Cygnet Hospital Maidstone

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• 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 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 this quality statement 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 reported serious incidents clearly and in line with the provider’s policy. Kingswood ward had 61 incidents from January 2025 to the end of May 2025.

Staff understood the duty of candour. They were open, transparent, and gave patients and families a full explanation if and when things went wrong. Managers debriefed and supported staff after any incidents. Managers investigated incidents thoroughly. Patients and their families were involved in these investigations.

Staff received feedback from the investigation of incidents, both internal and external to the service. The service distributed information about learning from incidents in a range of bulletins and through a range of meetings. The hospital had learning boards on display which identified recent incidents and their corresponding learning and actions taken to address this. Staff met to discuss the feedback and look at improvements to patient care.

We scored this quality statement 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. Staff told us that referral information for patients on the acute rehabilitation pathway could be limited. The service sought assurances from the referrer before accepting or declining the referral.

We scored the quality statement 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 received training on how to recognise and report abuse, appropriate for their role. Staff kept up to date with their safeguarding training and knew how to make a safeguarding referral. The hospital had a safeguarding lead and social workers, who staff contacted if they needed advice or support. From January 2025 to the end of May 2025, Kingswood ward had 2 safeguarding incidents that needed reporting to the local safeguarding team.

Staff could give clear examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew how to recognise adults and children at risk of or suffering harm and worked with other agencies to protect them.

The hospital had a policy that children were not allowed to visit the ward. Visits could be facilitated in extenuating circumstances and were facilitated in a suitable environment.

Managers took part in serious case reviews and made changes based on the outcomes.

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 from within the provider 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. The service too action when learning had been identified as a result of Mental Health Act visits and audits.

We scored this quality statement 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.

During the assessment, we reviewed 5 patients’ risk assessment records. Staff completed risk assessments for each patient on admission, using a recognised tool, and reviewed this regularly, including after any incident. Staff knew about any risks to each patient and acted to prevent or reduce risks. Staff involved patients in care planning and risk assessment.

Staff followed provider policies and procedures for use of observation and when they needed to search patients or their bedrooms to keep them safe from harm. The ward had a designated space to search patients on return from leave. Staff had access to magnetic search wands to support them in searching patients. We reviewed a sample of therapeutic observations records, and they were completed as described in care plans, with no gaps in recording.

Levels of restrictive interventions were low. Staff made every attempt to avoid using restraint by using de-escalation techniques and restrained patients only when these failed and when necessary to keep the patient or others safe. Kingswood ward had 2 episodes of restraint from January 2025 to the end of May 2025. None of these were prone restraint. Prone restraint is where a person is held down by staff. Staff told us that if any restraint (including prone restraint) is used, this is discussed within a daily multidisciplinary meeting. We observed staff managing incidents well and were able to de-escalate these quickly.

Staff participated in the provider’s restrictive interventions reduction programme, which met best practice standards. Kingswood ward restrictive interventions log was on display for all patients to view. The ward actively sought patient feedback about the items on the list and reviewed this feedback at weekly community meetings. At the time of the assessment, the ward had a blanket restriction of cups on the ward. This meant that cups were not readily available for patients. However, we observed staff being responsive to patients’ needs, supporting them with drinks and food whenever requested.

Staff followed NICE guidance when using rapid tranquilisation. Kingswood ward had 2 incidents resulting in rapid tranquilisation between January 2025 and June 2025.

Kingswood ward did not have its own seclusion room but had a process in place for managing patients who required seclusion. The ward used a seclusion room in another part of the hospital. When a patient was placed in seclusion, staff kept clear records and followed best practice guidelines.

We scored this quality statement 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.

All wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose. Staff used a full range of rooms and equipment to support treatment and care. Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

Each patient had their own bedroom, which they could personalise. Patients had a secure place to store personal possessions.

Staff now completed and regularly updated thorough risk assessments of all wards areas and removed or reduced any risks they identified. Ligature risk assessments were completed every 6months, which exceeded the provider policy of every 12 months. 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 now knew about any potential ligature anchor points and mitigated the risks to keep patients safe.

Staff could observe patients in most parts of the wards. Staff followed procedures to minimise risks where they could not easily observe patients. Staff conducted security checks daily. Staff had easy access to alarms which were allocated at reception at the start of the staff members shift. Staff alarms were tested prior daily to ensure they were charged and working appropriately. Patients had easy access to nurse call systems.

The ward complied with guidance and there was no mixed sex accommodation. The ward was for males only.

The ward had multiple quiet areas available for patients to use unrestricted and this was risk assessed on an individual basis. Patients could meet with visitors in private in a family room off the ward.

The service had an outside space that patients could access easily. This space had recently undergone improvements as part of a patient led quality improvement initiative. The space had a beach scene on one wall, and plants were being cared for by the patients. The ward also had access to gym facilities on (punching bag) and off the ward.

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

We scored this quality statement 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.

The service had enough nursing and medical staff, who knew the patients and received basic training to keep people safe from avoidable harm.

The service had enough nursing and support staff to keep patients safe. The ward ran on a staffing matrix that was determined by the number of patients admitted.

The service had low vacancy rates. Kingwood ward had no nursing or support worker vacancies at the time of the assessment. The responsible clinician position for Kingswood ward was vacant but was being covered at the time of the assessment. Hospital wide there were low numbers of vacancies. These included 2 occupational therapy assistant positions which had been recruited to, 1 admin role recruited to, 1 hospital manager position which was currently filled, and 1 part time housekeeping role.

The service had low rates of bank and agency nurses and nursing assistants. Managers limited their use of agency staff. Bank staff who were familiar with the service were used to fill gaps in care.

The hospital had low turnover rates. At the time of the assessment, the hospital had an average annual turnover rate of 21.51%.

Managers accurately calculated and reviewed the number and grade of nurses, nursing assistants and healthcare assistants for each shift. Managers used a matrix to determine how many staff were required on shift. The ward manager could adjust staffing levels according to the needs of the patients.

The service had enough staff on each shift to carry out any physical interventions safely. Staff shared key information to keep patients safe when handing over their care to others.

There was appropriate medical staffing available during the day on-site and an out-of-hours call rota was in place. Although there was no out of hours medical cover available on-site, medical cover could be reached remotely.

The hospital had a mandatory training programme that was comprehensive and met the needs of patients and staff. Staff had completed and kept up-to-date with their mandatory training. Kingswood ward had a statutory and mandatory training completion rate of 100%.

Managers monitored mandatory training and alerted staff when they needed to update their training.

We scored this quality statement 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.

Ward areas were clean, well maintained, well-furnished and fit for purpose. Staff made sure cleaning records were up-to-date and the premises were clean. The housekeeping staff had a regular visible presence on the ward. They were kind, friendly and understood the needs of the ward. The ward had received a 5 star rating by the provider.

Staff followed infection control policy, including handwashing. We observed staff following hygiene procedures and discussing these with patients.

We scored this quality statement 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. A multi-disciplinary team regularly reviewed prescription and administration records. Prescribed medicines were given in line with relevant Mental Health Act ‘consent to treatment’ authorisations where needed.

Medicines were stored safely and securely. Staff completed robust and regular stock checks of controlled drugs and drugs liable to misuse. The use of medicines to manage anxiety and agitation was appropriate.

Rapid tranquilisation (RT - 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 without the need to administer RT. When RT was being used, staff ensured they completed the required post-dose physical health monitoring and kept the patient safe.

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 had activity PRNs in place which were individual activities they could do with staff to reduce anxiety and agitation. These were effective in reducing the need for intervention with medicines.

Patients who were prescribed medicines which required additional physical health monitoring had this completed. There were robust records completed to support this monitoring, and paper records were uploaded onto the electronic care record in a timely way. Patients were supported to self-administer their own 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.