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Cygnet Hospital Sheffield Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 17 November 2017

We rated Cygnet Hospital Sheffield as requires improvement because:

  • Although we noted some improvements since our previous inspections, there were still instances where the provider had not sufficiently addressed previous shortfalls as well as further areas of concern that we identified.
  • The child and adolescent wards were not fully operating in accordance with the provider’s own policy on ‘same sex accommodation’. Haven ward required environmental improvements; these were underway at the time of inspection.
  • There were low compliance rates of staff being trained in a number of key areas to help ensure the safe running of the service. In particular, both Spencer and Shepherd wards had low rates of staff trained in managing actual and potential physical aggression and basic and immediate life support.
  • All wards, except for Haven ward, had not completed resuscitation simulations in accordance with hospital policy. Staff raised concerns about the accessibility of necessary medical supplies. We also found issues with fridge temperatures on all wards except Spencer, whereby temperatures were outside of recommended ranges with no evidence of staff taking action to address this.
  • Not all care plans for patients on child and adolescent wards were holistic. They did not include clear information about interventions to manage patients at crisis point and their preferences in such situations. There was limited evidence that debriefs took place following individual incidents
  • There were occasions of staff still using inappropriate terminology within care plans to end seclusion as opposed to a person centred approach. We found instances of where patients with long term health conditions did not have a care plan in place about the support they needed.
  • Feedback from some patients across all wards was that they did not feel involved in the care planning process. Some felt information staff documented about them was not reflective of their needs and that staff did not involve them in any reviews of their care. Feedback from some patients across wards was that staff were not always caring.
  • There was still a high use of agency staff within the hospital. This was more prevalent at night across all wards. There was higher agency usage on the child and adolescent wards where vacancies were the greatest. Some patients told us they felt uncomfortable approaching agency staff due to them not being familiar with their needs.
  • There was no information on display on child and adolescent wards about how to make complaints. Complaints that had been investigated and concluded did not always offer a right of appeal to the complainant.
  • Patient information was not stored centrally as the hospital used both electronic and paper systems to store information. Information was not always easy to locate and the use of several systems had the potential to cause confusion for staff. It also meant there was greater risk of staff not updating all relevant information.
  • The service had undergone several changes of senior management which had led to some instability within the hospital. We found governance systems had been strengthened and the provider had made improvements in a number of areas. However, these new working practices and systems were not yet embedded. We still found shortfalls in areas of the service.

However:

  • Our observations of interactions between staff and patients were positive. Staff treated patients appropriately, with respect and demonstrated good knowledge of their needs.
  • There was positive feedback from some patients from all wards about staff and the service. There were forums available for patients to attend meetings and put forward their views of the service.
  • Patients had risk assessments and management plans in place. Staff completed necessary monitoring of patients following episodes of rapid tranquilisation.
  • We saw evidence of changes to working practices and learning from serious incidents that had taken place. These included changes in policy and systems.
  • Staff described good multidisciplinary meeting working which we observed in practice, and good relationships with external organisations. Staff teams reported good communication within their teams and regular meetings. Staff had regular supervisions and appraisals and felt supported within their roles.
  • Haven ward, Peak View and Spencer ward had participated in the Royal College of Psychiatrists quality network reviews. All wards had achieved high scores for the criteria they were assessed against and received positive feedback.
  • Monthly integrated clinical governance meetings took place where staff were able to discuss and review the performance of the wards and look at any themes, trends and learning.

Inspection areas

Safe

Requires improvement

Updated 17 November 2017

We rated safe as requires improvement because:

  • Haven ward required environmental improvements. A schedule of refurbishment work was underway at the time of our inspection but was not completed.

  • The child and adolescent wards did not fully comply with their own policy on same sex accommodation and with applicable guidance.

  • There was low compliance with required mandatory training in a number of key subjects necessary for the safe running of the service. Spencer and Shepherd wards had the least number of staff current with restraint training and life support training.

  • On the child and adolescent wards there was little information about what support patients required if they were in a crisis or how staff should manage challenging situations. This included patients preferences in relation to the use of interventions such as restraint and seclusion should this be required.

  • There were instances of medicines being stored outside of the recommended storage ranges on Haven, Peak View and Spencer wards. There was no evidence that staff had taken action to remedy this.

  • The use of blanket restrictions had improved since our last inspection however patients on Haven ward were not allowed access to their mobile phones. This decision was not in accordance with policy and there was no individual patient rationale for this.

However:

  • The wards were generally clean and infection control practices had improved on Haven ward.

  • Although there were still vacancies across all wards which led to a continued high use of agency staff, staff felt in the main the staffing levels on the wards were suitable. Managers could adjust staffing levels to suit patient need. The provider was looking at ways of improving staff recruitment retention.

  • Patients had risk assessments and management plans in place. Risk information was shared between staff and relevant professionals.

  • Haven ward had addressed and improved the process for patient observations and allocations. This had not yet been implemented on Peak View or elsewhere.

  • Staff regularly monitored patients’ physical health following the use of rapid tranquilisation.

  • We saw evidence of learning from serious incidents such as changes in policy and working practices.

Effective

Requires improvement

Updated 17 November 2017

We rated effective as requires improvement because:

  • Not all patients on the child and adolescent wards had care plans in place to cover holistic needs, including what therapeutic input they required. Some patients had no care plans about their physical health needs including patients on adult wards who had long term health conditions.

  • The hospital had best practice tools in place to monitor and measure patient improvement however staff did not always use these correctly or consistently.

  • On the child and adolescent wards there were instances of incomplete mental capacity assessments which meant it was not evident that the assessor had considered all necessary principles.

  • Staff, particularly on the child and adolescent wards, did not always act upon the outcomes of Mental Health Act audits in a timely manner where issues were identified.

  • Patient information was not held centrally as the hospital used both electronic and paper systems to store this. As a result, information was not always easy to locate and it had the potential to cause confusion for staff.

However:

  • Staff on all wards received regular supervision and appraisals and told us they felt supported in their roles.

  • Staff could access additional training and were supported by the hospital where they were undertaking further external training. Some staff felt training in psychological therapies would be beneficial to help them better support the patient group.

  • Staff were involved in undertaking regular clinical audits of areas of the service.

  • There was good multidisciplinary working in the hospital and good links with external agencies and organisations.

Caring

Requires improvement

Updated 17 November 2017

We rated caring as requires improvement overall because:

  • Patients across all four wards had mixed views of how staff treated them; some felt staff were not kind and caring towards them. Some patients did not feel comfortable approaching agency staff for support as they did not feel they knew them well.

  • Some patients across all wards reported having little or no involvement in the care planning process and decisions relating to their own care.

  • Patients had access to advocates but this service was not as well integrated on the adolescent wards as on the adult wards.

  • Some parents and carers of patients on the adolescent wards felt communication was lacking and they had limited involvement in their relative’s care.

  • Patients on the child and adolescent wards did not have the opportunity to be present throughout the discussions that the multidisciplinary team had about them during their regular ward round meetings. Patients on the adult wards were not always present through the entirety of the discussions.

However:

  • We rated the adult wards as good in this domain.

  • We found that interactions and exchanges between staff and patients on all wards were positive, caring and respectful.

  • Patients on all wards had community meetings where they were able to discuss aspects of the service, give feedback and contribute their views.

  • Some patients, parents and carers gave good feedback about staff, the service and the care provided

Responsive

Requires improvement

Updated 17 November 2017

We rated responsive as requires improvement because:

  • Complaints that had been finalised and concluded did not always include information about the rights of the complainant to appeal to the ombudsman.

  • There was a lack of information for patients and visitors about how to complain on the adolescent wards. There was limited evidence of shared complaint learning between staff at ward level.

  • Some patients reported limited activities and a lack of things to do, especially at evenings and weekends. There was a lack of individualised activities for patients.

However:

  • Managers of the child and adolescent wards had regular meetings with commissioners to discuss patient referrals, admissions and discharges.

  • There was occupational therapy provision available to patients and activity groups patients could attend.

Well-led

Requires improvement

Updated 17 November 2017

We rated well-led as requires improvement because:

  • There was no registered manager operational in post at the hospital but an interim manager was in place. There had been several changes of senior staff which had caused some instability across the service.

  • Although the provider had undertaken work to address previously identified shortfalls, these were not yet embedded and sustained. We identified further areas of the service that were in need of improvements.

  • The service did not always operate fully in accordance with all relevant policies. The adolescent wards did not comply with the policy for the practice of mixed sex accommodation and access to mobile phones.

  • There was low compliance across the hospital in some areas of mandatory training.

  • The provider used several systems to store patient information which posed a risk of omissions in information and staff not updating all records. This was a known issue that we had also identified at previous inspections.

  • The provider’s systems and processes had not identified that complainants were not always provided with necessary information.

  • The system for recruiting new staff was not robust as there was a lack of evidence of verification of references in some instances.

However:

  • Most staff reported positive changes implemented by the current management team and felt the hospital was improving. Senior managers recognised and acknowledged that further improvements were still required.

  • Staff were knowledgeable about the hospital’s visions and values and aimed to work in accordance with these.

  • Haven ward, Peak View and Spencer ward had participated in the Royal College of Psychiatrists quality network reviews. All wards had achieved high scores for the criteria they were assessed against.

Checks on specific services

Child and adolescent mental health wards

Requires improvement

Updated 17 November 2017

Forensic inpatient/secure wards

Requires improvement

Updated 17 November 2017