All inspections: Cygnet Wast Hills - Care Quality Commission

Our rating of this hospital improved. Our previous inadequate ratings at key question level improved, and we have removed it from special measures.

We rated the hospital as good overall because:

The hospital had improved in a sustainable way those issues that led to it being placed in 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.

Our rating of this service improved. We rated it as good because:

Right Support:

The hospital was located on the outskirts of Birmingham. However, it is in a rural location, a mile from the nearest pub and local community. This meant that staff needed to accompany people to access the local community.

The hospital was undergoing extensive refurbishment which provided people with self-contained flats with their own bedroom, living area, ensuite shower and toilet and small garden. They also had access to communal areas where they could meet with others if they wanted to. People showed us they had personalised their flats and staff had supported them with this.

Staff supported people to be independent. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

People were supported by staff to pursue their interests and people said they had tried out new activities they wanted to do.

Staff worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people.

Staff enabled people to access specialist health and social care support in the community. They supported people to attend dental, optician, and health screening appointments.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. People and their relatives said that staff looked after them well and treated them with respect. Staff were able to tell us about people’s individual needs and how they wished to be supported.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People told us they felt safe.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People who had individual ways of communicating, could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life.

Right Culture:

People received good quality care, support, and treatment because trained staff and specialists could meet their needs and wishes.

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. People and their relatives knew what their goals were and where they planned to move to.

Staff placed people’s wishes, needs, and rights at the heart of everything they did.

People and those important to them, including advocates, were involved in planning their care. Relatives told us they were invited to meetings via video calls or in person and were kept updated at least weekly by the family liaison officer who worked at Wast Hills.

Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity. Staff were welcoming and open and eager to show us and commissioners the improvements they had made since our previous inspection.

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.

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

To meet peoples’ needs there were areas of improvement required despite the provider having made some changes since our last inspection. Those changes were new and still needed to be embedded.
Not all areas of the hospital provided a well-maintained environment which met peoples’ sensory and physical needs, although the provider had commenced a programme of environmental improvements. The hospital was not always clean and there were risks in the environment for people that the provider had not identified.
There were omissions in applying the Mental Health Act when prescribing medicines and we also found one patient had been administered a dose of medicine to control behaviour in excess of their prescribed dose on two occasions. The provider had stored out of date oxygen in the clinic, this was not labelled to indicate that staff should not use this. Nurses had access to clinics and could have accidentally used this in an emergency.
Physical health records were not always up to date, physical health observations were not recorded properly and had not been completed regularly. Several families had concerns about their family member’s weight and records indicated that weight was not always well managed by staff. Staff did not always weigh people and record this when they should have done.
Staff did not always keep care records up to date and accurate, there were omissions and inaccuracies, and information was not always easy to locate in the care records system used.
People did not always receive active, goal-orientated treatment. The provider had improved activity but there was further work to be done. People did engage in activity, but a number of people were sleeping excessively or had irregular sleep routines. We did not think there was enough meaningful activity for people seven days a week and this did not prepare them well for discharge.
There were ineffective governance processes. Leaders did not have oversight of all areas; not all local audits were effective and had not provided assurance in all areas. This meant that there were new concerns that required improvement that leaders were not aware of.

However:

The provider had increased staff on shift to meet peoples’ needs and although the service relied on agency support workers, they ensured that these staff were familiar with the service.
Risk management had improved; Staff completed high level observations in line with policy, incidents were reported and investigated. Staff monitored physical health after episodes of self-harm and had improved some aspects of medicines management. Staff were trained, supervised, and appraised.
Staff had completed annual health reviewed for all patients. Staff had recorded in patients’ care records that they had access to dental, chiropody and opticians reviews and electrocardiograms had been carried out.
All staff spoke highly of leaders and told us the culture was open and supportive. They followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to support peoples’ care, treatment, and support plans, these reflected their sensory, cognitive, and functioning needs.
People cared for at the hospital told us that they felt safe and overall families said that staff were kind and compassionate. One parent now attended monthly clinical governance meetings. However, families provided mixed feedback about the level of activity on offer.
People had clear discharge plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support after they went home.

This service remains in 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.

Following the inspection, we served the provider with a Letter of Intent under Section 31 of the Health and Social Care Act 2008, to inform them of our immediate concerns and warn them of possible urgent enforcement action. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within 24 hours that described how it was addressing our concerns. Due to the serious nature of the concerns we found during this inspection, we used our powers under Section 31 of the Health and Social Care Act 2008 to issue a Notice of Proposal. The proposal is to impose conditions on the providers registration through a Notice of Decision. However, at the time of publication the provider had the opportunity to make legal representations against the Notice of proposal.

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

The service did not always provide safe care. The environment required attention in some areas. The service had enough nurses and support workers in the Main House and the Annexe, although there were not enough staff deployed in the Lodge to safely meet the needs of the patients living there.
Staff did not always adequately assess and manage patients’ physical health particularly after incidents of self-harm such as head banging or nursing interventions, such as rapid tranquilisation, in line with national guidance. Records were not completed consistently or were missing which put patients at further risk of harm.
Incidents were not being recorded consistently either in the patient care record or on the providers incident reporting system, and some were not being recorded at all. Not all staff had full access to the incident reporting system and did not always receive feedback.
Not all staff were adhering to the provider’s high-level nursing observation policy and we were not assured staff had the relevant skills, competencies and training to do so. Some patients had incidents of self-harm whilst being observed by staff.
Medicine policies were not always followed correctly. Staff did not ensure medicines were always administered on time.
There was a lack of meaningful activity or occupation to keep patients engaged. All patients had an activity plan which was individualised, however staff were not proactively engaging patients in activities and structured activity plans were not always followed.
Governance processes were in place, however they did not always operate effectively to ensure that patients were safe, and performance and risk was managed well. Governance records were not fully completed locally. We were not assured that all staff followed and understood the provider’s policies and protocols.

However:

Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
The ward teams 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 developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a ward for people with a learning disability and autism and in line with national guidance about best practice.
Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
Staff planned and managed discharge well and liaised with services that would provide aftercare. However, discharges were delayed due to reasons beyond the provider’s control.
Staff felt respected, supported and valued and most staff enjoyed working for the provider and understood how their vision and values applied in the work of the team.

I am placing the service 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.

Professor Ted Baker

Chief Inspector of Hospitals.

We rated Cygnet Wast Hills as good because:

The service provided safe care. The ward environments were safe. The wards had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
Staff developed took a truly holistic, recovery-oriented approach to assessing, planning and implementing care plans which were individualised, and person centred. They included comprehensive plans for those with additional physical health needs such as epilepsy. They provided a range of treatments suitable to the needs of the patients cared for in a ward for people with a learning disability and autism and in line with national guidance about best practice. Staff engaged in clinical audit and monitoring outcomes for patients to evaluate the quality of care they provided. The hospital was accredited with the National Autistic Society and was committed to continually improving the quality of care it provided to its patients.
The ward teams included or had access to the full range of highly skilled specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal to ensure the highest level of care. The ward staff worked well extremely well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare. The multidisciplinary team were active participants in the daily life of the hospital and patients knew them well and interacted with them as people they trusted. This level of interaction ensured the multidisciplinary team knew and understood the smallest of details about a patient and this enhanced the bespoke packages of care they delivered.
The multidisciplinary team completed timely assessments as soon as a patient was admitted ensuring staff could fully meet their needs. The speech and language therapist assessed each patient to understand the form of communication they used and delivered bespoke training to staff so that they could effectively communicate with patients and help them to settle in and reduce the potential for challenging behaviour.
Managers ensured that staff a range of skills to meet the needs of patients and provide high quality care They were committed to encouraging staff to be creative and use skills outside of their role to enhance care for patients such as the staff member designing bespoke murals with patients. Managers provided a robust induction for all staff including agency workers which included opportunities for shadowing. Staff were encouraged and supported to raise concerns about poor practice and staff felt listened to and knew that manager would investigate any concerns without delay.
Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Staff ensured that where possible they explained to patients their rights under the Mental Health Act using a range of communication aids. Staff included patients in best interest decisions and ensured their views and wishes and been taken in to account. They always assumed patients had the capacity to make their own decisions unless a capacity assessment had been completed.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. There was a strong visible person-centred culture which was displayed by all staff we met during the inspection. Staff were highly motivated and inspired to offer care that was kind and promoted dignity and respect for their patients. They actively involved patients and families and carers in care decisions.
The hospital had a service user forum which allowed all patients to be actively involved in making decisions within the hospital setting. Staff acknowledged that bringing patients together as a group would not work so spent time with each patient discussing the current theme and documenting their responses. The team discussed how these would be actioned such as having pet therapy visit the hospital and would feedback to patients how this would be actioned.
The hospital was very focussed on the rehabilitation of patients back into the community at the earliest opportunity or once suitable accommodation was available. It was well led, and the governance processes ensured that ward procedures ran smoothly with managers well known and visible in all areas of the hospital.

However:

Not all areas of the ward had been cleaned thoroughly on our first visit which we raised with the manager. We visited again 10 days later and found that cleanliness had improved although The Lodge had an unpleasant odour in the entrance area. The manager had arranged for their estates department to investigate this and to do any work necessary to reduce the smell.
Cleaning schedules did not accurately reflect the current layout of rooms in use within the buildings which made monitoring of cleanliness difficult. There was no monitoring of the cleanliness and tidiness of the grounds.

This inspection was focused and so we did not inspect every domain. We fully inspected the effective, caring and responsive domains although we did not rate them. We did not inspect the safe or well led domains.

Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. A range of specialists in the team provided a variety of treatments suitable to meet the needs of the patients, in line with national guidance and best practice. Staff worked proactively and effectively as a multidisciplinary team and developed individualised and personalised care plans to achieve the best outcomes for patients. This enhanced the staff’s ability to fully understand patient needs and how to deliver tailored care for each individual.
Staff engaged in clinical audit to evaluate the quality of care they provided and made improvements to enhance the experience and care the patient received. The multidisciplinary team reviewed and revised care plans and positive behavioural support plans, following analysis of how each patient responded to their treatment plans.
The team included the full range of specialists required to meet the needs of patients on the wards. Staff worked proactively and effectively together as a multidisciplinary team and used effective sensory and communication prompts and aids to support consistency of care and individualised meaningful interactions with patients. Each member of the team had a specific role that contributed to the patients care, staff were mutually respected, and they felt their contribution and opinions were valued.
Managers ensured that staff received training, supervision and appraisal. Agency staff were expected to have the same training as regular staff, they participated in supervision and received an induction to the service. Managers ensured staff attended additional supervision sessions related to specific topics, to promote consistency in knowledge and practice within the staff team.
Staff had exceptional knowledge of the legal frameworks which they worked under, including the Mental Health Act 1983, the Mental Health Act Code of Practice and the Mental Capacity Act. Staff actively involved families and other professionals when discussing best interests for patients which was always recorded thoroughly and clearly.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and had an excellent knowledge of the individual needs of patients. They actively involved patients, families and carers in care decisions. Thorough and accessible care and treatment plans ensured staff always knew patients individualised care needs, their likes and dislikes and their preferred communication style.
The service went above and beyond to work proactively with external agencies and families to ensure appropriate care packages were in place before patients were discharged from the hospital. They liaised well with services that would provide aftercare and ensured a smooth transition before and after discharge.
The service had been proactive in capturing and responding to patients concerns and complaints. The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service. Staff were passionate about safeguarding patients and protecting them from abuse.

However:

The alarm system was loud, and staff reported that some patients could become distressed. This was recognised by the provider and a new bleep alarm system was due to be installed imminently that would reduce noise levels.

We rated Wast Hills House as outstanding because:

Staff minimised risk to patients by ensuring the environment was clean and tidy, equipment was safe and effective to use and appropriate measures were put in place when risks to patients and staff were identified.

The service managed incidents well. Clinical and non-clinical staff were trained in conflict resolution and positive behavioural support and managed challenging behaviour in the least restrictive way. Managers investigated incidents and analysed themes and trends, which ensured staff could adapt and modify patient care when required to reduce the frequency of further incidents.

Skilled and experienced staff worked exceptionally well together as a team, using a variety of nationally recognised assessment tools to create holistic, individualised, person centred care plans. They focused on positive behavioural support and these were written in patients preferred communication style.

The service used the ‘Personal PATHS’ model of care which we saw adopted across the service. This shaped the way the service provided care and treatment, and ensured they monitored their effectiveness by sharing the findings and making improvements to maintain quality of care and treatment.

All staff employed by the service received specialist training and worked together with mutual support and respect to provide good quality care and treatment. Staff worked closely and proactively with families, external agencies and partners to ensure the patients best interests were always prioritised when decisions were made.

Staff had good knowledge of the Mental Capacity Act, which was embedded within the service. Staff supported patients to make decisions, and when they could not, staff recorded detailed reasons why decisions were made on their behalf. Staff understood their roles and responsibilities under the Mental Health Act 1983 and this was effectively applied across the service.

There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted patients’ dignity. Patients told us that staff treated them well, with kindness and respect. Staff had excellent knowledge of their patients, their likes and dislikes and their preferred communication style. This meant they understood their individual needs.

Carers, families and external agencies were extremely positive about the service and believed the service always managed challenging behaviour well. They were confident their relatives were receiving great care and treatment in a safe environment. They felt involved and included in their relatives care and the service was open and honest, providing regular feedback on their relatives care and when things went wrong.

The service encouraged feedback and saw it as an opportunity to improve. Patients and carers had opportunities to provide feedback to the service and staff listened and made improvements when required.

The service worked proactively with external agencies and families to ensure the patients were treated in line with the NHS Transforming Care agenda. Staff adapted the service to meet the needs of individual patients and ensured that appropriate care packages were in place before they were discharged from the service. The service ensured a smooth transition between services by providing an intensive face to face handover over many weeks before and after discharge.

Patients engaged in wide ranging meaningful activity plans which were individualised to meet their needs, encouraged independence and improve their skills. Staff used communication ‘grab sheets’ so patients’ interactions were consistently understood. Staff understood what was important to patients and provided them with information to make informed choices.

The service had a robust governance structure in place to monitor its effectiveness and sought to continually improve the quality of the service they provided. The service was committed to quality improvement and had signed up to a national project, making changes to the service when required. They provided training in autism for external agencies and partners. Staff were nominated for nationally recognised awards and they were accredited with the National Autistic Society.

The service promoted a positive culture that supported and valued staff. Staff enjoyed working with their patients and the majority thought that staff morale was high. Staff had opportunities to develop their skills and were provided with specialist training.

We rated this service as outstanding because:

Wast Hills was a safe, modern and environmentally suitable facility for patients. There was a secure door entry system to prevent unwanted visitors and closed circuit television in some areas.
Staff managed risk well and Wast Hills had a good track record on safety. Staff undertook thorough risk assessments for each patient on admission, which they updated regularly. They also carried out environmental risk assessments and ensured equipment was tested and calibrated effectively.
Staff had received training in safeguarding adults, and regularly reported safeguarding concerns to the local authority. Mandatory training compliance levels for staff were good.
Staff knew how to report incidents. Local managers investigated incidents and there were systems in place so senior managers had oversight of outcomes. Local managers and the wider company shared lessons learned with staff in meetings and in a monthly newsletter.
Wast Hills had safe systems to manage medication and to prevent the spread of infection.
There was an ongoing recruitment programme to fill vacancies and managers had recruited a small bank of temporary staff to support the permanent team, most of whom were already familiar with the service. The company had agreed funding to “over fill” nursing vacancies so the unit would not be short staffed when patient numbers grew.
Commissioners, families and external staff who visited Wast Hills told us they believed the service was safe and patients were cared for safely.
Staff followed a model of care called ‘Personal PATHS’ that was developed by the Danshell Group. PATHS supported patients across five areas; positive behaviour support, appreciative enquiry for staff, patients and carers to reflect, to achieve therapeutic outcomes, promote healthy lifestyles, and provide safe services.
Staff provided good quality care and treatment. They routinely supported patients to address their physical healthcare needs as well as their emotional needs. Different professionals worked very well together to assess and plan for the needs of their patients.
The service followed Department of Health and the National Institute for Health and Care Excellence guidelines. Staff were able to access specialist training relevant to their roles. Staff used specialist tools to assess the specific needs of their patients.
All patients had up-to-date care plans. These focused on positive behaviour support, person-centred care, treatment, rehabilitation and independence-building skills as well as social and leisure-based activities.
To support their treatment, patients had access to specialist therapies, which included speech and language therapy, psychology, occupational therapy and creative art. Staff were keen to support patients to develop special interests and we saw examples of patients trying new experiences as well as things they had enjoyed for a long time. Some patients were involved in work experience placements. Staff encouraged patients to celebrate their achievements.
Staff had a very well developed understanding of the Mental Capacity Act 2005 and the Mental Health Act 1983. Assessing mental capacity and enabling patients to make decisions was thoroughly embedded throughout the service. Staff routinely referred patients for advocacy support if they lacked the capacity to do so themselves. Mental Health Act and Deprivation of Liberty Safeguards paperwork was all in order and was effectively stored.
Commissioners and community teams were extremely positive about the service and each commented on the high quality of multidisciplinary working and associated paperwork.
Staff used the positive behaviour support model, which ensured they understood patient behaviours and responded in ways which promoted patients’ rights, preferences and communication needs.
Staff treated patients with kindness, dignity and respect; and were able to accurately anticipate the needs of patients who could not verbally communicate.
Staff ensured patients and relatives were engaged with assessments, care plans and discharge arrangements. Patients were involved in developing their own care plans and staff gave them copies which were in an “easy read” format.
Staff routinely sought feedback from people who used the service including patients, relatives, community teams, commissioners and staff. The company analysed this feedback and made changes as a result.
Almost all relatives said they knew how to make a complaint and believed staff would deal effectively with any complaint. Relatives of patients using the service were highly complimentary and positive about the programme, the staff and the progress patients had made.
The service went to extensive lengths to meet the needs of patients who were ready to move but had nowhere to go.
Local managers led their team very well. They were available and accessible to staff. Staff and patient families spoke very highly of the local managers. Managers routinely held supervision and annual performance reviews with staff. They monitored mandatory training to ensure compliance. Managers did not tolerate poor staff performance and took effective action if any concerns came to light.
The company invested in, and was responsive to the needs of staff. As a result, staff morale was very good. Managers listened to their staff and provided them with additional resources when they needed them.
Staff had access to specialist training and the company routinely supported them to undertake vocational and academic study such as Masters degrees and diplomas. The company supported staff who needed to work flexibly due to caring commitments and provided confidential support and counselling if staff needed it. There were a range of benefits available to staff.
The service had a detailed audit programme, the outcomes of which were open and transparent. The service had good systems in place so they could monitor and audit the quality of care. The senior management team were accessible to staff and local managers.
The service was in the process of becoming accredited with the National Autistic Society.
Between May 2015 and April 2016, a serious case review took place, which looked at issues surrounding the treatment and discharge of a patient at Wast Hills. The patient had been at Wast Hills between July 2013 - March 2014. During this inspection, we found that Wast Hills had addressed the issues raised in the Serious Case Review. We found they had changed their processes, implemented new procedures and improved monitoring.

We rated Wast Hills as good because:

Staff carried out environmental risk assessments in areas such as health and safety, access to therapy rooms, use of any equipment and infection control and prevention.
All units carried out comprehensive assessment of needs when patients were admitted. This included a detailed risk assessment and risk management plan that were updated regularly after every incident. These were based on positive behaviour support approach.
Staff were trained in safeguarding and demonstrated a good understanding of how to identify and report abuse. Staff knew how to recognise and report incidents through the reporting system. Learning from incidents was shared with staff.
In the records we checked we saw details of regular physical health checks and that staff continued to monitor health. Staff were trained in different areas of physical health such as dysphagia, postural positioning and epilepsy.
Patients could access psychological therapies as part of their treatment. For example, anxiety management and therapeutic support programme recommended by the National Institute for Health and Care Excellence.
Staff treated patient with respect and dignity and they were polite, kind and willing to help. Patients and families were happy with the support they received from the staff and felt that they got the help they needed.
Staff involved patients in their clinical reviews and care planning and encouraged them to involve relatives and friends if they wished. Patients and their families told us that they could access advocacy services when needed.
All discharges and transfers were discussed in the multi-disciplinary team meeting and were managed in a planned and co-ordinated way.
Patients told us that the quality of food was good and meal times were flexible. Patients were supported in maintaining contacts with families by use of Skype and other information technologies. Care was personalised to meet individual needs.
Staff used a variety of communication tools to help individuals communicate their needs. Families and carers told us that they could raise any concerns and complaints freely.
Staff told us that they knew how to use the whistleblowing process and felt free to raise any concerns. Staff were offered the opportunity to give feedback on services through the annual staff surveys.
The unit used performance indicators to gauge the performance of the team. The managers put action plans in place where performance did not meet the expected standard.
Staff were open and transparent when things went wrong. Incidents were discussed with patients, their families and care managers. Staff felt supported by their managers.

However:

Not all electrical equipment was checked regularly to ensure it continued to be safe to use.
The unit did not have arrangements with the pharmacist to specifically audit or monitor prescriptions to ensure doses were safe. The Pharmacist had no direct input into clinical care.
Staff did not record patients’ advance decisions. These are decisions made by patients earlier about how they wanted to be treated at some time in future.
Patients were not actively engaged in meaningful activities that promoted their independent living skills. Not all patients in the Main house had access to the kitchen and laundry room. The activities appeared to focus more on leisure.
Wast Hills had information on the number of incidents reported, episodes of restraint and safeguarding, which they analysed for trends and themes. They did not share this information with staff or patients so they could know how the unit was performing.

There were five people staying at The Annexe, five people at Wast Hills House and two people at The Lodge on the day of our inspection. Three people were detained at the hospital under the Mental Health Act 1983. We spoke with three people who used the service, nine members of staff and one relative who visited during our inspection.

Since our last inspection the provider and the registered manager had changed. Due to these changes and safeguarding investigations that had been undertaken by the local authority the provider had chosen to limit the number of new admissions. This meant that the hospital was under occupied because the provider wanted to ensure they met the needs of the current people who used the service before they admitted others.

We saw that people who used the service and their relatives were involved in their care. People were supported to have an advocate to help them to be involved.

People's mental capacity was assessed. This ensured that if people did not have the capacity to consent to their care and treatment this was given in their best interests.

Staff had the information they needed in order to support people to meet their individual needs. We saw that people's needs had been assessed by a range of health professionals and their healthcare needs were monitored and met.

People spoken with told us that they felt safe there. Systems were in place to ensure that people were safeguarded from harm.

We saw that people were given their medicines safely and to ensure that their healthcare needs were met.

Cygnet Wast Hills

All Inspections

30 August 2022, 31 August 2022

During an inspection looking at part of the service

16,17,19, 22 and 26 November

During a routine inspection

10 May, 11 May, 13 May, 17 May

During a routine inspection

03/04 December 2019

During a routine inspection

11th July 2019

During an inspection looking at part of the service

15 and 16 May 2018

During a routine inspection

12 -13 October 2016

During a routine inspection

6 August 2015

During a routine inspection

9 June 2014

During an inspection in response to concerns