Cygnet Views

Updated 30 May 2023

About the service

Cygnet Views is an independent hospital managed by Cygnet Learning Disabilities Midlands Limited.

Cygnet Views registered with the Care Quality Commission for the following regulated activities:

Treatment of disease, disorder or injury and Assessment or medical treatment for persons detained under the Mental Health Act 1983.

The hospital provides care for up to 10 women who have a learning disability or autism and complex mental health needs. At the time of inspection, the service was supporting 7 people, one person was using two bedrooms to support her needs.

The service has a registered manager and accountable drugs officer.

We carried out this unannounced, comprehensive inspection following receipt of 2 serious incident notifications: 1 whistleblowing report and a further 6 notifications relating to one person. After discussions with the provider and the local Integrated Care Board we held a desk top review of the information we had received over the previous three months. Our conclusion indicated we should carry out onsite inspection due to potential increase in risk to people.

What people who use the service say

We spoke with 3 people using the service, and 2 of their family members. We reviewed the people’s individual satisfaction survey dated February 2022.

People’s opinions about Cygnet Views hospital were mixed.

Person 1 told us that she gets frightened when other people start shouting. She said she had not been at the hospital very long but did not get a proper introduction to other people. She could not remember where rooms were, and no one had taken her around the hospital since the first day. She said she was not sure what she should be doing and did not know what her timetable was going to be, because she had only met someone the previous day who had asked her what she liked doing. She also told us that she had already been disappointed when staff had needed to cancel a visit with her mother the previous day because another person was upset, and staff told her it was not safe for visitors to be in the hospital. She had not been there long enough to have any section 17 leave from the hospital to meet her mother off site. However, she told us that staff had helped her to stay connected with family and friends using her mobile phone. She was pleased and thought this was good because she had not been allowed to keep her phone with her all the time at her previous placement.

Person 2 told us that she thought it was OK at the hospital unless other people got upset. She said the staff had paid for her family to visit her at Views and because they lived a long way from the hospital, they provided hotel accommodation so they could stay over. She told us that most of the regular staff were OK but temporary staff were not good. She said that they never introduced themselves properly and did not do what they should be doing, they just sat watching them (the people using the service) or using their mobile phones.

Person 3 told us she was not happy at the hospital. The temporary staff did not always talk to them (the people using the service). She said there never seemed to be enough staff when she wanted to go off the hospital grounds even though her section 17 leave allowed her to do this with staff escort. She thought this was because so many of them were looking after some of the other more unwell people. She also said she did not think staff encouraged her enough to do what was on her timetable and if she said no to doing something they just left her to get bored. She added that if they tried to encourage her to do things then she would do them.

Family member 1 told us that her daughter’s care was excellent – she had settled at the hospital and was doing well. She felt staff enabled her daughter to make choices, they knew she could not process a lot of information at any one time and so gave her a choice of 2 or 3 options for each decision. She said she had been involved in her daughter’s discharge planning and when the doctor had changed her daughter’s medication he explained why.

Family member 2 told us that she did not think staff could manage all the people at the hospital and her daughter was afraid of a recently admitted person who was not nice to her. Staff did not seem to know what to do with the person or how to stop the other person being nasty to her daughter. She also told us that on a few occasions she had visited her daughter at the hospital there had not been a lot going on and people often just sat around saying they were bored.

How we carried out this inspection

This inspection was an unannounced, comprehensive inspection.

We were on site for one day, telephone interviews with staff and analysis of data and information sent to us by the provider was reviewed in the week following inspection.

Our inspection team comprised two inspectors and a specialist advisor nurse. An expert by experience carried out face to face interviews with people using the service and telephone interviews with family members.

Before the inspection visit, we reviewed information that we held about the location and asked a range of other organisations for information.

During this inspection, the inspection team:

spoke with 3 people in the service,

spoke with 14 members of staff including a doctor, maintenance staff, occupational therapist, psychologists, registered nurses, and support workers,

interviewed the registered manager,

looked at the quality of the hospital environment, including communal areas and the clinic,

looked at 4 peoples’ care and treatment records in detail,

looked at 7 people’s medicine records

spoke with 2 family members of people who used the service,

observed peoples’ care,

attended one nurse handover,

spoke with the advocate,

looked at other documentation and records related to peoples’ care and overall governance of the service.

You can find information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 30 May 2023

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.

People’s experience of using this service and what we found

The service was not able to show how they met some of the principles of right support, right care, right culture all the time.

Right Support

The Model of Care and treatment setting maximised people’s choice, control and independence for people who were settled. It prepared people to take the final steps of their rehabilitation before going to community placements. However, the Model of care and setting did not meet the needs of people who were also experiencing acute mental ill health or people with limited mobility. Staff were clear that if a person with limited mobility was referred to the service, they would not be able to meet their needs. Managers accepted that this would limit their quality of life as they would find it difficult to access the garden and the cobbled stones in the car park would limit their opportunity to use the salon and access the meeting room.

People told us staff supported them to take part in activities and to pursue their interests in their local area when the hospital was settled. One person said they liked to go out for walks and could go out when they wanted to with staff. People had opportunities to use local facilities for learning, education, and voluntary work. Permanent staff supported people whenever possible to play an active role in maintaining their own health and wellbeing. Staff gave people information about accessing well woman checks and supported people to attend these. The service provided care and support in a safe, clean, and well-furnished, environment. Although space was limited, the service prided itself on providing a homely environment in which people could develop their skills and knowledge, to help them move onto community settings. However, some people said they did not always know staff because they did not wear clear name badges and there was no photo board of staff they could refer to.

Right Care

Care is person-centred and promotes people’s dignity, privacy, and human rights. However, not all staff knew of, or understood all peoples care needs. Some staff did not always meet the individual care needs identified or treated people in a way that encouraged them to achieve their potential. While care plans were person centred and showed people’s goals for treatment and hopes for their future not all staff were following the care plans, risk management plans or positive behavioural support plans. Risk management plans, while appropriate for the person they were intended for, did not always consider the impact they would have on other people using the service.

The service worked well with other agencies such as the local authority and the police to manage safeguarding. They had worked hard to strengthen their links with their Integrated Care Board. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

The ethos, values, attitudes and behaviours of leaders and most care staff ensured people using services led confident, inclusive, and empowered lives. Most staff placed people's wishes, needs, and rights at the heart of everything they did. The registered manager and all staff understood the importance of family to people. However, one relative said communication could be better, they were unable to attend their relative’s last review and did not receive notes from it. However, another relative told us that because they lived a long way away and did not drive the provider had paid for them to travel to Matlock and stay overnight so they could see their relative. The relative also told us the doctor rearranged their relative’s care and treatment review to coincide with their visit, so they could be present. People, and those important to them, were involved in planning their care. People said they liked going out but due to the remote location many outings had to completed using the hospital minibus. One person thought having the hospital minibus was a good thing as they could go further afield with their friends and in safety. People's quality of life was enhanced by the service's culture of improvement and inclusivity.

The service had policies and systems in place to support people in the least restrictive way. Although staff used these to support people who had acute mental health needs, the restrictive practices negatively impacted on other people who did not have these needs. However, leaders in the service had worked hard to create a learning culture. Most permanent staff we spoke with said they felt valued and empowered to suggest improvements and question poor practice. There was a transparent, open, and honest culture between people, those important to them, staff, and leaders. They all felt confident to raise concerns and complaints.

SUMMARY

Our rating of this service went down. We rated it as requires improvement because:

Not all temporary staff knew the people they were looking after, this prevented staff from interacting with people in a way that encouraged people to achieve their potential and ensure all peoples individual needs were met.

People using the service did not always know who the staff were. Staff did not wear clear name badges and there was no staff photograph board in the communal area. This could have prevented people from feeling comfortable enough around staff to exercise their autonomy.

People could not always access support from independent advocacy. The advocate was not able to be in the communal areas when people were distressed.

Some staff were not always aware of individual risk. Some support staff were not always following individual risk management plans. While risk management plans were adequate for the person they were intended for, they did not always consider the impact of a person’s actions on other people and visitors.

There was no evidence to show how staff monitored people’s physical health if the person declined physical observations. We reviewed two people’s records; one person was on high dose anti-psychotic medicine and the other person required intra-muscular rapid tranquilisation.

Staff were not always following handwashing procedures. There was risk of cross contamination from people’s laundry. Staff had not separated out people’s laundry and there no process for keeping dirty laundry separate from clean laundry.

Staff had not cleaned the splashback around the sink in the therapy kitchen. Staff had not cleaned a medicines trolley or inside a clinic room cupboard properly.

Due to the design and layout of the hospital the environment was not suitable for people who were experiencing acute mental ill health or who had a history of using ligatures. Staff could not control the heating in the communal areas of the hospital. On the day of our inspection the communal areas were uncomfortably hot.

Although audits and governance were in place some of the systems and processes had not been used to full effect.

Apart from the new manager and new Head of Care the registered nurses did not have a learning disability background. Registered nurses were not always present in communal areas and were not providing leadership or positive role modelling for healthcare support workers.

Managers were not monitoring support staff’s competency or understanding following completion of their online learning disability training. Therefore, some staff were not always confident when working with people with a learning disability and autistic people.

The admission policy did not identify what measures should be in place if a newly admitted person was later found to be too acute for the service to manage safely. Due to its design and layout the hospital environment was not suitable for acutely unwell people. We judged that the provider should address this issue.

Staff did not always follow the new protocol for administering medicines ‘when needed’. We judged that the provider should address this issue. Staff had not ensured that the glucose monitors taken in by people using the service were all calibrated.

However:

There was a full multidisciplinary team of staff working in the hospital. Their specialist assessments were thorough and comprehensive.

Information about people who use the service was easily accessible in both electronic and hard copy format. Positive behaviour support plans, and risk management plans were available in easy read and grab sheet format.

There were enough staff to meet people’s needs.

Although the registered manager and new Head of Care were new to the service, having only been in post five weeks, both were experienced in hospital management and caring for people with learning disability and autistic people.

Managers at the hospital were responsive and keen to learn from our inspection findings. Within two weeks of our onsite visit, they had already sent an action plan and evidence of having addressed the issues we raised in our initial feedback.

Updated 30 May 2023