Cygnet Lodge Lewisham

Updated 20 September 2019

Cygnet Lodge Lewisham is an independent hospital for 17 male adult patients. The hospital is run by Cygnet Health Care (one of several hospitals it runs throughout the country). At the time of the inspection, 16 patients were receiving treatment at the service.

The service is registered with the Care Quality Commission to provide the following regulated activities:

• assessment or medical treatment for persons detained under the Mental Health Act 1983
• treatment of disease, disorder or injury

The service has a registered manager.

The service is a long-term, high dependency rehabilitation unit. All patients are subject to detention under the provisions of the Mental Health Act at the point of admission. Patients at Cygnet Lodge Lewisham have a primary diagnosis of mental illness such as schizophrenia, schizoaffective disorder, bipolar affective disorder or depression. Most patients had additional complex needs, such as Ministry of Justice restrictions, substance misuse or physical health problems.

We previously inspected Cygnet Lodge Lewisham in June 2016 when we rated the service as ‘good’ overall. At that time, we rated safe, caring, responsive and well-led as ‘good’. We rated effective as ‘requires improvement’. At that inspection, we found that some legal requirements were not met. We had concerns that the service did not have enough staff to meet patients’ needs. We issued one requirement notice for breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. This notice related to breaches of regulation 18 (Staffing).

Updated 20 September 2019

We rated Cygnet Lodge Lewisham as good because:

• 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 mental health rehabilitation ward and in line with national guidance about best practice.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the ward. These included occupational therapists, nursing, psychologist and a consultant psychiatrist. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing recovery.
• Staff worked hard to provide safe care in most areas. The service had enough nurses and doctors with the right skills and qualifications. Staff assessed and managed risk well. Staff completed risk management plans in collaboration with patients in their ‘my safety plan’. Ligature risks had been assessed and fire safety arrangements were in place. Staff carried out regular physical health checks such as blood tests and monitoring patients’ vital signs.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients, families and carers in care decisions.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. Discharge planning arrangements were well defined within patient care plans and started approximately six months following a patient’s admission.
• The service had a pathway for rehabilitation which outlined timeframes and what the patient could expect from the service.
• The service worked to a recognised model of mental health rehabilitation. Governance processes operated effectively at ward level and senior management level. Staff managed performance well. The service took part in internal quality reviews of the hospital to ensure the effectiveness of the service.

However,

• Some parts of the building were run down and required extensive maintenance and refurbishment, including patient bedrooms. The provider had a schedule of works planned to improve the decoration and maintenance of the building. However, some parts of the schedule of works were not taking place until 2020, rather than sooner.
• Patient bedrooms did not provide a therapeutic environment for patients to recover. Bedrooms were bare and contained old furniture that needed replacing.
• Staff did not always store controlled drugs safely. During the inspection we found the controlled drug cupboard unlocked and the keys with the manager rather than the nurse in charge.
• Even though the service reviewed blanket restrictions every six months, staff imposed a blanket restriction on patients. After every meal staff collected cutlery back in, counted it and recorded that it was all there. This was not based on a patients’ individual need.
• Staff did not always actively promote the needs of all patients, including those with a protected characteristic. The service could do more to encourage an open and inclusive environment to support patients’ sexual, cultural and spiritual preferences.

Updated 20 September 2019