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Cygnet Hospital Godden Green Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 January 2021

On 10 November 2020 the Care Quality Commission undertook an unannounced comprehensive inspection of Cygnet Hospital Godden Green. This was following a focused inspection carried out on 02 October 2020.

We had not previously rated acute wards for working age adults and psychiatric intensive care units at Cygnet Hospital Godden Green under our comprehensive methodology as it had opened since our last comprehensive inspection. At the time of this inspection only one ward was open, Castle ward, a psychiatric intensive care unit for females. Castle ward comprised of 12 en-suite bedrooms. At the time of the inspection there were six patients on the ward.

Our rating of Cygnet Hospital Godden Green stayed the same. We rated it as requires improvement because:

  • Staff did not always use physical restraint as the last resort to manage behaviour. The service had not identified all environmental risks. Personal evacuation plans did not explain to the emergency services how to assist the patient to exit the ward in an emergency. A blanket restriction prevented patients keeping toilet paper in their bedrooms.
  • Staff did not always respect the privacy and dignity of patients. Patients were not always actively involved in planning their care.
  • Patients could not make private telephone calls on the ward. Patients did not have enough storage space, in their bedrooms, for all their belongings.
  • The management team had not fully embedded the governance processes to ensure the ward procedures ran smoothly.

However:

  • There was a new leadership team in place at the hospital who had the experience, knowledge and skills to manage the service.
  • The ward environments were clean. The wards had enough nurses and doctors. Staff 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.
  • Staff kept families informed about their relative’s care.
Inspection areas

Safe

Requires improvement

Updated 8 January 2021

Effective

Good

Updated 8 January 2021

Caring

Requires improvement

Updated 8 January 2021

Responsive

Requires improvement

Updated 8 January 2021

Well-led

Requires improvement

Updated 8 January 2021

Checks on specific services

Child and adolescent mental health wards

Updated 27 November 2020

  • Neither ward was safe or clean. In addition, Knole ward was not well furnished, well maintained or fit for purpose.
  • Environmental and ligature risk assessments did not always capture risks or have appropriate mitigation. Repeated incidents occurred where young people suffered harm and injury.
  • Staff were not always able to keep young people safe from avoidable harm because many of them did not have the skills, knowledge or experience to care for young people. Staff felt the induction was poor, didn’t prepare them to meet the needs of the young people, there was no assessment of staff competence and many staff on the ward didn’t know how to safely support the young people.
  • Staff did not always assess and manage risks to patients and themselves well. Young people did not always receive timely access to emergency care when they needed it. Risk assessments and care plans did not always identify or address all of a young person’s needs, despite being regularly reviewed through multidisciplinary discussion.
  • The wards did not have a good track record on safety. The service did not always manage patient safety incidents well. Staff did not always recognise or report incidents appropriately, and systems presented additional risk. Managers investigated incidents, however the quality and depth of investigations varied, and conflicting information showed that managers were not investigating incidents properly. Although learning from incidents was shared with the whole team and the wider service, this did not always appear to improve practice.
  • Staff who assessed the physical health of patients were not always appropriately trained to do so. Care plans did not always reflect the assessed needs, were not always personalised, holistic and recovery-oriented.
  • Managers did not always support staff with supervision and opportunities to update and further develop their skills. Managers did not provide a comprehensive induction programme for new staff.
  • Staff from different disciplines did not always work together as a team to benefit patients. They did not always support each other to make sure patients had no gaps in their care. The ward teams did not always have effective working relationships with other relevant teams within the organisation. However, we did see effective working with a community mental health team.
  • Staff did not always treat young people with compassion and kindness. They did not always understand the individual needs of young people or support them to understand and manage their care, treatment or condition.
  • Staff did not always involve young people in care planning and risk assessment and did not actively seek their feedback on the quality of care provided. Staff did not always inform and involve families and carers appropriately.
  • The provider did not always treat concerns and complaints seriously or investigate them thoroughly. Despite some lessons from these being shared with the whole team and wider service this had not resulted in improvements to practice and the service. Outcomes were poor and patients, families and carers viewed the process as ineffective.
  • Hospital leaders did not provide clear and robust leadership, and some did not have the skills, knowledge and experience to perform their roles. They did not have a good understanding of the services they managed and were not always visible in the service or approachable. They did not have adequate support and oversight from the senior leadership at Cygnet Health Care Limited.
  • Staff did not feel respected, supported and valued. They reported that the provider did not always promote equality and diversity in its day-to-day work and in providing opportunities for career progression. They did not feel able to raise concerns without fear of retribution.
  • Governance processes did not operate effectively at ward level, and performance and risk were not managed well. Oversight of incidents and complaints was poor. Leaders at the hospital had not identified the concerns we found during our inspection. There was poor oversight from senior leaders at Cygnet Health Care Limited and so missed opportunities to improve the service and manage risk.

Acute wards for adults of working age and psychiatric intensive care units

Requires improvement

Updated 8 January 2021