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

Cygnet Hospital Maidstone

Overall: Requires improvement read more about inspection ratings

Gidds Pond Way, Weavering, Maidstone, ME14 5FT (01622) 580330

Provided and run by:
Cygnet Health Care Limited

All Inspections

6 and7 June 2023

During a routine inspection

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

  • The provider did not manage ligature risks well. There were multiple ligature points across the ward which were not sufficiently mitigated. The provider's ligature risk assessment process was not robust enough to remove ligature risks. Staff had not received training on how to complete a thorough and detailed environmental and ligature risk assessment. Due to the nature of the concern, the provider was issued a warning notice immediately after the inspection to address this concern. A warning notice is what we serve to a provider where we identify a concern with the quality of care they are responsible for that requires a current need for significant improvement.
  • Staff did not ensure that patients’ medicines were managed safely. Staff did not ensure that medicines were safely administered and recorded. Staff did not ensure that the physical health of patients who were administered rapid tranquilisation were sufficiently monitored to mitigate against or reduce the risk of harm. For example, patients were administered overdose of rapid tranquilisation medicines above the recommended limits. Staff did not ensure that controlled drugs were appropriately signed for. On Kingswood ward, staff did not always ensure the emergency bag check list was up to date with the relevant contents in the bag. The index on drugs liable for misuse was not completed. There were no cleaning records or audits in place for clinic room equipment. The emergency bag was not sealed with a standardised fitting which meant that it required cutting with scissors to gain access.
  • Not all patients had a care plan that met their holistic needs, and care plans were not always written to reflect patients’ views. For example, on Saltwood ward, one patient who had been prescribed medicines for substance misuse disorder did not have a specific substance misuse management plan in place. Some patients told us they had refused their care plans because they did not reflect their views or assessed needs. One patient was discharged from their section following a tribunal, but staff did not have aftercare plans in place. On Kingswood ward, care plans we reviewed did not identify whether a patient had signed or been given a copy of their care plan. In addition, recording of patient involvement was not seen in all care plans.
  • The provider did not always ensure the provision of meaningful activities suitable for the rehabilitative needs of patients. On Kingswood ward, there was no focus on recovery- orientated activities within care planning, ward rounds or team meetings. When meaningful activity engagement was recorded as below 25 hours per week on the ward, leaders did not put in place actions to address this. Patients on Saltwood ward told us that planned activities were sometimes cancelled. Some patients reported that their section 17 leave was often cancelled.
  • Staff did not always treat patients with kindness and compassion. Four out of six patients we spoke with on Saltwood ward told us that night staff did not always care for them well or treated them kindly. Patients said that staff did not always listen to them or respected their wishes. Two patients on Saltwood ward reported that staff did not respect their dignity or privacy and often walked in on them in the shower. On Kingswood ward, four patients said the night staff were disrespectful, were not caring and did not respect their privacy and dignity.
  • Governance processes around quality assurance and audits were not robust enough to mitigate or reduce risks. We saw that there were concerns in prescription charts and care records which had previously been identified in the pharmacy audit but had not been acted upon. When lessons were learnt following an incident, the provider did not ensure that the actions were embedded to reduce such risks. For example, there were two battery swallowing incidents within a 48 period in February 2023. Although the provider took some action, we saw that another battery swallowing incident occurred again in May 2023. The provider did not ensure that actions following Mental Health Act 1983 (MHA) monitoring visits were completed and improvements were fully embedded.

However:

  • The ward environments were clean. The wards had enough nurses and doctors. They followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Staff engaged in clinical audits to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision, and appraisal. 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.
  • Spoke highly of the culture and the senior leadership team. They felt the senior leaders were very supportive and valued them. Staff reported that managers cared for their wellbeing and gave them opportunities and support to grow in their careers.

2 and 3 December 2019

During an inspection looking at part of the service

We carried out a focused inspection in response to concerns shared with us from members of the public, external agencies and intelligence held by the CQC. Concerns included: patient safety; patient risk and management of risk; high use of observation levels; the number of incidents on the ward; staffing levels; high use of agency staff; staff training; and culture and morale on the ward. The concerns were specific to Roseacre ward and we therefore only inspected this ward.

We did not re-rate the service following this inspection. The ratings from the comprehensive inspection on 19 and 20 March 2019 stay the same. The service was rated good overall. However, a requirement notice was issued for breach of Regulation 12, safe care and treatment. This was specific to Bearstead ward only. The inspection found patients’ risk assessments were not always completed and did not mitigate risks, and action taken to respond to incidents on the ward was not always appropriate.

During this focused inspection we inspected the safe, effective and well-led questions for Roseacre ward and we found:

  • The recording of risk information was variable and inconsistent. Patients risk assessments were not always updated following an incident or reflective of all risks identified during assessment or following an incident. The governance processes and audits for monitoring the quality of patients’ individual risk assessment records was not always effective.

  • Staff did not always report incidents on time. Some incident forms were completed sometime after the incident happened and the senior clinical team were not aware of those incidents until a later date. Incidents forms were not always fully completed and lacked some information which was needed. The process for monitoring and responding to reports of incidents submitted late and not in line with their policy was not effective.

    However:

  • Ward staff, senior managers and patients on Roseacre ward told us that the last few months prior to the inspection had been challenging on the ward but they felt things had improved a lot recently. Staff felt respected, supported and valued. They felt able to raise concerns without fear of retribution. Patients told us they felt safe on the ward and were happier now the ward had settled down and less agency staff were on duty.

  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for all new staff.

  • The service managed all reported patient safety incidents well. Staff recognised incidents. Managers investigated all reported incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.

19-20 March 2019

During a routine inspection

We rated Cygnet Hospital Maidstone as good because:

  • The ward environments were safe and clean. The wards had enough nurses and doctors. They managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. 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.
  • On most wards, staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led by senior managers and the governance processes ensured that most ward procedures ran smoothly.

However:

  • On Bearstead ward, which is a psychiatric intensive care unit, the staff did not always assess and manage risks to patients well. The lack of clear communication between the team, for example during handovers, meant that staff were not clear on the current risks for patients and how these should be mitigated. This meant that incidents were continuing to take place which could have been potentially prevented.
  • There were some inappropriate blanket restictions across all three wards including access to some areas of the ward and access to fresh air and outside space. Patients on Bearstead ward did not have access to drinking cups for water. However, the ward staff participated in the provider’s restrictive interventions reduction programme and were working to reduce restrictions.
  • The staff team on Bearstead needed more support to develop the skills and experience to support the patients who had complex needs. This included the need to improve the therapeutic engagement with patientst.
  • The local management of Bearsted ward did not fully support staff to manage patient safety risks. However, the hospital director was aware of the need to provide additional support to this ward and team.