Cygnet Hospital Wyke

Updated 30 December 2022

Cygnet Hospital Wyke is an independent mental health hospital provided by Cygnet Health Care Limited, situated in West Yorkshire. It has been registered with CQC since November 2010. The hospital is registered to provide care and treatment to up to 46 patients and the following regulated activities:

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

The hospital had three inpatient mental health wards. These were:

• Bennu - a 12-bed psychiatric intensive care unit for male adults of working age.
• Phoenix - a 19-bed acute mental health ward for male adults of working age.
• Adarna - a 15-bed high dependency rehabilitation ward for male adults with autism and/or a learning disability.

The hospital had a registered manager and an accountable controlled drugs officer. At the time of our inspection the registered manager was on long term leave and there was an interim manager in post. The provider had followed the correct procedure to notify us of this.

We have inspected this location 12 times previously. We last carried out a comprehensive inspection of the hospital in February 2021. We rated the hospital as requires improvement overall with requires improvement ratings for all key questions except caring, which was rated good. Following that inspection, we issued requirement notices to the provider in relation to the following breaches:

Regulation 9 (Person-centred care)

Regulation 12 (Safe care and treatment)

Regulation 13 (Safeguarding service users from abuse and improper treatment)

Regulation 17 (Good governance) and

Regulation 18 (Staffing)

Following the inspection, the provider sent us updated action plans setting out how all the concerns leading to these breaches had been addressed.

At this inspection, we inspected all five key questions across all three wards.

What people who use the service say

People on the acute and psychiatric intensive care wards told us that they did not always feel safe at the hospital. Several of the people we spoke with told us that they had been injured in an assault by another patient. People on the psychiatric intensive care unit told us that they did not have much to do on the ward, staff were not always available and they were bored due to a lack of activities. People who had been granted leave from the hospital told us they were getting this leave and they were able to do the things they wanted to outside the hospital. People mostly said the food was good and they had choices, but some people complained that their specific dietary needs were not met.

Relatives and carers told us that they had not seen the wards where their relation was cared for but the parts of the hospital they had seen were clean and well maintained. Some relatives told us that they did not feel sufficiently informed in relation to their relative’s care and most of the relatives we spoke with said they had not had an opportunity to be involved in their relative’s care planning.

People on the specialist rehabilitation ward also reported not feeling safe. They complained of the ward being noisy which many of them found particularly distressing due to their sensory needs as autistic people. The patients were not happy with the high use of agency staff and some said the staff did not understand their needs, although some also commented that staff were professional.

The family members we spoke with in relation to the rehabilitation ward were satisfied with the care that was being delivered to their relative and said they found the staff approachable.

Updated 30 December 2022

Our rating of this location stayed the same. We rated it as requires improvement because:

• The service did not always provide safe care. The ward environments were not always safe, clean or well-maintained. Medicines were not always managed safely. Emergency equipment was not always accessible.
• A high proportion of patients on all three wards had experienced violence or aggression from a peer and the provider was not taking sufficient action to work towards reducing this.
• Ward teams did not always have access to the full range of specialists required to meet the needs of patients on the wards. Staff were not always receiving regular training updates or appraisals.
• Staff on the specialist rehabilitation ward had not always had training to support them in meeting the specific needs of the patient group on this ward and as a result were not always able to meet patients’ needs.
• Staff did not always actively involve patients and their families and carers in care decisions.
• Patients were not always well supported in relation to their cultural and spiritual needs.
• We identified blanket restrictions which were not justified on the basis of risk and these had not always been recognised by the provider.
• Governance processes were in place but these did not always ensure that wards ran smoothly.

However:

• The wards had enough nurses, doctors and support staff. Staff assessed and mostly managed clinical risks well. They minimised the use of restraint and seclusion and followed good practice with respect to safeguarding.
• 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 usually treated patients with compassion and kindness, and respected their privacy and dignity.

Updated 30 December 2022

Although this ward falls within the long stay/rehabilitation core service for CQC inspection purposes we also used our guidance on inspecting services for people with a learning disability and/or autism to inform the inspection because the ward provides specialist rehabilitation services for autistic people including input from a consultant psychiatrist with a special interest in neurodevelopment.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Our rating of this location stayed the same. We rated it as requires improvement because:

Right Support: Model of Care and setting that maximises people’s choice, control and independence

• The service did not give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs
• All patients were out of area which affected their ability to engage in activities, especially relating to education or employment as there would be difficulty in ensuring this could continue following their discharge.
• The discharge plans did not outline progress against an action plan. They did not set out a clear pathway towards discharge and people’s families were not involved in discharge planning.
• The ward had a high use of agency staff and there was a high turnover of staff, particularly healthcare support workers. Some staff had not received training on autism prior to starting work on the ward.
• Staff did not effectively support people to play an active role in maintaining their own health and wellbeing.

However:

• The service supported people to have the maximum possible choice, control and independence and they had control over their own lives.
• The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.
• Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.
• People had a choice about their living environment and were able to personalise their rooms.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

• People’s care, treatment and support plans did not always fully reflect their range of needs in order to promote their wellbeing and enjoyment of life.
• People could not consistently take part in activities and pursue interests that were tailored to them.
• There had been an ongoing concern over noise levels on the ward that had still not been addressed adequately.
• Although the food menu showed a variety of options for vegetarian and vegan meals, these were not always available. As a result, some people told us they had limited options for their dietary needs.

However:

• Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care
• Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
• People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

• People did not always receive good quality care, support and treatment because trained staff and specialists could not always meet their needs and wishes.
• There was a consistent theme of people not feeling safe and there were a high number of incidents of violence and aggression on the ward.
• The ward had used bedroom seclusion without an environmental audit or checklist to ensure the person was safe in their room.
• Although audit systems were in place, they were not always effective in reducing risk or improving the quality of care.
• The service had not reported all notifiable incidents to the Care Quality Commission.

However:

• Most staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.
• Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.
• People and those important to them, including advocates, were involved in planning their care.

Updated 30 December 2022

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

• The service did not always provide safe care. The ward environments were not always safe, clean or well-maintained. Medicines were not always managed safely. Emergency equipment was not always accessible.
• A high proportion of patients had experienced violence or aggression from a peer on the ward and the provider was not taking sufficient action to work towards reducing this.
• Ward teams did not always have access to the full range of specialists required to meet the needs of patients on the wards. Staff were not always receiving regular training updates or appraisals.
• Staff did not always actively involve patients and families and carers in care decisions.
• Patients were not always well supported in relation to their cultural and spiritual needs.
• We identified blanket restrictions which were not justified on the basis of risk and these had not always been recognised by the provider.
• Governance processes were in place but these did not always ensure that wards ran smoothly.

However:

• The wards had enough nurses, doctors and support staff. Staff assessed and mostly managed clinical risks well. They minimised the use of restraint and seclusion and followed good practice with respect to safeguarding.
• 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 usually treated patients with compassion and kindness and respected their privacy and dignity.