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

Cygnet Lodge Lewisham

Overall: Good read more about inspection ratings

44 Lewisham Park, Lewisham, London, SE13 6QZ (020) 8314 5123

Provided and run by:
Cygnet Health Care Limited

All Inspections

23 and 24 July 2019

During a routine inspection

We rated Cygnet Lodge Lewisham as good because:

  • 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 teams included or had access to the full range of specialists required to meet the needs of patients on the ward. These included occupational therapists, nursing, psychologist and a consultant psychiatrist. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing recovery.
  • Staff worked hard to provide safe care in most areas. The service had enough nurses and doctors with the right skills and qualifications. Staff assessed and managed risk well. Staff completed risk management plans in collaboration with patients in their ‘my safety plan’. Ligature risks had been assessed and fire safety arrangements were in place. Staff carried out regular physical health checks such as blood tests and monitoring patients’ vital signs.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients, families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. Discharge planning arrangements were well defined within patient care plans and started approximately six months following a patient’s admission.
  • The service had a pathway for rehabilitation which outlined timeframes and what the patient could expect from the service.
  • The service worked to a recognised model of mental health rehabilitation. Governance processes operated effectively at ward level and senior management level. Staff managed performance well. The service took part in internal quality reviews of the hospital to ensure the effectiveness of the service.

However,

  • Some parts of the building were run down and required extensive maintenance and refurbishment, including patient bedrooms. The provider had a schedule of works planned to improve the decoration and maintenance of the building. However, some parts of the schedule of works were not taking place until 2020, rather than sooner.
  • Patient bedrooms did not provide a therapeutic environment for patients to recover. Bedrooms were bare and contained old furniture that needed replacing.
  • Staff did not always store controlled drugs safely. During the inspection we found the controlled drug cupboard unlocked and the keys with the manager rather than the nurse in charge.
  • Even though the service reviewed blanket restrictions every six months, staff imposed a blanket restriction on patients. After every meal staff collected cutlery back in, counted it and recorded that it was all there. This was not based on a patients’ individual need.
  • Staff did not always actively promote the needs of all patients, including those with a protected characteristic. The service could do more to encourage an open and inclusive environment to support patients’ sexual, cultural and spiritual preferences.

29-30 June 2016

During a routine inspection

We rated this service as Good because:

  • Patients said that staff treated them with respect and dignity and supported their needs. Staff were caring and supportive and they listened and responded to patients’ wishes and concerns. Both patients and the independent advocate who worked at the service said that staff supported patients to be involved in their care and treatment, including during clinical meetings. As part of this involvement, staff met with patients to discuss their recovery goals and staff recorded these objectives in patients’ care and recovery plans. This ensured that staff were working as far as possible according to patients’ wishes.

  • Staff maintained an environment that was safe for everyone at the service. Staff assessed the location for ligatures and took effective steps to reduce the risks from these ligatures. Staff also undertook detailed risk assessments of patients, updated these and transferred information relating to risks into patients’ care plans. Staff responded promptly and effectively to incidents and to any safeguarding concerns. There were effective systems in place to ensure that staff investigated all incidents and identified any lessons from those incidents. Staff managed medicines in a safe and secure way.

  • A range of therapeutic activities were available to support patients’ rehabilitation and recovery. These included paid work at the service that staff supported patients to apply for, group activities, IT skills training and art and music therapy.

  • The service provided a range of facilities to meet patients’ needs, including a therapy room, recreational spaces, meeting rooms, and laundry and kitchen that staff encouraged patients to use.

However:

  • Many patients and staff members said that there were too few staff to supervise the activities and as a result many were often cancelled. This undermined the principal purpose of the service which was to support patients’ recovery and rehabilitation and to prepare them to return to life in the community.  The provider had recruited additional staff to address this problem, although they had not yet started work at the time of inspection.

  • An alarm system used to tell staff where potential emergencies were taking place was not working. This put people at risk of harm.

  • Some areas were not always sufficiently clean and tidy, including the clinic room and some communal toilets and washing facilities.

4-5 December 2014

During a routine inspection

At Cygnet Lodge Lewisham there were enough staff on duty to meet people’s needs. Detailed environmental and individual risk assessments were carried out and action taken to manage the risks identified. Medicines were managed safely. Staff knew how to recognise and report potential abuse in order to protect people. The service had a good safety record. Incidents were fully investigated to identify learning. Learning was shared with staff to minimise risk of reoccurrence. A detailed ligature risk assessment had been completed and an action plan was being developed to ensure that staff knew about all identified risks and they were managed safely.

The needs of people using the service were assessed in detail. This included their physical as well as mental health needs and there was on-going monitoring of their needs. Most care plans and individual risk assessments were reviewed and updated after new risks were identified but some were not. Staff followed best practice guidelines when providing care and treatment. Staff received the training and supervision they needed to enable them to care for people appropriately. The staff team worked well together to meet the needs of people. Staff used the Mental Health Act and Code of Practice correctly.

Staff were kind and respectful towards people using the service and were positive when planning their care and support. Care was person-centred and people were involved in developing their own care plans. Staff recognised people’s individual needs and understood how to care for them. Families and friends were involved in care when this was appropriate. People gave feedback about the service and this was listened to by staff and managers.

People could take part in a range of activities and groups both inside and outside the service. Staff focussed on people’s recovery and helped them build on their strengths. There were paid work opportunities within the service. People knew how to make a complaint and staff responded appropriately when they did. Meals were cooked on site and there was a good choice available. The chef actively sought people’s views about the meals they would like. People had access to outside space.

Staff knew the vision and values of the organisation. There were good systems in place to measure how well the service was providing care and treatment. The manager knew that staff had received the training they needed and conducted checks to see that policies and procedures were being followed. Staff actively learned from incidents, complaints and feedback from people and staff, and took action to improve the quality of service.

Mental Health Act responsibilities

At the time of the inspection 13 of the 14 people using the service were detained under a section of the Mental Health Act 1983 (MHA). One person had been conditionally discharged from their section.

Staff received training in the MHA and had good understanding of the main provisions of the Act and MHA Code of Practice.

People using the service had access to an independent mental health advocate who could support them. The advocate for the service reported a good working relationship with staff at the service. Discussions of people’s rights were regularly repeated and recorded in people’s records.

MHA documentation had been completed appropriately. Consent to treatment and capacity requirements were mostly adhered to and copies of consent forms were attached to medicine administration records. A standard form was used to record a discussion of consent and the treating clinician’s assessment of patients’ capacity to consent to treatment. These were completed with people on a regular basis.

We found a lack of clarity in respect of the recording of the capacity and consent to treatment interview for two people. In addition, in the records of one person we found a section 17 leave form that had been superseded by a more recent form and had not been cancelled. The out of date form remained in the person’s records which was potentially confusing for staff and the person concerned.

Mental Capacity Act and Deprivation of Liberty Safeguards

Staff had received training in the Mental Capacity Act 2005 (MCA). However, their understanding of the legislation and how it affected their everyday clinical practice varied. Some staff had a good understanding of the MCA and how it applied to their clinical practice. However, others could not clearly explain the details of a mental capacity assessment. The manager told us MCA training had been combined with MHA training and this may not have been the most effective way of ensuring all staff understood the MCA.

There had been no applications made under Deprivation of Liberty Safeguards.

4 February 2014

During a routine inspection

We found that this service sought consent from people who used it in relation to their care and treatment and that it met peoples' care and welfare needs.

One person who used this service told us they were very happy with the care and treatment they received. however another person told us that they were unhappy with the medication they had been prescribed.

A health professional who we spoke to told us that they were very satisfied with the service being provided.

We found that this service kept people safe from the risks of being abused and that safeguarding was a high priority for managers and staff. We also found that the service managed peoples' medicines well and took steps to help people to self-medicate wherever possible.

We found that this service undertook relevant checks before employing staff and that this ensured that people were supported by staff who were suitably qualified, skilled and experienced.

We found that the service did not always report safeguarding issues to the Care Quality Commission as stipulated in Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

18 March 2013

During a routine inspection

At our inspection we spoke with four patients and with six members of staff. We also looked at three patient care folders and other patient and staff records.

People using the service were satisfied with the quality of the service and with the staff team. We observed good staff patient interactions throughout our visit.

People were involved in decisions about and planning their care. One person told us, 'we discuss everything in the planning meetings.' Care plans and risk assessments were up-to-date and relevant to individual needs. Patients were asked to comment on their care plans as part of their recovery process; one patient had commented, 'I'm stable at the moment'I'm managing alright'.

12 September 2011

During a routine inspection

At this visit we spoke with four patients in private and others in open and group settings.

People using the service who we spoke to praised staff, as individuals and as a team. We observed good staff/patient group and individual interactions throughout the day. Informal patients told us that they could come and go as they pleased; detained patients were encouraged to request leave. People said that visitors were made welcome by staff, and that people in the hospital were like 'a family'. One person said he would like to be able to have overnight visitors, as this would be more like the 'real world'.

Only one person we talked to felt that he had been overtly involved in writing his care plan, although others told us about their scheduled one to one time with named nurses.

A range of activities and facilities were available, including access to psychology, occupational therapy, one to one time with nurses, group sessions, access to computers and trips. Although people felt that there was not much to do at weekends, many said they visited family and friends at weekends anyway.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.