Cygnet Hospital Maidstone

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

We reviewed all 8 quality statements in the safe key question. This means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question Requires Improvement. At this assessment the rating has changed and is now rated as Good. This meant people were always safe and protected from avoidable harm. All wards were safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report and how to report them. Staff raised concerns and reported incidents and near misses in line with the provider’s policy. Staff received feedback from investigations of incidents. The service sent out a patient safety bulletin every month which included a lessons learnt section.

Managers investigated incidents thoroughly. Patients and their families were involved in these investigations where appropriate. Staff understood the duty of candour. The service was open and transparent, and staff gave patients a full explanation when things went wrong. The team had reflective practice sessions and debriefs following incidents, which staff described as supportive and constructive.

Staff demonstrated a proactive approach to learning from incidents and described a positive learning culture. Systems were in place to report, investigate, and share learning from adverse events. Learning from incidents was discussed in team meetings. An example of learning from an incident included introducing an additional member of staff to always observe the entrance to the bedroom corridor so that all areas of the ward could be seen.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met on the ward.

Transitions between services were well-managed, with clear protocols for admission and discharge. Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. Professional meetings were arranged as needed to aid the discharge planning process. Staff routinely held Care Programme Approach Meetings and invited external professionals from social care and community mental health teams to attend.

The service had operational policies and procedures in place to support safe systems, transitions and pathways. Staff worked within multidisciplinary teams and worked well together to look at the patient pathway.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did when appropriate. The hospital had a safeguarding lead which staff contacted if they needed advice or support.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to identify adults at risk of, or suffering, significant harm. This included working in partnership with other agencies.

Staff applied blanket restrictions on patients’ freedom only when justified. The ward kept a comprehensive blanket restrictions log that was reviewed regularly.

Mental Capacity Act

Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles. Staff had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards and the ward was 100% compliant.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.

Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. We saw evidence of best interest decisions recorded in patient records.

The service had arrangements to monitor adherence to the Mental Capacity Act and this was audited every three months.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint and seclusion only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed six patient care records during the assessment. Staff completed a risk assessment of every patient on admission and updated it regularly, including after any incident, using a recognised risk assessment tool.

Staff followed good policies and procedures for use of observations and for searching patients or their bedrooms. We reviewed a sample of therapeutic observations records, and they were completed as described in care plans, with no gaps in recording.

Staff made every attempt to avoid using physical interventions by using de-escalation techniques and restrained patients only when these failed and when necessary to keep the patient or others safe.

Rapid tranquilisation is the process of administering a medicine intramuscularly for rapid sedation. The ward had low numbers of physical intervention, rapid tranquilisation and use of seclusion. There has been no incidents of long-term segregation in the previous 12 months.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff completed and regularly updated thorough risk assessments of all ward areas and removed or reduced any risks they identified. Ligature risk assessments were completed every six months, which had increased from annually since the last inspection. The assessment covered all areas of the wards and had been completed by skilled and competent senior managers. A ligature heat map was also available in the nursing office, clinic room and laundry room which staff referred to.

Staff could observe patients in all parts of the wards. Staff knew about any potential ligature anchor points and mitigated the risks to keep patients safe through observations.

Staff had easy access to alarms, and these were allocated in reception before entering the ward. They were tested prior to issue to ensure they were charged and working appropriately. Patients had easy access to a nurse call system.

Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly.

Staff checked, maintained, and cleaned equipment.

The seclusion room allowed clear observation and two-way communication. It had a toilet, shower and a clock that was visible to patients.

There was access to outside spaces. One area was restricted and this was clearly documented to demonstrate the reasons why.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Managers made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development and worked together effectively to provide safe care that met people’s individual needs. The service had low vacancy rates, with one vacancy for an activities co-ordinator.

Managers had calculated the number and grade of nurses and healthcare assistants required. The ward manager could adjust staffing levels daily to take account of changing patient needs. A qualified nurse was always present in communal areas of the ward.

Staffing levels allowed patients to have regular 1:1 time with their named nurse and participate in activities on and off the ward. Staff shortages rarely resulted in staff cancelling escorted leave or ward activities.

There were enough staff to carry out physical interventions such as observations, restraint and seclusion if needed, safely. Staff received the necessary training and induction to do this effectively.

Staff had received and were up to date with mandatory training courses. There was high compliance with statutory and mandatory training and all courses had a 90% completion rate. The training was appropriate for the patient group using the service.

There was appropriate medical staffing available during the day on-site and an out-of-hours call rota was in place. There was no out of hours medical cover available on-site however medical cover could be reached remotely and staff could contact emergency services if required.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. All ward areas were clean, had good furnishings and were well-maintained. Cleaning records were up to date and demonstrated that the ward areas were cleaned regularly. There was adequate numbers of housekeeping staff who ensured the ward and hospital site was clean, tidy and that hand towels and cleaning equipment were replenished. Staff adhered to infection control principles, including handwashing.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

The service had systems and processes in place to safely administer and record medicines use. Prescription and administration records were regularly reviewed by a multi-disciplinary team. When needed the relevant Mental Health Act consent to treatment forms were in place. Medicines were stored safely and securely. There were robust and regular stock checks of controlled drugs and drugs liable to misuse. The use of medicines to manage anxiety and agitation were low. Rapid tranquilisation (the process of administering a medicine intramuscularly for rapid sedation) was used as a last resort and staff actively worked to use alternative person-centred ways to de-escalate patients.

When PRN (‘when required’) medicines were used the reason for their use and what else had been tried first was clearly recorded on the daily electronic care records.

Patients who were prescribed medicines which required additional physical health monitoring had this completed. There were robust records used to support this monitoring, and paper records were uploaded onto the electronic care record in a timely way. Patients were supported to self-administer medicines to promote independence and understanding of their treatment. Staff completed risk assessments and checks to ensure patients continued to take their medicines as prescribed. However, we found this was not always being recorded for those patients on the second stage of self-medication where they kept medicines in their rooms.