a dedicated female only lounge. Female patients told us they felt safe on the ward and staff did all they could to protect patients’ dignity and privacy.

13-14th June 2016

During a routine inspection

We rated Cygnet Hospital as good because:

  • Staffing levels were planned, implemented, and reviewed to keep patients safe at all times. Managers responded quickly and adequately to any staff shortages. Staff held effective handovers to ensure they managed the risks to patients.

  • Staff received meaningful and timely supervision and appraisal to support the effective delivery of care to patients. Managers supported staff to maintain and develop their skills and experience and applied a consistent approach for managing staff when their performance was poor.

  • We observed kind and caring interactions between staff and patients. Most patients and their relatives spoke about staff attitudes in a positive way and said staff treated them with respect. Staff involved patients in decisions and helped them to understand their care and treatment.

  • Patients could raise concerns or complaints easily and staff were open and transparent in their approach. Issues were taken seriously and staff responded to concerns and complaints in a timely way.

  • The hospital had clear governance structures in place where managers had oversight of the quality and the performance of the service. The senior managers provided strong leadership and were knowledgeable about the service priorities and challenges.

However;

  • The wards did not provide an area used solely as a day lounge for use by women. This did not meet national guidelines for same sex-accommodation.
  • Staff received training in restraint  that included techniques that inflicted pain on patients. Current national guidance supports the use of these techniques in exceptional circumstances such as when there is an immediate risk to life. However, the incident we reviewed did not appear to be a life-threatening situation.  
  • Staff did not always follow their own medicine management policy when they carried out rapid tranquillisation.

  • Risk assessment and management plans did not contain sufficient detail and staff did not always review the plan when risks changed. Patients were subject to restrictions that were not supported by individual risk assessments and management plans.

  • The hospital had limited space available for patients and visitors to use which meant bedrooms and communal areas had a number of uses. The children’s visiting room was located in an area that was potentially unsafe. Patients did not have access to rooms for quiet space or activities where they would not be disturbed. The location of some bedrooms meant that patients’ privacy, dignity, and confidentiality was compromised.

  • Care plans were not always personalised or recovery orientated or contain sufficient details about patients’ care and treatment. Staff did not always fully document patients capacity assessments and consent for care and treatment.

  • The makeup of the mutli-disciplinary team was limited to medical staff and nurses. This meant that patients did not have routine access to an occupational therapist, psychologist, or social worker assessment during their admission on the wards.

  • Staff who worked in Detox Five did not receive the necessary specialist training to support their role and did not have a local operational policy to follow.

4 December 2013

During a routine inspection

We observed that staff and patients had positive relationships and patients appeared relaxed and comfortable with their surroundings, staff and the activities they were engaged in. Patients had care plans and risk assessments in place which helped staff to understand and meet their needs. Staff had the knowledge and skills to meet those needs.

We spoke with five patients. All expressed satisfaction with the care and support they received. One person said 'The focus here is very much around talking therapies and not just doing therapies.' Another said "I feel listened to and am involved in deciding my treatment plan.'

The hospital had developed positive links with other agencies which promoted a coordinated approach where a number of agencies were included in people's care and treatment.

We saw that medicines were kept safely and that appropriate arrangements were in place in relation to the recording and administration of medicines.

There were sufficient staff available. We saw people being assisted promptly and we saw that staff had time to spend engaging with people.

The provider had effective system in place to regularly assess and monitor the quality of service that people received.

11 October 2012

During a routine inspection

At the time of the inspection there were no Detox 5 admissions. Other patients had been admitted from NHS Trusts either detained under the Mental Health Act 1983 or informal patients with acute mental health needs and at risk to their own wellbeing.

We asked people if they would like to talk to us and only two patients elected to do so. We visited all three wards in the hospital even though the ward for Detox 5 treatment was empty. We spoke with four members of staff about understanding of patients' needs; their training and support. In general we found staff to have good understanding of people's needs and they all said that training and support from the organisation was good.

People told us that they had been involved in decisions regard their care and treatment. They explained that when they had first arrived at the hospital they had been included in an initial assessment of their needs. They described how they had been given information about individual restrictions for their own health and well being and had signed agreements to this effect.

People told us that they had a choice about whether they joined in group therapy sessions and this would be agreed as part of their treatment and recovery plan. One person said 'the staff here are lovely, very supportive, I feel safe.' Another person said 'I have been here before and returned because I knew I would get the support I need.'

2 February 2012

During a routine inspection

Patient's told us they had received the care and treatment which met their needs and had aided their recovery. Examples of the comments they made were that they had found the unit a "haven".

Patients' explained how they and their families were informed about and had been involved in their care and treatment. They described how they had regular unit meetings, where they could express their views and how their views were responded to.

A group of patients told us they felt 'safe" at the hospital, even when they were at their " worst'.

Patients' confirmed they had attended both multi-disciplinary team and care planning meetings where their treatment and care is reviewed by the medical and nursing staff twice a week.

The patients we talked with described how the choice and type of therapeutic groups as 'Fantastic' and 'Brilliant' and provided us with examples, such as, meeting with a nurse regularly to discuss any concerns, yoga and massages.

All told us they were listened to and treated with respect, they explained how staff knock on their doors before entering and are always very polite.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.