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

Cygnet Hospital Derby

Overall: Good read more about inspection ratings

London Road, Derby, Derbyshire, DE24 8WZ (01332) 365434

Provided and run by:
Cygnet Health Care Limited

All Inspections

10-18 May 2022

During a routine inspection

Cygnet Hospital Derby provides one male and one female low secure wards and a locked rehabilitation ward for male patients who no longer require secure care.

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

  • The service provided safe care. 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.
  • Patients had an opportunity to manage their own medicines as part of their rehabilitation or recovery.
  • 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 audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the ward, which included substance misuse workers and social workers.
  • Managers ensured that staff received training, supervision, and 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.
  • 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 their families and carers in care decisions. This included carers' days and there was an allocated staff member on each ward to communicate with carers.
  • 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 was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • The wards looked tired and in need of redecoration particularly on Alvaston and Wyvern wards. There was a programme of planned refurbishment and we saw this had started in the corridors leading to the wards.
  • There was a blind spot in the toilets of the seclusion rooms on Litchurch and Alvaston wards. Seclusion on Litchurch ward was not always in line with the Mental Health Act Code of Practice and one of the seclusion records was incomplete. Documentation was messy and handwritten and not always easy to understand.
  • On Alvaston ward, staff had administered prescribed intramuscular injections to a patient but had not always documented what physical health observations had taken place. One patient did not have a T2 attached to their medicine record on Wyvern ward, but staff ensured this was done during our inspection.
  • Although staff mostly managed medicines safely and where appropriate, patients had an opportunity to manage their own medicines as part of their rehabilitation or recovery, there were some gaps in the recording of monitoring the self-administration of medicines on Wyvern and Litchurch wards, so it was not always clear that patients were managing these safely.
  • Staff did not always make reasonable adjustments in multidisciplinary team meetings to ensure patients could fully participate.

5th and 6th April 2018

During a routine inspection

We rated this service as Good because:

  • The hospital provided a good standard of accommodation to patients. The hospital was clean and records demonstrated this. There were adjustments in place for people requiring disabled access, support of patients’ spiritual needs and an extra care facility for patients needing seclusion or long-term segregation.
  • The hospital was staffed safely and all shifts occurring from staff sickness, absence and vacancies were filled. Each ward had a multi-disciplinary team. Employment records demonstrated that staff were qualified and experienced for the positions they held, and all staff received an induction and mandatory training.
  • Information needed to deliver care was stored securely and was available to staff when they needed it. Risk assessments and care plans were present and up to date in patients’ records. Care plans were recovery focussed and demonstrated that staff shared copies with patients. The Recovery Star provided a visual record of a patients’ recovery progress.
  • Patients said that staff were caring, respectful and polite, and we saw evidence of this in interactions. Patients felt involved in their care and had the opportunity to make decisions about how they would like to be treated if they were unable to make that decision in the future. The hospital had initiatives in place to involve patients in making decisions about the service.
  • The hospital had an established recovery college, offering educational and recovery focussed courses that were co-produced and facilitated by staff and patients. Outcome measures demonstrated the effectiveness of the college and patients described the college’s activities as meaningful.
  • The hospital had a strategy and delivery plan for reducing restrictive practice. Following a risk assessment from staff, where safe to do so, patients could have a key to their bedroom and their own mobile phones. Figures demonstrated that occurrences of restrictive practice including restraint, rapid tranquilisation, seclusion and long-term segregation, were low.
  • The hospital used key performance indicators to gauge the performance of ward teams and had effective governance systems to monitor performance. There was an overarching local action plan that brought together all the actions from risk assessments, incidents, the Peoples Council, peer review assessments, and staff, patient, and carer surveys.

However:

  • Staff had not always completed medicine charts to confirm administration of medicine or record a reason why the medicine had been omitted. Staff had not always kept records of high dose antipsychotic monitoring updated with the correct dates and outcomes of physical health checks.
  • Staff did not routinely record return details on leave risk assessment forms. This meant that a record of the outcome of Section 17 leave was not maintained to inform future decision-making.

1 -2 July 2015

During a routine inspection

We rated services as good because;-

  • All patients we spoke with said they felt safe in the environment. Patients had risk assessments and care plans, these were linked to “the recovery star” and “my shared pathway outcomes” tools which enabled patients to visually see the progress they were making.

  • Patients said that staff were respectful, caring and showed an interest in their wellbeing. Patients had access to advocacy to support them in making complaints and during meetings.

  • There were safe staffing levels on all wards. Staff understood the different security procedures for low and rehabilitation wards .Staff and records confirmed that staff knew how to report safeguarding concerns and incidents. Staff gave examples of changes in practice as result of learning from incidents.

  • There was good multi-disciplinary working, the clinical team reviewed patient outcome to assess patients progress.

  • Staff explained the organisation's values. Staff were committed to support patients to recover, so they could be discharged to less secure environments quickly.

  • Local senior managers were visible in the clinical areas. The hospital had clear arrangements to monitor performance through its governance structures. The hospital had an action plan which incorporated actions from the risk register, complaints, audits and incidents. These were discussed in the team business meetings.

However;

  • The Litchurch ward seclusion room had no intercom system. This meant that communication occurred by talking through the door.

  • All wards and Litchurch seclusion room had blind spots which meant that patients could be hidden from view.This was a breach of regulation 15 of the Health and Social Care Act. Staff managed by observation and supervision of patients. Closed circuit television (CCTV) had been installed in communal and corridor areas to support mitigation of risks.

  • Some staff were unaware of the ligature audit results.

  • Records reviewed did not confirm that patients had been given information when medication was first administered or about the effects of high dosage medication.

  • Nursing staff's understanding of the Mental Capacity Act (MCA) was not consistent.

  • Not all patients had copies of their Section 17 leave forms so that they knew their conditions of leave.

  • Records reviewed did not contain advance decisions on how patients wished to be treated.

  • Patients’ unlabelled personal items were found in the storeroom on Alvaston ward. The quiet room could not be used because patient belongings had been stored in it.

  • Alvaston ward had 16 beds. Department of Health guidance states there should be 15 beds for low secure units.

  • There was one visitor’s room available to three wards, which meant that visiting was by appointment.

4 February 2014

During a routine inspection

We visited all three wards as part of this inspection and spoke with eight people. People told us they were generally treated with respect and their dignity maintained. Comments included 'Staff treat me with respect and observe my dignity' and 'Most staff treat us with respect and observe our dignity but sometimes the bank staff can be a little difficult to get on with.' People felt listened to and able to express their views about how the service was run.

People were supported to maintain their independence and community involvement when safe and appropriate to do so. Each person had an individual activity plan, and were encouraged to take part in activities.

People spoken with told us their care plan had been explained to them, and they were aware of their rights. Care plans were detailed and set out the care, support and treatment required to meet people's needs. People told us their general health care needs were met.

There were good links with a wide range of providers and agencies, to ensure that people received safe and co-ordinated care, treatment and support.

People told us they received their medication as required, and their medication had been explained together with the possible side effects.

4 December 2012

During a routine inspection

We visited Litchurch Ward during our visit and spoke with three people. They all told us they had been involved in planning their care, had seen their care plans and signed to indicate that they agreed with them. People also told us they were involved in weekly ward rounds with medical staff.

People told us they chose what activities they took part in. People were interacting with staff during our visit, playing pool or sitting chatting. We saw people were supported to access the community, either with support from staff or independently. Risks associated with involvement in community projects, or access to community facilities, for example the local gym, was clearly documented and planned for.

All of the men we spoke with told us staff treated them with dignity and respect. They told us staff always knock on their room door prior to entering. People told us they all felt safe and comfortable to raise any issues. One person told us that staff were very good at calming down people when they were angry as well as protecting everyone else. We found systems were in place to protect people and staff had a good knowledge of the procedures.

We saw staff had been recruited safely, and were provided with on going training to maintain their skills and knowledge. Staff received regular supervision, to ensure their practice was satisfactory.

We found the service maintained records appropriately and securely, so confidentiality was maintained.

18 November 2011

During a routine inspection

People we spoke with told us they were generally satisfied with the service. They were involved in decisions about their care and treatment. They had access to a range of therapeutic activities including IT, a gym, gardening and arts and crafts. One person told us the food was, 'always fresh and we have plenty of variety but sometimes it's a little exotic.' People had complained to the service about smoking breaks. One person said, 'There is not enough staff to allow cigarettes at night and staff sometimes have to send for someone from another ward to cover.' They thought the management team was working with them to resolve this.