Cygnet Hospital Colchester

Updated 9 September 2021

The location Cygnet Hospital Colchester is a 54-bed hospital for men aged 18 years and above based in Colchester, Essex. The provider is Cygnet Learning Disabilities Ltd. There are three core services:

Acute wards for adults of working age

• Highwoods ward has 19 beds and is an acute in-patient service.

Long stay rehabilitation mental health wards for working age adults.

• Ramsey ward has 21 beds and is a high dependency inpatient rehabilitation service.

Wards for people with a learning disability or autism

• Oak court has 10 beds for patients with a learning disability, associated complex needs and behaviours that challenge. Four beds are for patients in short term crisis or those who no longer require acute care but remain on an acute ward. Five beds are for patients with high dependency needs and supports assessment, treatment and rehabilitation. There is a one bed apartment to provide a more independent living environment.
• Larch court has four beds and provides intensive support for patients with autism, learning disabilities and complex needs.

Clinical teams give multidisciplinary input to all wards including nursing, occupational therapy, psychology, psychiatry and vocational training. The hospital has an off-site activity centre (Joy Clare) although this was not open at the time of our inspection due to Covid-19 restrictions. This location is registered with the Care Quality Commission to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983.
• Treatment of disease, disorder or injury.

At the time of the inspection the location had an interim manager in post and were attempting to recruit into the position of a permanent registered manager.

The Care Quality Commission carried out a focused inspection on Flower Adams 1 and 2 wards at this location on 9, 15 April and 2 May 2019. The service was placed in special measures and breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified for:

• Regulation 12 Safe care and treatment
• Regulation 17 Good governance
• Regulation 10 Dignity and respect

The Care Quality Commission placed urgent conditions on the location's registration and also issued a warning notice and requirement notices. The Care Quality Commission placed the location in special measures on 20 May 2019. The provider sent the Care Quality Commission their action plans outlining how they would address the breaches of regulations. They closed Flower Adams wards and the Care Quality Commission removed the conditions.

At the last rated comprehensive inspection on the 12, 13, 14 and 20 November 2019, we found the provider had taken actions to make improvements, but we identified breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for:

• Regulation 9 Person centred care
• Regulation 12 Safe care and treatment
• Regulation 17 Good governance

The provider sent the Care Quality Commission their action plans outlining how they would address the breaches of regulations. Additionally, we identified a breach of Regulation 13 safeguarding service users from abuse and improper treatment and issued a section 29 warning notice to the provider.

The Care Quality Commission carried out a focused inspection at this location on 10 and 11 March 2020 to check on the provider’s action regarding a section 29 warning notice regarding a breach of Regulation 13 safeguarding service users from abuse and improper treatment. The provider had taken action to address the warning notice. However, breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified for:

• Regulation 17 Good governance
• Regulation 18 Staffing

The Care Quality Commission carried out a focused inspection on all wards at this location on 19 and 26 August, 2,3,8,9, September 2020. The Care Quality Commission placed urgent conditions on the location's registration and also requirement notices. Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified for:

• Regulation 12 Safe care and treatment
• Regulation 17 Good governance

The provider sent the Care Quality Commission their action plans outlining how they would address the breaches of regulations. The Care Quality Commission held regular engagement meetings with the provider to monitor the service and its improvement. Some conditions were removed, and others varied in November 2020. The provider no longer has any conditions placed on their registration. A new registration certificate was issued on 6 April 2021 and the service remained in special measures.

The provider submitted action plans that described how it would make the required improvements and we found that it had addressed the concerns identified at the previous inspections.

This inspection was a focused inspection looking at all key lines of enquiries with the aim to re-rate the service. Significant improvements were identified across all areas.

What people who use the service say

We spoke with eleven carers or relatives of patients. The majority spoke positively about the hospital and the quality of the care that their relative received. Most of the carers and relatives felt they were kept informed of and involved in the care received to their relative. The majority of relatives and carers felt that the needs of their relatives were being met with the few exceptions where two relatives felt this could improve and had complained to the provider. The majority of relatives were aware of how to complain and examples were given where complaints had been made. Relatives and carers wanted the opportunity to be able to provide formal feedback to the provider. This was facilitated after our inspection in June 2021, where the provider requested relatives and carers to complete a survey.

We spoke with ten patients. Eight were positive about the hospital and said they felt safe and staff supported them well. Patients said there were things they were unhappy about and had raised these with the service. These included improving access to section 17 leave, improving and co-producing psychology groups and discharge. Patients said they spoke with advocacy staff if they needed to.

Updated 9 September 2021

Cygnet Hospital Colchester was placed into special measures by the CQC Chief Inspector of Hospitals in May 2019. This followed findings of significant concerns about the safety and leadership of the service. Since then the CQC has continued to monitor the service closely and has found some improvement. We have judged that enough improvement has been made to remove the provider from special measures.

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

The service provided safe care. The ward environments were safe and clean. During this inspection, we found the provider had made improvements since our inspections in 2019 and 2020. Staff were now following the provider’s infection prevention control policy and disposed of clinical waste appropriately and managers had ensured processes of monitoring and learning from restraint incidents had improved. Managers held de-briefs with staff to ensure learning had been identified after incidents of restraint. Managers also ensured improvements had been made to ligature risk assessments which were comprehensive with timeframes for actions to be completed and staff ensured alarms were regularly checked, there were enough of them and they were repaired if necessary.

The wards had enough nurses and doctors. Staff assessed and managed risk well. Patients were involved in managing their own risks whenever possible. Improvements were made since our inspection in 2019 where staff now completed daily risk assessments of patients and risk assessments of patients prior to going out of the hospital. Patients, where possible, were involved in developing their positive behavioural support plans.

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 met patients’ physical and sensory needs. Staff minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.

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. This had improved following our inspection in 2019 where staff did not receive regular supervision for their work. 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. Patients had their communication needs met and information was shared in a way that could be understood. Staff involved patients and families and carers in care decisions.

The service managed beds well. At the time of the inspection beds were available. Although there were some delays to patients being discharged, staff worked actively with commissioners and allocated staff to improve timeliness of discharges. Advocates would assist patients with their discharge, where necessary.

Staff supported patients through recognised models of care and treatment for people with a learning disability or autistic people. Patients were supported to be independent and had control over their own lives. Their human rights were upheld, and they made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals and ensured their care, treatment and support plans, reflected their sensory, cognitive and functioning needs. Care focused on people’s quality of life and followed best practice.

The service was well led, leadership was good, and governance processes helped the service to keep people safe, protect their human rights and provide good care, support and treatment. The provider had made significant changes to their senior management team and had ensured staff were now in roles to enhance improvements to systems and processes at the service. Managers had made improvements to their processes in ensuring duty of candour was followed.

We found that the provider had made improvements to their recruitment, selection and appointment of staff policy. Since our last inspection in 2020, staff files were now in line with the provider’s policy when recruiting, selecting and appointing all new staff.

Staff said the changes in leadership and management were positive and had improved their experience of working at the service. Staff were keen to talk to us about the improvements they had made to the service and were passionate and enthusiastic in demonstrating this.

However:

Although some work had been completed on diversity and ethnicity at a local level, the provider had further work to do in ensuring their action plan for the Workforce Race Equality Standard was fully embedded.

Although infection prevention control guidelines were followed and the service was clean, staff on Highwoods ward, had not always recorded that they had cleaned high touch areas every three hours in line with the provider’s Covid-19 Healthcare Cleaning Manual and Schedule policy.

Staff on Oak and Larch Court did not always clearly document in people’s records when their next yearly physical health checks were due to ensure that appointments were not missed or delayed. The provider acknowledged this during our inspection had had plans to make immediate improvements.

Updated 9 September 2021

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

• Please see overall summary.

Updated 9 September 2021

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

• Please see overall summary.

Updated 9 September 2021

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

• Please see overall summary.