We rated Cygnet Newbus Grange as inadequate because:
- We have taken enforcement action against the registered provider in relation to our concerns about this location. This limits our overall rating of this location to inadequate.
- The staff at the hospital imposed a number of restrictions on patients. For example, no patient was allowed use a mobile phone, camera or tablet unless supervised by staff, to use ceramic crockery, to hold keys for their bedrooms or to access some parts of the building. Six patients were routinely denied access to their own possessions. This meant that their bedrooms were bare of the person’s personal effects. These blanket restrictions were applied without having made individual assessments of the risks posed to individual patients. We therefore concluded that the service had inadequate systems and processes around restrictive practices. They did not have formal governance processes to identify, approve and review individual and blanket restrictions, and little documentation to record that these decisions were proportionate and the least restrictive option. At the factual accuracy stage, the provider submitted documents completed in July 2019 to show they had undertaken work to address these issues and had appointed a reducing restrictive practice lead.
- There had been a very substantial increase in the use of restraint since 2016. This was despite the provider having written a strategy to support a restrictive interventions reduction programme. We saw no evidence of this strategy having been turned into tangible action.
- Although the hospital had been taken over by Cygnet in August 2018, staff were still using the previous provider’s policies and documentation at the time of our inspection. The medication policy had passed its review date and the on-call policy did not reflect national guidance on doctors’ attendance to psychiatric emergencies.
- One patient was at risk of harm because staff had not ensured they had followed the medication policy for administering medication off-licence. They had not completed a risk assessment or produced a care plan for crushing a medicine and giving it in that form. Until we raised it with the provider, there was no mental capacity assessment or best interest decision in place for the administration of this medication.
- Patient safety, privacy and dignity was not a sufficient priority. Two patients’ bedrooms did not have any blinds or curtains to protect their privacy and dignity and to allow them to block out natural light. There were safety risks from exposed blind cords in some bedrooms which had not been considered on the hospital’s risk register and there were no actions to reduce or remove these risks following risk assessments.
- Staff did not always demonstrate good practice when working with patients. Managers had identified both individual staff performance issues and general cultural issues with the staff team. These included staff sleeping while on duty and one incident of staff using inappropriate techniques when restraining a patient. Two carers told us that they had raised concerns around staff interactions. One member of staff described the hospital had a ‘zero tolerance approach to wrong doing’ culture and we were concerned this could make staff reluctant to bring forward concerns. We carried out 13 periods of observation of the interactions between staff and patients. These amounted to about five hours of observations. The analysis found that one-half of the interactions observed were poor or neutral. Staff did not respond to patients promptly, nor did they often initiate interactions or activities.
- The managers and staff did not do all they could to keep the hospital in a good condition. The interior of the building was worn and tired in places and some rooms smelt of damp or urine. Also, staff did not always follow good infection control practices in relation to food storage.
- We raised a safeguarding alert because two carers raised concerns about unexplained injuries to one patient and one carer raised concern about the same patient not receiving appropriate medical attention following an injury. The provider told us after this they had completed some monitoring at Newbus Grange instead of taking the patient the hospital for treatment.
- The hospital had a high staff turnover rate of 39%. In the 12 months prior to our inspection, 24% of shifts were filled by bank or agency staff. There was not enough substantive nursing staff to cover the shifts available.
- None of the staff had received training in immediate life support.
- There was no reported use of seclusion, long-term segregation, rapid tranquilisation or prone restraint.
- Staff ensured that patients had easy access to physical healthcare.