Cygnet Bury Hudson

We rated the service as inadequate overall and decided to place it in special measures.

When an independent healthcare service is in special measures it is the provider’s responsibility to improve it. We expect the provider to seek out appropriate support to improve the service from its own resources, and from other relevant organisations or oversight bodies or both.

We will inspect the service again within six months. If insufficient improvements have been made to justify a higher rating than inadequate overall or for any key question or core service, we will consider whether it is appropriate to extend special measures for a further six months, or whether to begin the process of preventing the provider from operating the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

For more information about special measures for independent healthcare, see our Guide to special measures: independent healthcare on the CQC website.

We rated the service as inadequate overall because:

• Patients we spoke with said they were being bullied and abused by their peers and staff members and they did not feel safe on the wards. Staff were not always discreet, respectful or kind when caring for patients. Patients and one carer told us staff could be patronising, antagonistic, rude and made negative comments about patients. Safeguarding issues were not always recognised and managed effectively by staff and patients’ needs were not always being put first. A security breach had led to a patient’s index offence being disclosed to their peers and they had to be moved to another ward after receiving abuse.
• Staff did not always meet the communication needs of patients on the wards. A patient with a learning disability told us they were given information in a way they could not understand and information on noticeboards was in English and Welsh only.
• Staff did not always actively involve or inform families and carers about their loved ones progress.
• Staff turnover within the service was high. However, managers were taking steps to recruit more permanent staff and used bank and agency staff to cover staff shortages.
• Medicines were not always well managed, and we found medicines which were out of date. There was no poster in the clinic room on Upper West ward to inform staff who the first aiders were in the service.
• Staff did not always follow best practice in relation to the use of rapid tranquilisation. On Upper East ward, a doctor was aware that rapid tranquilisation medicine had been administered to a patient, but staff had not recorded this in the patient’s care record.
• Staff had not informed a doctor that a patient had been placed in seclusion, so no medic review took place for this patient.
• The ward environments were not always comfortable for patients. A problem with the central heating system was causing the heating to come on even though it was warm which was making the temperature in the hospital uncomfortable for patients and staff.
• On East Hampton ward, patients’ sleep was being disturbed by slamming doors and lights from a sensor shining into their bedroom.
• Staff found difficulty finding information we requested to see in care records which meant staff did not always have timely access to important information they needed to deliver appropriate care to patients.
• Posters about advocacy were not specific in relation to the roles of Independent Mental Health advocates and Independent Mental Capacity advocates and not all of the staff we spoke with knew what the difference was between the two roles.
• Governance processes within the service did not always ensure that wards ran smoothly, and clinical audits were not always effective. We found issues in relation to safeguarding, complaint handling, responses to feedback, staff not being able to access patient information in a timely manner, medicines management, staff attitudes to patients and carers, blood monitoring machines not being calibrated, and communication needs not being met for a patient.

However:

• The ward environments were clean. The provider was taking steps to recruit more nursing staff to the service.
• Staff minimised the use of restrictive practices and used de-escalation techniques to minimise the use of restraint on the wards. Blanket restrictions were in accordance with identified risks on the wards and were reviewed regularly.
• Staff provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• 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.