Cygnet Sedgley House and Cygnet Sedgley Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained.

Good: This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Description: We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

Staff and managers had good oversight of incidents across the wards. We reviewed 7 incidents during the assessment. Staff had recognised incidents, reporting them appropriately and managers had investigated them thoroughly. They were discussed and reviewed in the morning risk meetings, handovers and clinical governance meetings.

Staff told us learning from safety incidents was shared, and they implemented this learning into their work practices. Staff received lessons learnt through various forms such as team meetings, emails, staff intranet and handovers. This included lessons learnt from other hospitals across the Country. Staff gave us examples of recent learning, for example ensuring staff were vigilant regarding a patient who had absconded from the hospital on multiple occasions.

Managers told us that all incidents and complaints were investigated thoroughly with outcomes and feedback given to all involved. There were regular patient safety, team and de-brief meetings to discuss incidents, complaints and lessons learnt.

Description: We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

Patients told us they were involved in planning their care and attended multidisciplinary care and treatment review meetings to share their views. Families and carers said they were invited to attend and felt involved and listened to.

Managers told us they and members of the multi-disciplinary team were involved in reviewing and assessing referrals into the service to ensure the care and support available was suitable for the patient.

Staff worked well with external partners and they attended multidisciplinary treatment reviews to enable continuity of care and support for discharge.

Description: We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

People told us they felt safe. Staff we spoke with had good knowledge about safeguarding and any potential safeguarding concerns were discussed in morning risk meetings, handovers, clinical governance and multidisciplinary meetings.

The hospital had a nominated safeguarding lead. We saw examples of staff reviewing safeguarding concerns within patient care notes.

Staff were up to date with safeguarding training. At the time of our assessment, staff were 100% compliant.

Description: We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

Staff kept patients safe and involved them to help manage their risk. Staff knew patients' needs well and helped them manage risk well.

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Risk assessments were comprehensive and updated regularly, including after incidents. The provider used the short-term assessment of risk and treatability (START) risk assessment on admission and risk management plans were created for any current and ongoing risks.

There were some blanket restrictions within the environment at the House. Staff discussed reducing restrictive practice and completed quarterly audits, however, they had not identified locked doors as a restriction. The outside door to the garden area was locked at 6 periods within a 24-hour period. Staff told us this was to discourage patients from constantly smoking and these times mostly coincided with meal times and at night time. Other patient accessible doors that were locked included the multi faith room and laundry room, although these had been identified on the audit with actions in place. There were less restrictions at the Lodge and the patio door was always open. Individual patient restrictions were kept to a minimum and appropriately care planned.

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Restraint was not often used although staff were adequately trained. Staff said that patients received a debrief following restraint.

We observed a patient on nursing observations. Staff engaged with them and gave people privacy and dignity when required. Staff were aware of the observing and engaging patients policy and worked in line with this. All patients were checked and observed at least once within a 60-minute period.

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Description: We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

The environment was safe, clean and well maintained. However, the main open plan ward area at the House was relatively small for 20 patients, not including staff. There were 4 dining tables and 16 chairs. Staff told us that patients did not come for mealtimes all at once so this was not a problem. We observed a mealtime and there was enough space for patients to sit down and eat.

Patients told us they felt safe in the environment. There were ligature risks across the wards although staff were aware of them and told us how they would mitigate against them for any patient who would be at risk, such as nursing observations. Ligature and environmental risk assessments were in place with appropriate actions required. Staff completed regular environmental checks. Managers said they did not accept referrals for patients who would be a high risk of self-harm or had a history of tying ligatures. This was included on the hospital’s exclusion criteria.

There were no viewing panels in most of the bedroom doors. Bedroom doors were heavy which could cause a risk of self-harm or an accident.

Staff did not have a clear line of site from the nursing office. They could only observe small areas of the main ward area. Concave mirrors were placed throughout the ward area to prevent any blind spots.

CCTV cameras were situated across the general ward areas but there was no live stream. Footage could be accessed by managers when required, such as to review an incident or complaint.

The hospital only accepted male patients, therefore there was no mixed sex accommodation.

The wards did not have any sensory areas or quiet rooms. Therapy rooms were mostly used by staff as an office base, although they would see patients for one-to-one conversations. Patients said the therapy rooms were not used much for group therapy sessions which staff reiterated. Patients had access to their bedrooms when they required a quiet area. Staff said space was limited so they had engaged with experts by experience and patients to help plan a larger therapy space, for quiet areas, sessions and music.

Equipment used to monitor patients physical health was well maintained and calibrated regularly to ensure it worked effectively.

Description: We make sure there are enough qualified, skilled and experienced people who work together effectively to provide safe care that meets people’s individual needs. However, not all staff think there are enough staff at the Lodge who receive effective support and supervision.

Staff said they did not always think there were enough staff. They told us that when there were gaps, specifically for qualified nurses, staff either did not know about them because the rota was not correct or were told to try and fill them, often without success. They said when staff were unable to fill them, managers were not always readily available to help out. This was contrary to what we were told on site or what we saw on rotas viewed. Managers told us when staffing was short, they would work ‘on the floor’ but some staff told us this was not the case and they were in their office at the House. Staff who worked at the Lodge said they often had to work at the House when the ward was short, because the House was a busier ward with more acutely unwell patients. This meant the Lodge would then be short of staff and impacted the qualified nurses who would then have to work on their own.

Agreed staffing levels for the House during the day were 2 qualified nurses and 4 support workers. At night, it was 1 qualified nurse and 3 support workers.

Agreed staffing levels for the Lodge during the day were 1 qualified nurse and 2 support workers; at night it was 1 qualified nurse and 2 support workers.

Managers told us staffing numbers were often higher as the hospital was full. At the time of our assessment there were 2 qualified nurses and 7 support staff at the House and 2 qualified nurses and 4 support workers at the Lodge.

Managers said the wards had not been short of staff in the 6 weeks prior to our assessment. The hospital used bank and agency staff when required to ensure shifts were filled.

Over the 6 months prior to our assessment, some staff had left to join another Cygnet hospital which had opened in Wolverhampton. This had created vacancies although some staff had been promoted to more senior roles.

Vacancies at the time of the assessment were 1 team leader and 1 support worker. Recruitment was in place and candidates had interview dates. One qualified nurse and 1 maintenance worker had been recruited to and were undergoing post recruitment checks.

All new staff received an induction from the provider, however, newly qualified staff said they did not feel they had received a good local induction. Some said they were unsure of some procedures as they had not been shown and they did not feel adequately supported and often had to work alone with little supervision.

Staff received and were up to date with required training. At the time of our assessment, staff were 95% compliant for all required training. The lowest compliance was 89% for Protecting Our Health and Safety.

Description: We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

The wards were clean, tidy and well maintained. Staff demonstrated a good knowledge of infection prevention and control. Staff had completed mandatory training for infection control. Domestic staff were visible during the assessment. Staff completed regular environmental and infection prevention control audits and actions and mitigation plans were in place.

Description: We make sure that medicines and treatments are safe and meet people's needs, capacities and preferences by enabling them to be involved in planning, including when changes happen, although storage of medicines in the fridge requires attention.

Staff followed systems and processes to prescribe medicines safely, although not all medicines were stored safely. All clinic rooms were clean and staff had access to all appropriate equipment.

Generally, medicines were stored appropriately, however the fridge in the clinic in the House was not big enough for the number of medicines stored there. The fridge was overstocked with insulin which meant this could reduce its ability to keep the medicine at the correct temperature and potentially reduce its efficacy. The pharmacist had raised a concern to staff and an action plan had been put in place. Managers told us they had ordered a bigger fridge. Some staff we spoke with said medicine reconciliation was completed but was not considered when ordering medicines, which led to an overstock.

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We reviewed 12 prescription charts. Medicines were prescribed, administered and recorded in line with national guidance including the management of controlled medicines. Staff had access to relevant patient medicines documentation, including information on patient allergies. Most patients at the Lodge were self-administering their medicines in line with their rehabilitation care plans. Medicines were kept in locked cupboards in patients bedrooms and staff completed a weekly spot check.

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Authorisation documentation for the Mental Health Act 1983 and capacity assessment forms were in place with the associated prescription cards. Staff completed regular medication audits and where areas of improvement had been identified an appropriate action plan was in place.

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