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Inspection Summary


Overall summary & rating

Good

Updated 3 June 2016

We rated Cygnet Hospital Woking as good because:

All patients had risk assessments. Risk information was reviewed regularly and documented. We saw that the reviews of risk were part of the multi-disciplinary care review process. There were appropriate systems embedded with regards to safeguarding vulnerable adults and children. De-briefing for both staff and patients took place after incidents.

  • Patients’ needs were assessed and care was delivered in line with their individual care plans.
  • Records showed that all patients received a physical health assessment and that risks to physical health were identified and managed effectively. Staff followed best practice in treatment and care. Staff participated in a wide range of clinical audits to monitor the effectiveness of services provided. Staff received appropriate mandatory and statutory training, supervision and appraisals.

  • Most patients spoke highly of the daily and weekly therapeutic activities that were offered across the wards. Staff respected patients’ diversity and human rights. Attempts were made to meet people’s individual needs including cultural, language and religious needs.
  • Complaints were appropriately reviewed and responded to.
  • Patients we spoke with were positive about the staff. The interactions we observed between patients and staff were friendly and respectful. Feedback received from families and external stakeholders was good.
  • The service had good governance processes in place to monitor performance and trends.

However:

  • The seclusion facilities across the wards did not meet current guidelines as per the Mental Health Act Code of Practice 2015, to ensure safety and patients dignity was maintained. This was a breach of regulation at the previous inspection visit.
  • On Acorn and Parkview Ground ward the use of the Extra Care Area (ECA) was not in line with the Mental Health Act code of practice.
  • Staff did not clearly document when restraint was used in seclusion records and correct terminology was not used to help identify this.
  • Not all ligature points had been identified on audits and for some of those identified staff could not explain the reason why it was considered a ligature risk.
Inspection areas

Safe

Requires improvement

Updated 3 June 2016

We rated safe as requires improvement because:

  • Seclusion facilities across the wards did not meet current guidelines as per the Mental Health Act Code of Practice 2015, to ensure safety and patients dignity was maintained. This was a breach of regulation at the previous inspection visit

  • On Acorn and Parkview Ground ward the use of the Extra Care Area (ECA) was not in line with the Mental Health Act code of practice

  • Staff did not clearly document when restraint was used in seclusion records and correct terminology was not used to help identify this

  • Not all ligature points had been identified on audits and for some of those identified staff could not explain the reason why it was considered a ligature risk.

However:

  • Staff received appropriate mandatory training

  • The majority of permanent staff had completed the training required in 19 different areas

  • The clinic rooms was fully equipped and emergency medications were all in date

  • Resuscitation equipment was in good working order, readily available and checked regularly by staff

  • All patients had risk assessments

  • Risk information was reviewed regularly and documented. We saw that the reviews of risk were part of the multi-disciplinary care review process

  • There were appropriate systems embedded with regards to safeguarding vulnerable adults and children

  • De-briefing for both staff and patients took place after incidents.

Effective

Good

Updated 3 June 2016

We rated effective as good because:

  • Patients’ needs were assessed and care was delivered in line with their individual care plans

  • Records showed that all patients received a physical health assessment and that risks to physical health were identified and managed effectively

  • Staff followed best practice in treatment and care

  • Staff participated in a wide range of clinical audits to monitor the effectiveness of services provided

  • Staff received appropriate mandatory and statutory training, supervision and appraisals

  • Staff participated in regular reflective practice sessions where they were able to reflect on their practice and incidents that had occurred on the ward. Patients capacity to consent to treatment was recorded and assessed on admission and then regularly throughout. However, Mental Capacity Act training was not provided as mandatory training for staff.

Caring

Good

Updated 3 June 2016

We rated caring as good because:

  • The patients we spoke with were positive about the staff

  • The interactions we observed between patients and staff were friendly and respectful

  • Feedback received from families and external stakeholders was good

  • Staff had a good understanding of the individual needs of patients

  • Staff had good knowledge on how to de-escalate situations and worked as a team to promote a safe environment.

Responsive

Good

Updated 3 June 2016

We rated responsive as good because:

  • Patients were not moved between wards other than for clinical reasons and beds remained open for them to return to following leave from the ward

  • There was a quiet room on each of the wards and a room off the ward where patients could meet visitors

  • Each ward had access to secure outside space

  • Staff respected patients’ diversity and human rights

  • Attempts were made to meet people’s individual needs including cultural, language and religious needs

  • Complaints were appropriately reviewed and responded to.

Well-led

Good

Updated 3 June 2016

We rated well-led as good because:

  • Staff told us they felt the senior management team were approachable at all times and felt confident in speaking with them

  • Staff told us they were aware of the whistle-blowing process and were confident they could raise concerns if needed

  • Staff demonstrated that they were motivated and dedicated to deliver the best care and treatment they could for the patients on the wards

  • There was good staff morale

  • We found the wards to be well-led and there was clear leadership at a local level.

However:

  • staff were not aware of the services visions and values.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 3 June 2016

Forensic inpatient/secure wards

Good

Updated 3 June 2016