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

Cygnet Hospital Taunton

Overall: Good read more about inspection ratings

Orchard Portman, Taunton, Somerset, TA3 7BQ (01823) 336457

Provided and run by:
Cygnet Health Care Limited

Important: The provider of this service changed. See old profile

All Inspections

30/03/2022 to 31/03/2022

During an inspection looking at part of the service

Cygnet Hospital Taunton is an independent mental health hospital near Taunton in Somerset, providing a range of specialist mental health services. This can include people detained under the Mental Health Act and those with challenging behaviour, as well as patients with long-term mental illness and additional physical health conditions.

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

  • There had been significant improvements on the acute inpatient ward since the previous inspection in 2019. The hospital had separated the acute inpatient ward into two wards; namely Sycamore 1 and Sycamore 2.
  • There was a new leadership team since our last inspection in 2019 who had a clear plan in place for the site and had started to make progress. The new hospital manager was aware of the risk areas and performance issues facing the service. They had reviewed the site improvement plan and had developed this in response to the identified areas for improvement, and progress with this was already evident. Staff said there had been a positive shift in culture.
  • The service provided safe care. All ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed environment and individual risk well. They minimised the use of restrictive practices such as the use of seclusion and restraint, managed medicines safely and followed good practice with respect to safeguarding.
  • 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 such as National Early Warning Score (NEWS2). NEWS2 is based on a simple aggregate scoring system in which a score is allocated to physiological measurements, these are recorded in routine practice, when patients are in hospital. Staff engaged in clinical audit to evaluate the quality of care they provided such as The National Audit of Dementia (NAD).
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. These included Speech and Language Therapy (SALT) and Occupational therapy. Managers ensured that these staff received training, including specialist training to support them to meet the needs of patients, regular supervision and an annual 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 such as mental health community teams which is delivered mostly by the local NHS trusts.
  • 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. Most patients we spoke with told us most staff were caring and treated them with respect and kindness. The hospital held daily reflection meetings, and weekly community meetings. Patients were encouraged to raise any issues, compliments and complaints during these meetings.
  • 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. Staff we spoke with talked positively about their roles and were passionate about the service developing. Staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation.

However:

  • Documentation around mental capacity was not always clear on Sycamore ward 1 and 2. It was difficult to identify mental capacity assessments in records. Some records identified that capacity was assessed and documented as patient having “insight” whilst other records identified that “patient had capacity” and these were recorded in different parts of the record keeping tool the hospital used. This meant it was not always clear if a patient had capacity to make a specific decision.
  • Staff on Swift ward did not always carefully plan patients’ discharge. Staff did not always complete the fit to travel assessment documentation to ensure patients could travel safely once discharged.
  • Carers that we spoke with expressed their frustration with contacting the wards via telephone regarding visit access during Covid-19 outbreaks at the hospital. Carers told us that it could sometimes take multiple phone calls in one day to get through to ward staff and get conflicting messages regarding visit access.
  • The hospital lacked a robust assurance system to verify the training status of agency staff. Managers we spoke with told us they requested agency staff who had completed certain training but were not able to verify if this training actually took place.

2 - 3 October 2019

During a routine inspection

We inspected the acute wards for adults of working age and psychiatric intensive care units on 2 – 3 October 2019, as when we completed the comprehensive inspection of the hospital in 26 March 2019 2019 these wards had just recently opened so were not inspected at that time.

We rated Acute wards for adults of working age and psychiatric intensive care units as requires improvement overall because:

  • Staffing levels were not always safe. The wards had a high vacancy rate, particularly amongst registered nurses. Starling ward had a 38.9% vacancy rate and Sycamore ward had a 46.4% vacancy rate.
  • Patients did not always receive the support they required from staff. They told us that night staff were difficult to engage with. Patients also said that it was difficult to get one to one time with their named nurse and that there were not enough activities to do on the ward. Patients had raised this with staff, but it had not been dealt with.
  • Although there were convex mirrors to cover some blind spots in the corridors, staff did not have always have a direct line of sight throughout the ward. This meant staff were not always aware of the whereabouts of all patients.
  • Managers did not have robust governance structures in place to support staff. Only 61% of staff on Sycamore had received management supervision in the month prior to our inspection and there were no mechanisms in place for staff to receive clinical supervision. Supervision records did not consistently highlight development needs for staff and their practice. We observed that managers did not use appropriate language when discussing skills deficits across the staff group.
  • Ward areas were not clean. There was a lack of clarity of who was responsible for overseeing the housekeeping staff.
  • Patient’s care records did not always contain necessary, timely information. Not all discussions relating to patient’s risks were adequately documented in care records. It was not always clear if patients had been offered copies of their care plans.
  • Staff did not complete mental capacity assessments within an appropriate timescale.
  • There was a lack of therapeutic space for multidisciplinary staff to see patients and complete therapy sessions.

However:

  • The ward teams included, or had access to, the full range of specialists required to meet the needs of patients on the wards. 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 supported patients to engage in the wider community. There were opportunities to access sport facilities and to watch sport at local clubs. Patients were able to access support groups in the local community, such as drug and alcohol support groups. Friends and family were encouraged to facilitate community leave and overnight visits.
  • Patients gave positive feedback about the day staff on both wards. They told us the day 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.

26 March 2019

During a routine inspection

Our rating of this service is good because:

  • The provider managed risks well. Staff completed regular environmental and patient risk assessments and had a good knowledge of individual patient needs. The hospital had an up-to-date risk register that highlighted key concerns and had plans in place to manage these. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.  
  • Patient records were person centred, up to date and overall were of a good standard. Physical health monitoring and care were well managed and staff were suitably trained and up to date with mandatory training requirements. The provider had clear processes for monitoring and investigating incidents and complaints and undertook a variety of audits to monitor and improve the quality and safety of the service. Systems were in place to learn from these and improve practice as a result.
  • Managers adjusted staffing levels to meet changing needs, utilising extra bank and agency staff who were familiar with the wards to cover any shortfall. The hospital ensured agency and bank staff were familiar with the wards and had access to the same induction, support and training as permanent staff.  
  • Staff provided a range of care and treatment interventions suitable for the patients in line with guidance from the National Institute for Health and Care Excellence (NICE). Robust arrangements were in place to meet patients’ physical and mental health needs. Staff were compassionate, respectful, responsive; providing patients with help, emotional support and advice at the time they needed it.
  • The ward managers and senior leadership team provided strong and effective leadership and staff members had confidence in them. Managers within the service promoted an open and honest culture. Staff felt able to raise concerns, report incidents and make suggestions for improvements without fear of consequences. Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff felt respected, supported and valued by senior managers and leaders. They were proud to work at the hospital and felt positive about their work and the support they gave patients.

However:

  • Staff did not ensure patient privacy and dignity whilst they were in the bedrooms and when they were using the bathroom, for example by not ensuring doors were closed. Staff were observed talking about patients care in front of other patients.
  • Do not attempt to resuscitate forms were not always easily found in the patients notes.
  • Although staff received Safeguarding Individuals at Risk E-Learning which was equivalent to Safeguarding Training Level 2, the provider had identified that this level of training was not adequate and had enrolled staff on Safeguarding training Level 3 including safeguarding children.
  • Managers did not ensure that appraisals were individual for each staff member. We saw one record contained two staff members names’ in the same record.

21 February 2017

During a routine inspection

This was a short notice announced re-inspection to determine what progress Cygnet Hospital Taunton had made since being rated inadequate at the previous Care Quality Commission inspection in February 2016.

During this inspection (February 2017) progress had been made and we were able to amend the ratings for safe from inadequate to good, caring and well led from requires improvement to good and effective from inadequate to requires improvement. Overall we were able to re-rate the hospital from inadequate to good.

At this February 2017 inspection we rated Cygnet Hospital Taunton as good because:

  • Some work had been carried out to improve the environment within the hospital since our inspection in 2016, for example wards had been redecorated and carpet had been replaced with vinyl flooring.
  • Wards were clean, and free of odour.
  • The senior management team within the organisation had supported new managers at the hospital to make a range of service improvements. The new managers provided strong leadership and staff that we spoke with had embraced the drive to improve the service.
  • Patients and relatives commented positively on the care they and their family members received. Care records contained up-to-date, personalised, recovery orientated care plans.
  • The provider had reviewed their medicines administration systems to ensure that medicines were administered to patients in a timely manner and followed safe practice.
  • Required staffing levels had been achieved regularly. There was appropriate use of bank and agency staff. Staff had completed a thorough risk assessment for each patient. Records indicated that staff were carrying out the required level of patient observations.
  • The provider had a pro-active approach to reporting safeguarding incidents. The provider had demonstrated learning from serious incidents and displayed an open approach when liaising with external agencies.
  • Eighty-eight percent of staff were up-to-date with mandatory training.
  • Staff from all disciplines participated in audits. Audits were reviewed at a monthly team meeting, actions were generated at the meeting in the form of action plans.
  • We saw evidence of good discharge planning throughout the hospital.
  • Staff told us that they felt able to raise issues through their managers and that their concerns were responded to appropriately. Staff told us that morale was good and teams functioned well.

However:

  • Some staff were unable to tell us about the needs of the client group and how best to support them. Psychological interventions were delivered by the psychologist only. Ward staff did not describe using psychologically informed approaches in their interaction with patients. This was relevant as many patients displayed challenging behaviour and it was not clear how this was being addressed.
  • Staff on an upstairs ward told us that often they could not facilitate patients going outside due to staff availability. Staff told us that when patients said they did not wish to go outside they would respect this.  We did not see staff distracting two patients who were becoming agitated.
  •  Some patients had rooms that had been personalised by relatives or staff but not all. Staff that we spoke with on the wards about this did not appear to see this as their role. There was more work to do on the wards to make them appropriate for the needs of the client group, this included consideration of appropriate furniture and decoration.
  • Staff had difficulty telling us how they might apply the principles of the Mental Capacity Act on a day to day basis in their interactions with patients. We found that in most care plans reference to mental capacity was completed with standard phrases. In some files we saw that assessments of capacity had not recently been completed and it was not clear if they had been reviewed or updated to ensure their ongoing validity.
  • Whilst some changes had been made to the environment since the last inspection, it still lacked some resources for people with dementia such as items in the environment to cognitively stimulate patients. Some wards had features or furniture that was not appropriate for the client group such as bookcase wallpaper. Furnishings were in good condition but some were not appropriate for the safety of the client group. For example there were small side tables in patient lounges, some were located next to armchairs. On the day of the inspection we saw that two patients had difficulty manouevering around a small table to sit down in an armchair. 
  • There was no training for staff on mental illness.

23 – 24 February 2016

During a routine inspection

We rated Cygnet Hospital Taunton as inadequate because:

• All wards had blind spots which meant staff could not respond immediately to defuse potential assaults between patients or respond to a fall. Falls were not always recorded and falls plans put in place. Patients with a history of falls were not assessed by either a falls nurse or physiotherapist. Whilst the staff used observations to mitigate risk, we found some observation records incomplete. The provider acknowledges that line of sight could be improved in order to mitigate the risks posed.

• Risks to patients health such as pressure areas, nutrition and other health problems were not always monitored effectively. Information from discussions about patient care was not always recorded in records in a timely way. Pressure areas were not always checked and care records updated.

• We saw one patient who was left in bed until 12:30 despite asking to get up. Staff told us as the patient was mobile and that the patient had to stay in bed as staff were too busy delivering care to other patients.

• Staff did not follow best practice when administering medication. Medicines were not always administered at the correct time and important information was not always recorded on the prescription chart. Staff did not give patients information about what medicines they were about to receive. Directions for the administration of covert medication were not documented on the medication administration sheets. There could be long delays in obtaining medicines.

• Incidents were not always reported. We found incidents recorded in patients’ notes but no incident form completed. During our visit we witnessed a patient fall. That evening the same patient fell again. We looked in the patients care records the following day and could find no record of the first fall.

• Patients' physical heath was not always assessed on admission or regularly reviewed thereafter. Important regular physical health checks were not always carried out.

• Assessments and care plans were not routinely reviewed and updated. There was little evidence of patient involvement in developing their own care plans. There was no system in place to support patients with dementia to make choices.

• The ward environments were stark and not suitable for those patients living with dementia. Bedrooms were not personalised nor decorated unless a family member came in to do this with a patient. There were restrictions on access to outdoor space.

• The hospital did not deliver any rehabilitation services and access to physiotherapy, occupational therapy and psychology to support rehabilitation was minimal. Patients with challenging behaviour had no psychological input and there were no systems in place to develop any behaviour support plans.

• There were 38 staff leavers between Feb 2015 and Feb 2016. Of these 38 leavers only one member of staff, a Health Care Assistant, was dismissed for gross misconduct in July 2015.

• Staff training was low in some areas and the induction of new staff was not always fully completed. Staff did not receive supervision in line with the provider's policy.

• There was a generally poor service for women at the hospital. Women on Willow ward had very limited space and could not be protected from a noisy environment. There was insufficient communal space on the ward and access to fresh air was via the male dementia ward.

• The provider had a governance system in place, however it had failed to identify and address serious shortfalls in care across the hospital. There was no effective system of audits in place to identify areas needing improvement.

However:

• The hospital maintained good health and safety checks.

• There was availability of equipment to assist with poor mobility.

• Staff were caring, respectful and attentive to patients. Patients were complimentary about the staff. Patients were clean and tidy and relatives told us that this was always the case.

• Staff reported they felt well supported by their managers. There were regular integrated governance meetings and improvements had been made to hospital systems. Sickness and absence rates were low. There was good morale in the team. There were opportunities for career development for staff at all levels.