Cygnet Hospital Woking

Updated 21 March 2023

Cygnet Hospital Woking is an independent mental health hospital run by Cygnet Surrey Limited. The hospital offers a range of mental health services for men and women across four wards.

The service has a sister hospital close by, Cygnet Lodge Woking, which provides a high dependency inpatient rehabilitation service for men and extends the care pathway and a male acute ward for working age adults which opened in July 2021. Cygnet Lodge Woking was inspected at the same time as this inspection but is rated as a separate location.

The same leadership team and registered manager oversee both locations.

There are three core services at Cygnet Hospital Woking delivered across four wards with a total of 57 beds.

• Oaktree ward – 11 bedded female only forensic inpatient / low secure ward

• Greenacre ward – 18 bedded male only forensic inpatient / low secure ward

• Acorn ward – 10 bedded female only psychiatric intensive care unit

• Picasso ward – 21 bedded female only acute ward for adults of working age

We carried out this focused inspection because at our last inspection in 2022 we found areas of concern continued to remain and we were concerned that actions had not been implemented at ward level to maintain the safety of the patients on Picasso Ward. In addition to this, information of concern had been escalated to the Care Quality Commission in relation to patients bringing dangerous items onto the ward.

Following the 2022 inspection the hospital responded immediately to the concerns and the hospital provided the CQC with an action plan to address all the identified concerns. We monitored the progress of the action plan during 2022 with regular engagement meetings.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met the required standards.

This report only covers our findings in relation to the key questions: Safe and Well led which contain the previous concerns. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

What people who use the service say

We spoke with ten patients on the ward who gave us an overall positive view of their experiences on Picasso. They felt the staff treated them well and the atmosphere in the wards was relaxed and safe. The patients were able to identify the difference between the upstairs environment and the downstairs area of the ward stating that it was busier downstairs and calmer and more peaceful upstairs.

Patients told us they felt involved in their care planning and decision making and were able to be supported by their family members in the care planning process.

Patients that had been newly admitted to the ward felt they had the issues with bringing dangerous items on to the ward explained to them when they were admitted and told us they were searched regularly when they were coming on and off the ward. The patients felt this was a suitable restriction and were understanding of the reasons why staff had to do this to maintain safety of the ward.

The patients told us that staff were available and there was always lots of therapeutic activities to take part in if they wanted to. They told us the food was good, that staff managed incidents well and that the doctors were available and supported their recovery journey.

All patients felt the wards were regularly cleaned and their rooms were comfortable with suitable fixtures and fittings.

Updated 21 March 2023

Our rating of this location improved. We rated it as good because:

• The service provided safe care. The ward environments were safe, clean and well furnished. The wards had enough nurses and doctors. Staff assessed and managed risk well. They analysed and minimised the use of restrictive practices through clinical governance, they managed medicines safely and followed good practice with respect to safeguarding.
• Clinical rooms and clinical medical devices were well managed and physical health monitoring had significantly improved.
• 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.
• Patients reported that staff treated them with compassion and kindness, respected their privacy and dignity, and understood their individual needs. They actively involved patients, families and carers in care decisions.
• The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
• The service was well led and the governance processes ensured that ward procedures ran smoothly.

Updated 11 August 2022

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

• 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 and followed good practice with respect to safeguarding. Individual risk assessments were also carried out to manage any specific risk, for example, kitchen access, possession of bedroom keys and access to computers. Staff on both wards followed the observation policy to ensure the management of patient risk. We reviewed observation records and saw that these were clear, and that the allocation of staff matched the prescribed observation level. Both wards had low use of restrictive practices. Staff were confident in identifying and responding to safeguarding concerns.
• They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. The service provided several therapeutic activities including Cognitive Behavioural Therapy, staying well groups, mindfulness and meditation
• Staff engaged in clinical audit to evaluate the quality of care they provided. The service had a comprehensive audit schedule in place which covered many areas of the service including medication, safeguarding, health and safety, physical health, Mental Health Act and Mental Capacity Act, observation and engagement and Infection, Prevention and Control (IPC). We saw evidence that action had been taken from audit data to ensure improvements were made. The service was also involved with the Quality Network for Forensic Mental Health Services and were expecting a peer review the month of the inspection.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The service had access to clinical staff including ward doctors, GP’s, nurses and support workers, and therapy staff including psychologists, occupational therapists, social workers and activity coordinators. Where additional specialists were required, such as speech and language therapists, the service told us that these were accessed externally.
• Managers ensured that staff received training, supervision and appraisal. Managers supported staff through yearly appraisals, quarterly clinical supervisions and monthly managerial supervisions. All staff were up to date with mandatory training.
• The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare. We saw evidence of multidisciplinary involvement in daily entries on patient notes and staff accessing multidisciplinary teams for support and advice. Ward teams had effective working relationships and liaison with external community teams and organisations, for example, care coordinators were invited to attend ward round meetings.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Patients had easy access to information about independent mental health advocacy and patients who lacked capacity were automatically referred to the service. We saw evidence that staff informed all patients of their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s notes each time. Staff made sure patients could take section 17 leave (permission granted to leave the hospital for those detained under the Mental Health Act) when this was agreed with the Responsible Clinician and/or with the Ministry of Justice. Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. We observed interactions between staff and patients and found them to be warm, helpful and supportive. Patients told us that staff listened to patients and addressed their individual needs and that they felt that staff genuinely cared for their wellbeing.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason. The service had low numbers of delayed discharges. We saw evidence of involvement from NHS commissioning and Forensic Outreach Liaison Services (FOLS) in patients’ discharge. Staff told us that they had positive working relationships with community teams which helped in facilitating discharges.
• Leaders had the skills and experience to perform their duties. They engaged actively with patients, staff and local health and social care providers.

However,

• There were some concerns around the medicines management within the service. For service users with physical health needs, their care plans were not always detailed enough and did not always contain important follow up information. We also did not always see that appropriate monitoring required by prescribed treatment was in place to review the effects of each patient’s medication on their physical health.
• There were also concerns around medical equipment and storage. For example, blood glucose monitoring machines were not being consistently calibrated. Without proper calibration the service cannot be assured the readings taken on these machines were accurate and that the treatment being offered to patients was appropriate. When temperatures of medicines storage areas were outside of the appropriate range, action was not always taken to safeguard medicines supplies.
• We found concerns with the monitoring and management of medical equipment, for example on Greenacre ward emergency bag and equipment checks were not consistent, there were items which were out of date or unpackaged and oxygen cylinders were not stored securely. The service also did not always ensure the safe management of healthcare waste.
• On both wards, patient paper notes did not always correlate with the electronic records and some of the paper copies were out of date.
• While the seclusion room on Greenacre ward had not been used for four months, we saw that it had issues with privacy and dignity in that it could be viewed from the external ward garden. Managers told us that they were putting in place a fence to prevent the ability to see in through the windows
• The provider did not always provide feedback to patients when they raised concerns or issues. Patients told us that they did not receive updates to issues raised and we saw that community meeting minutes were not always consistent in feeding back on actions taken and “You said, we did” boards on the wards were blank.
• The provider did not always ensure the family members were involved in their relatives care where this was appropriate.

Updated 21 March 2023