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

Cygnet Views

Overall: Requires improvement read more about inspection ratings

22 Wellington Street, Matlock, Derbyshire, DE4 3JP (01629) 831004

Provided and run by:
Cygnet Learning Disabilities Midlands Limited

Important: The provider of this service changed - see old profile

All Inspections

08 - 22 March 2023

During an inspection looking at part of the service

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.

People’s experience of using this service and what we found

The service was not able to show how they met some of the principles of right support, right care, right culture all the time.

Right Support

The Model of Care and treatment setting maximised people’s choice, control and independence for people who were settled. It prepared people to take the final steps of their rehabilitation before going to community placements. However, the Model of care and setting did not meet the needs of people who were also experiencing acute mental ill health or people with limited mobility. Staff were clear that if a person with limited mobility was referred to the service, they would not be able to meet their needs. Managers accepted that this would limit their quality of life as they would find it difficult to access the garden and the cobbled stones in the car park would limit their opportunity to use the salon and access the meeting room.

People told us staff supported them to take part in activities and to pursue their interests in their local area when the hospital was settled. One person said they liked to go out for walks and could go out when they wanted to with staff. People had opportunities to use local facilities for learning, education, and voluntary work. Permanent staff supported people whenever possible to play an active role in maintaining their own health and wellbeing. Staff gave people information about accessing well woman checks and supported people to attend these. The service provided care and support in a safe, clean, and well-furnished, environment. Although space was limited, the service prided itself on providing a homely environment in which people could develop their skills and knowledge, to help them move onto community settings. However, some people said they did not always know staff because they did not wear clear name badges and there was no photo board of staff they could refer to.

Right Care

Care is person-centred and promotes people’s dignity, privacy, and human rights. However, not all staff knew of, or understood all peoples care needs. Some staff did not always meet the individual care needs identified or treated people in a way that encouraged them to achieve their potential. While care plans were person centred and showed people’s goals for treatment and hopes for their future not all staff were following the care plans, risk management plans or positive behavioural support plans. Risk management plans, while appropriate for the person they were intended for, did not always consider the impact they would have on other people using the service.

The service worked well with other agencies such as the local authority and the police to manage safeguarding. They had worked hard to strengthen their links with their Integrated Care Board. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

The ethos, values, attitudes and behaviours of leaders and most care staff ensured people using services led confident, inclusive, and empowered lives. Most staff placed people's wishes, needs, and rights at the heart of everything they did. The registered manager and all staff understood the importance of family to people. However, one relative said communication could be better, they were unable to attend their relative’s last review and did not receive notes from it. However, another relative told us that because they lived a long way away and did not drive the provider had paid for them to travel to Matlock and stay overnight so they could see their relative. The relative also told us the doctor rearranged their relative’s care and treatment review to coincide with their visit, so they could be present. People, and those important to them, were involved in planning their care. People said they liked going out but due to the remote location many outings had to completed using the hospital minibus. One person thought having the hospital minibus was a good thing as they could go further afield with their friends and in safety. People's quality of life was enhanced by the service's culture of improvement and inclusivity.

The service had policies and systems in place to support people in the least restrictive way. Although staff used these to support people who had acute mental health needs, the restrictive practices negatively impacted on other people who did not have these needs. However, leaders in the service had worked hard to create a learning culture. Most permanent staff we spoke with said they felt valued and empowered to suggest improvements and question poor practice. There was a transparent, open, and honest culture between people, those important to them, staff, and leaders. They all felt confident to raise concerns and complaints.

SUMMARY

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

Not all temporary staff knew the people they were looking after, this prevented staff from interacting with people in a way that encouraged people to achieve their potential and ensure all peoples individual needs were met.

People using the service did not always know who the staff were. Staff did not wear clear name badges and there was no staff photograph board in the communal area. This could have prevented people from feeling comfortable enough around staff to exercise their autonomy.

People could not always access support from independent advocacy. The advocate was not able to be in the communal areas when people were distressed.

Some staff were not always aware of individual risk. Some support staff were not always following individual risk management plans. While risk management plans were adequate for the person they were intended for, they did not always consider the impact of a person’s actions on other people and visitors.

There was no evidence to show how staff monitored people’s physical health if the person declined physical observations. We reviewed two people’s records; one person was on high dose anti-psychotic medicine and the other person required intra-muscular rapid tranquilisation.

Staff were not always following handwashing procedures. There was risk of cross contamination from people’s laundry. Staff had not separated out people’s laundry and there no process for keeping dirty laundry separate from clean laundry.

Staff had not cleaned the splashback around the sink in the therapy kitchen. Staff had not cleaned a medicines trolley or inside a clinic room cupboard properly.

Due to the design and layout of the hospital the environment was not suitable for people who were experiencing acute mental ill health or who had a history of using ligatures. Staff could not control the heating in the communal areas of the hospital. On the day of our inspection the communal areas were uncomfortably hot.

Although audits and governance were in place some of the systems and processes had not been used to full effect.

Apart from the new manager and new Head of Care the registered nurses did not have a learning disability background. Registered nurses were not always present in communal areas and were not providing leadership or positive role modelling for healthcare support workers.

Managers were not monitoring support staff’s competency or understanding following completion of their online learning disability training. Therefore, some staff were not always confident when working with people with a learning disability and autistic people.

The admission policy did not identify what measures should be in place if a newly admitted person was later found to be too acute for the service to manage safely. Due to its design and layout the hospital environment was not suitable for acutely unwell people. We judged that the provider should address this issue.

Staff did not always follow the new protocol for administering medicines ‘when needed’. We judged that the provider should address this issue. Staff had not ensured that the glucose monitors taken in by people using the service were all calibrated.

However:

There was a full multidisciplinary team of staff working in the hospital. Their specialist assessments were thorough and comprehensive.

Information about people who use the service was easily accessible in both electronic and hard copy format. Positive behaviour support plans, and risk management plans were available in easy read and grab sheet format.

There were enough staff to meet people’s needs.

Although the registered manager and new Head of Care were new to the service, having only been in post five weeks, both were experienced in hospital management and caring for people with learning disability and autistic people.

Managers at the hospital were responsive and keen to learn from our inspection findings. Within two weeks of our onsite visit, they had already sent an action plan and evidence of having addressed the issues we raised in our initial feedback.

7 March 2022, 8 March 2022, 9 March 2022

During a routine inspection

We found improvements made at this inspection were sufficient to remove Special Measures.

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.

About the service

Cygnet Views is an independent hospital managed by Cygnet Learning Disabilities Limited situated in Matlock, Derbyshire.

Cygnet Views provides care for up to ten women who have a learning disability and complex mental health needs. At the time of inspection, the service was supporting five people.

People's experience of using this service and what we found

The service was able to show how they met the principles of right support, right care, right culture.  

Right Support

People and relatives told us staff supported people to take part in activities and pursue their interests in their local area. People had opportunities to go to the local college and local arts centre. One person said they liked to go out for walks and could go out when they wanted.

Staff supported people to play an active role in maintaining their own health and wellbeing. Staff gave people information about well woman checks and supported people to attend these. Staff supported people to cook their own breakfast and promoted healthy alternatives.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. This had improved since our previous inspection, the environment met people’s sensory and physical needs, while making it feel homely. Staff were clear that if a person with limited mobility was referred to stay there, they would not be able to meet their needs. This would limit their quality of life as they would find it difficult to access the garden and the cobbled stones in the car park would limit their opportunity to use the salon and access the meeting room.

Right Care

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. People said that staff respected their belongings and always knocked on their door before entering. Staff understood and responded to people’s individual needs with genuine regard for the person. One person said, “Staff are good, patient, nice. Staff listen to you and support you in every way.”

People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. People had developed their plans that included their goals and hopes and dreams for the future.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. They had worked hard to improve links with the local safeguarding teams and the local police. Staff had training on how to recognise and report abuse and they knew how to apply it. People and relatives told us they felt safe which had improved since our previous inspection.

Right culture

Staff placed people's wishes, needs and rights at the heart of everything they did. The registered manager and staff understand the importance of family to the people. However, one relative said communication could be better, they were unable to attend their relatives last review and did not receive notes from it. Relatives said they had not been able to visit during the COVID-19 pandemic, but they hoped this would change as restrictions eased.

People and those important to them, including advocates, were involved in planning their care. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. We saw staff fully involving people with activities and tasks of their choosing. People said they liked going to the cinema and bowling.

People's quality of life was enhanced by the service's culture of improvement and inclusivity. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The leadership of the service had worked hard to create a learning culture. Staff felt valued and empowered to suggest improvements and question poor practice. There was a transparent and open and honest culture between people, those important to them, staff and leaders. They all felt confident to raise concerns and complaints.  

8, 9, 14 June 2021

During a routine inspection

The Chief Inspector of Hospitals, Ted Baker, is placing Cygnet Views into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Cygnet Views is an independent hospital situated in Matlock, Derbyshire providing care for up to ten women with learning disabilities, behaviour that could challenge and complex mental health needs. Our rating of this location went down. We rated it as inadequate because:

Patients didn’t always receive safe care. Managers did not always follow good practice with respect to safeguarding and the use of restrictive practices.

Opportunities to prevent or minimise harm were missed. Local risk assessments failed to identify significant ligature points across the hospital.

Staff didn’t always have the skills required to support this patient group. The provider only made specific training available for some staff which meant not all patient needs were understood and addressed.

Patients were not always supported with their physical health or encouraged to live heathy lives by staff.

Staff did not always understand how the Mental Capacity Act 2005 related to the patients they supported.

The hospital was not always well led, and the governance processes did not ensure that hospital procedures ran smoothly.

However:

Staff followed infection control policy, including handwashing. This was an improvement from our previous inspection when we issued a warning notice about this and told the provider they must improve staff infection prevention and control practices to keep people safe during the COVID-19 pandemic.

Staff developed recovery-oriented care plans informed by a comprehensive assessment. They worked with patients and with families and carers to develop individual care and support plans and updated them as needed. Care plans reflected the assessed needs and were personalised and strengths based. However, they were not consistent as we found that care plans around patients' physical health needs were not collaborative, holistic and updated to the same standard.

The hospital environment was clean and tidy. Staff assessed and mostly managed risk well and managed medicines safely.

The multidisciplinary team were able to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging. However, they communicated this to staff in an inconsistent way.

The hospital team included or had access to the full range of specialists required to meet the needs of patients in the hospital. The hospital staff worked well together as a multidisciplinary team and with those outside the hospital who would have a role in providing aftercare. Staff were able to access supervision and appraisal.

Staff treated patients with compassion and kindness. However, they did not always respect their privacy and dignity. They involved patients and families and carers in care decisions.

Staff planned and managed discharge well and liaised with hospitals that would provide aftercare. Discharges were delayed only due to clinical reasons.

22 September 2020

During an inspection looking at part of the service

We carried out a focused inspection of Cygnet Views in response to a number of concerns. We looked at areas relating to the safe, responsive and well led domains. The rating of the well led domain changed to requires improvement and this meant that the overall rating for the hospital was requires improvement. The reason for this was a follows:

  • Staff did not always follow infection prevention and control guidance specific to the COVID-19 pandemic. There had been an outbreak of COVID-19 earlier in year. Following the inspection, we issued a warning notice about this and told the provider they must improve staff infection prevention and control practices to keep people safe during the COVID-19 pandemic.
  • There were not always enough staff on duty to keep patients safe. There had been a shortfall in the number of support workers required and this had particularly affected night shifts where there was a high use of bank staff. Whilst the provider had recognised the need to increase the numbers of qualified nurses in the hospital, this still needed to be fully implemented.
  • There had been an improvement in staff culture since the last staff surveys in July 2020. However, there were still areas for improvement so that the whole staff team felt positive about working for the provider and valued and supported by their managers.
  • The culture described by patients and carers was not always positive. Some patients and carers said that staff were not always kind to patients.
  • Our findings from the other key questions demonstrated that governance processes did not always operate effectively and that this meant not all processes were implemented consistently to ensure patient safety, staff safety and consistent learning. For example, not all staff knew where ligature risks were on the ward.
  • The service had not ensured that their reception area was secure and identifiable information was not stored securely at the time of our inspection.
  • Learning from incidents and complaints was inconsistent. Not all staff were aware of this learning being shared. Staff did not consistently receive a debrief after an incident that would require one.

However:

  • Staff were supervised and appraised and compliance levels for this were at 90% for the service. Managers dealt with poor staff performance when needed.
  • The ward environments were safe and clean. Staff assessed and managed patients’ individual risks well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices.
  • The hospital managed discharge well and discharges were only delayed if there was a delay in community provision. Staff planned patients’ discharge and worked with other professionals well.
  • Leaders had a good understanding of the services they managed and had plans where improvements were required.
  • Staff had access to the risk register. Staff at ward level could escalate concerns when required. Staff concerns matched those on the risk register.

29th August 2018

During a routine inspection

We rated Cygnet Views as good because:.

  • There were sufficient numbers of staff to deliver care and treatment. Staff were well supported by managers and supervised regularly; 90% of staff were up to date with their supervision. Staff compliance with mandatory training was high at 94%.
  • Patients had up to date detailed risk assessments. Staff knew and understood patient risk and met to discuss these. Care plans were holistic, individualised and recovery focused and staff updated these regularly. Patients were involved in care planning and risk management and were invited to meetings to discuss their care.
  • We observed staff were kind, respectful and responsive when they interacted with patients. Staff understood the individual needs of patients and ensured their care was individualised. Staff assessed patients’ communication needs and met these individual needs; each patient had a communication file to support this.
  • Staff ensured patients received good physical health care. Staff monitored physical health and patients had access to annual health screening and specialists as required. There was good practice in relation to medicines management. Medicines were organised well, stored safely and recorded correctly. Medicines management processes were overseen by a commissioned pharmacist.
  • Staff were involved in local audits and there was a robust audit cycle that provided the service with assurance about how care and treatment was delivered. There was a clear hospital dashboard to monitor and manage hospital performance and this was accessible to all staff.
  • Managers understood the hospital well; they were visible and engaged in improving care. There was a healthy and supportive culture within the team and staff supported each other well.
  • Staff demonstrated that they were committed to reducing restrictive practice, listened to patients’ feedback and gave examples of where they had made changes. Staff were involved in quality improvement projects relating to patient admissions and discharges.
  • Staff reported incidents and learning from incidents and complaints and incidents was shared. Changes were made following learning and when required both patients and staff received debriefs after incidents.
  • Care and treatment was in line with National Institute of Health and Care Excellence guidance for patients with learning disabilities. There was a range of interventions to aid patients’ psychological interventions, activities and a group programme.

However:

  • We saw that some staff wore nail varnish and gel nails. This was not in line with policy as it was a potential infection control risk and a potential safety risk for staff carrying out restraints as it could potentially cause patient harm.
  •  At the time of our inspection staff were not offered sepsis training, this meant that they were not trained to notice signs of sepsis in patients. The organisation did not have a sepsis policy for staff to access for guidance. The hospital manager immediately responded to our concerns regarding this, after our inspection posters about sepsis were displayed on the ward, a policy was developed and there was a plan for local staff training. 
  • Patients gave us mixed feedback about staff. Some feedback related to a safeguarding concern that patients raised about a member of staff but there was also negative feedback that concerned staff attitudes towards patients.