Cygnet Hospital Godden Green

Updated 26 November 2021

Cygnet Hospital Godden Green is a 27 bed hospital located near Sevenoaks, Kent. Castle ward is a 12 bed psychiatric intensive care unit (PICU) for female patients, and Oakwood ward is a 15 bed acute ward for female patients. At the time of our inspection, there were 11 patients receiving treatment on Castle Ward and 13 patients receiving treatment on Oakwood ward.

The hospital receives referrals from all areas including other acute services and prisons. They provide short term care for women both detained under the Mental Health Act as well as informal patients, those experiencing mental health crisis and those experiencing difficulties that present a risk to the wellbeing of themselves and/ or others. The hospital treats patients with a range of conditions including acute mental illness and co-morbidities. It provides assessments and treatment with the aim of providing a safe and stabilising environment, supporting service users to manage their mental health and return to living independently within the community.

The hospital is preparing to open a further ward, Upper Oakwood Ward, in late October 2021. This aims to be a small and supportive 6 bed female mental health acute service for female patients who have lower level care and treatment needs and who are in the later stages of their care and planning their discharge out of hospital. We will return to inspect this ward in due course.

The hospital is registered 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.

A hospital manager has recently been appointed full time at the service and had applied to be registered with the Care Quality Commission as the registered manager. The registered manager, along with the registered provider, is legally responsible and accountable for compliance with the requirements of the Health and Social Care Act 2008 and associated regulations.

Cygnet Hospital Godden Green was last inspected on 10 November 2020. This was an inspection of the PICU Castle ward, as Oakwood ward was not open at the time. Following previous inspections at the hospital in September and October of 2020 the provider made the decision to close its Child and Adolescent Mental Health Service (CAMHS) wards at this location.

At our last inspection we told the provider that they must take action to improve the following: 

• The provider must ensure that staff only use physical interventions as a last resort and only following the use of de-escalation techniques.
• The provider must ensure that patients have adequate access to toilet paper.
• The provider must ensure personal evacuation plans are individualised and contain information relevant to assisting the patient to leave the ward during an emergency.
• The provider must ensure that all risks are identified on their environmental and fixed ligature point assessments, that staff are aware of the risks and know how to mitigate the risk.
• The provider must ensure that potentially dangerous items are always stored securely.
• The provider must ensure staff re-assess and rate risk regularly to reduce un-necessary restriction on patients.
• The provider must ensure patients are able to make private phone calls either on their personal mobile phone or via ward phones.
• The provider must ensure staff knock and wait before entering patients’ bedrooms, unless it is an emergency.
• The provider must ensure patients have enough space to store their personal belongings within their bedrooms.

At this inspection we found that the provider had made improvements and had addressed the majority of concerns highlighted to them in the previous inspection report.

What people who use the service say:

Patients told us that the environment was clean and comfortable. They told us that a housekeeper attended the wards daily and that anything broken or damaged was removed or repaired quickly. Patients told us that they were able to keep personal items in their bedrooms, if assessed as safe to do so. If not, personal items were locked away in the office.

Patients said that they were able to use their mobile phones in their bedrooms and had access to a ward tablet with supervision.

Patients told us that they felt safe and that staff were always proactive when anything happened on the wards. Some patients who had been restrained told us that they had been debriefed afterwards.

Patients said that there had not been any staff shortages and that they never had issues with taking leave or attending therapies/ activities. They told us that staff were present on the wards and available to help.

Patients told us that they had been able to raise issues with staff and were able to give feedback about the service and make suggestions on improvements in both community meetings and patient forums.

All patients spoke positively of most staff and felt they were respectful, polite and caring. They said that they always knocked on their bedroom doors before entering. Patients also told us that the staff took the time to engage with them and explain things to them.

Patients said they were involved in their care decisions and three patients told us that their family members were involved in their care. One patient also told us that they had an advocate.

Patients were very positive about the food available and said that there was plenty of choice with kitchen staff accommodating requests and any dietary requirements. Patients told us that they have snacks and drinks available outside of mealtimes.

Patients told us that they really enjoyed the variety of activities available.

Updated 26 November 2021

Cygnet Hospital Godden Green is an independent hospital providing specialist inpatient Acute and Psychiatric Intensive Care Unit (PICU) services to adult women of working age.

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

The service provided safe care. The ward environments were safe and clean. A housekeeper tended to the wards daily and staff were proactive in repairing or removing anything broken or damaged. Environmental risks were identified and removed or reduced as appropriate.

The wards had enough nurses and doctors. Staff assessed and managed risk well. They managed medicines safely and followed good practice with respect to safeguarding.

The service minimised the use of restrictive practices, with staff making every attempt to avoid using restraint by using de-escalation techniques. The hospital was also training staff in “safewards”. This was an initiative to improve the ward environment, reduce incidents of aggression and improve safety for both patients and staff.

Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. The care plans we saw included detailed inputs from other members of the multidisciplinary team. In addition, patients had Positive Behaviour Support (PBS) plans which were in place to support staff to manage challenging behaviours and ensure appropriate follow up with patients.

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.

Risk assessments were updated and reviewed more than once a week and considered any changes/ incidents. Full risk screenings were completed frequently. During this inspection we saw evidence of risk being assessed at admission, as well as frequent risk reviews for both increases and decreases in risk and full justifications of these decisions being recorded.

The ward teams 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. 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 told us that they were dedicated to fostering effective working relationships and communication within the multidisciplinary teams and worked together to address issues. Staff also told us that they maintained contact with external agencies including care co-ordinators, GPs and social workers.

The service held regular multidisciplinary handover and information sharing meetings, with good attendance and significant information shared which enabled them to monitor and discuss patient’s risks and needs, and other issues impacting the service. We observed positive attendance and information sharing at daily board and flash meetings where staff made sure they shared clear information regarding incidents, risks, safeguarding, medication changes and admissions/ discharges.

Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Staff knew who their Mental Health Act administrator was and were positive about the support and guidance given by them on both MHA, and MCA. Staff told us that they made sure the service applied the MHA and MCA correctly by completing audits and discussing the findings.

Staff treated patients with compassion and kindness and understood the individual needs of patients. All patients spoke positively of most staff and felt they were respectful, polite and caring. They actively involved patients and relatives/ carers in care decisions. Staff often gave feedback over the phone regarding their relative’s care.

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 hospital had contracted block beds on each ward to provide availability to the local NHS trust. We saw that patients on Castle ward were reviewed regularly to ensure their placement remained appropriate. On Oakwood ward, the emphasis was on short term treatment with an expectation that the length of stay would be kept to a minimum.

The service was well led, and the governance processes ensured that ward procedures ran smoothly. Staff were complimentary about the leadership and support provided by the senior management team. Staff told us that there were open lines of communication amongst local level teams and senior managers so that risks were shared and managed well.

However:

There was poor practice on both wards of staff frequently entering the clinic rooms without knocking or identifying whether it was suitable to enter. This challenged patient's privacy and dignity and disrupted staff carrying out clinical activities, such as administering medicines.

We were aware that patients on Oakwood Ward did not have access to their own keys for their bedrooms. This challenged their privacy and the safety of their belongings when they left their rooms unattended. We saw that patients had made complaints relating to losses of their possessions to staff.

Patient care plans and PBS plans had improved since the last inspection. However, there was room for further personalisation to include triggers and interventions that were specific to each patient and described individual de-escalation preferences.

Updated 26 November 2021