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Cygnet Hospital Wyke Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 May 2021

In June 2019 we placed Cygnet Hospital Wyke into special measures following a comprehensive inspection of the service; including one ward for older people with mental health problems and the acute and psychiatric intensive care service.

We inspected Cygnet Hospital Wyke in February 2021 because we received information giving us concerns about the safety and quality of the services currently provided. We inspected one new service, a high dependency rehabilitation ward for men suffering a mental illness with an additional diagnosis of Autism Spectrum Disorder. In addition, we also inspected the existing acute and psychiatric intensive care wards.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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

  • Since our last inspection, the provider had taken action to increase patient safety and improve the quality of care. However, at this inspection, we identified issues with governance and some areas of practice had deteriorated due to the re-prioritisation of resources during the Covid 19 pandemic.
  • Across both core services, staff did not receive regular supervision and all the mandatory training elements required. The climb risk assessments relating to outside space across the hospital did not contain completion dates and the ligature risk assessment for Adarna ward was incomplete.
  • Staff on Adarna ward did not always regularly check the resuscitation equipment.
  • Staff did not always monitor patients’ physical health after administration of medication by injection in line with providers policy and national guidance. On Bennu and Phoenix wards, seclusion records were not in line with the provider’s policy or Mental Health Act code of practice.
  • Staff and managers did not use the full clinical audit process effectively to identify issues and improve the quality of care.
  • On Adarna ward, the understanding and application of the model of care was inconsistent, staff did not plan for patient discharges effectively and did not always record the views of relatives and carers.
  • The care environments were not always fully therapeutic. The environmental noise from Bennu ward impacted on patients below on Adarna ward. Patients on Bennu and Phoenix wards had limited dedicated activity and therapy space in the hospital.
  • The seclusion room required decoration and repair. On Bennu ward, there was a protruding hinge on a bedroom door.

However:

  • Staff provided patients with compassionate and respectful care. Staff had effective de-escalation skills and there was a commitment to reducing restrictive practices.
  • Across the hospital, the multi-disciplinary teams were newly established and developing working relationships internal and external to the hospital.
  • Leaders were visible and supportive. Staff could raise concerns confidently without fear.
  • The hospital was clean and mostly well maintained. Staff followed infection prevention and control measures very well.
  • Staff involved patients in their care and treatment and recorded their views in their care plans. Staff completed comprehensive patient risk assessments and ensured these were regularly updated.
  • On Bennu and Phoenix wards, staff managed the beds available well and there were no discharges delayed other than for clinical reasons.
Inspection areas

Safe

Requires improvement

Updated 6 May 2021

Effective

Requires improvement

Updated 6 May 2021

Caring

Good

Updated 6 May 2021

Responsive

Requires improvement

Updated 6 May 2021

Well-led

Requires improvement

Updated 6 May 2021

Checks on specific services

Wards for older people with mental health problems

Requires improvement

Updated 15 May 2018

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

Requires improvement

Updated 6 May 2021

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

  • Although some elements of the service require improvement, the overall standard of the service had improved since our last inspection.
  • At this inspection, staff did not always monitor patients’ physical health after administering medication by injection in line with provider’s policy. There was a protruding hinge on a bedroom door on Bennu ward and the hospital’s seclusion room required redecoration and repair.
  • There were lapses in record keeping and governance processes which impacted on the hospital’s ability to manage performance and risks. We identified climb risk assessments that were not dated, seclusion records were not always complete and did not always follow the provider’s policy or the Mental Health Act code of practice. The service did not monitor leave being cancelled and meaningful activity data provided limited assurance around performance.
  • Some areas of practice had deteriorated as a result of re-prioritisation of resources during the COVID 19 pandemic. Staff were not always up to date with mandatory training or did not always receive regular clinical supervision. The provider’s audit schedule had been relaxed which meant leaders were unable to effectively identify and manage all risks, issues and performance.
  • There were limited dedicated therapy and activity spaces in the hospital which had more impact during national lockdown COVID 19 restrictions because patients could not access the community as often. The multidisciplinary team was in the process of establishing and members had had limited time and opportunities due to COVID 19 restrictions to form relationships in the community for therapies and activities.

However:

  • The culture of the service had improved considerably. Staff provided compassionate and respectful care to patients. They used effective de-escalation skills to manage conflict and involved patients in their care and treatment. Staff felt supported and valued and could raise concerns without fear of retribution. Leaders were visible and approachable.
  • Staff adhered very well to infection control principles and followed the latest government guidance on managing COVID 19. Both wards were clean and well maintained.
  • The service provided a range of care and treatment interventions suitable for the patient group in line with best practice guidance, patients had personalised and recovery-oriented care plans. Staff understood and carried out their roles and responsibilities in line with legislation and guidance.
  • The service managed beds well and discharges were rarely delayed other than for clinical reasons.

Long stay or rehabilitation mental health wards for working age adults

Requires improvement

Updated 6 May 2021

We rated it as requires improvement because:

  • The service did not always provide safe care. The ward environment was not always safe, as the ligature risk assessment was incomplete, the climb risk assessment was not dated and the recording of observations of patients following rapid tranquilisation was not in line with the providers policy. Staff did not regularly check the wards resuscitation equipment.
  • Staff did not always fully complete the clinical audit process to evaluate the quality of care they provided.
  • Managers did not always ensure all staff received training and supervision. Relationships between the ward and multi-disciplinary team were developing; requiring time to establish effective relationships; including with those outside the ward who would have a role in providing aftercare.
  • Staff did not always record in care records family and carer involvement.
  • Staff did not plan effectively for the discharge of patients.
  • Staff understanding of the service model on Adarna ward was inconsistent and this meant staff did not have a collective approach to the model of mental health rehabilitation.
  • Governance processes did not ensure that ward procedures ran smoothly. Leaders were unable to effectively identify and manage all risks, issues and performance.

However:

  • The ward environment was clean and staff adhered very well to infection control principles and followed the latest government guidance on managing COVID 19. The ward had enough nurses and doctors. Staff assessed and managed patient risk well. Staff minimised the use of restrictive practices, 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 cared for in a mental health rehabilitation ward and in line with national guidance about best practice. The ward team included the full range of specialists required to meet the needs of patients on the ward.
  • 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 in care decisions. Staff felt supported and valued and could raise concerns without fear of retribution. Leaders were visible and approachable.