Cygnet Joyce Parker Hospital

Updated 28 September 2023

Cygnet Joyce Parker Hospital is a location operated by Cygnet Healthcare Ltd. The hospital provides mental health care and treatment for children and young people aged between 12 and 18 years.

The location is registered 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 hospital opened on 15 October 2020 and has 4 wards:

Dragon ward - a mixed gender children and young people’s low secure ward with 10 beds, which opened on 15 February 2021.

Mermaid ward - a mixed gender children and young people’s psychiatric intensive care unit, this ward has 10 beds and opened on 3 November 2020.

Pixie ward is a mixed gender general children and young people’s unit, this ward has 12 beds and opened on 15 February 2021.

Faun ward is a child and young female psychiatric intensive care unit, this ward has 8 beds and opened on 11 October 2022.

The hospital has been inspected 4 times since it opened. The last inspection was in January-February 2023. That was also a focused inspection which looked at the key questions of safe, caring and well-led. Following that inspection, the service was rated requires improvement for those 3 key questions. We issued requirement notices for regulatory breaches in the following areas: regulation 10 (Dignity and respect), regulation 12 (Safe care and treatment) and regulation 17 (Good governance).

We did not check if the service had made improvements following the inspection in January- February 2023 as the report was not published at the time of this inspection.

We received concerning information about Dragon ward, therefore this inspection only focussed on this specific ward. We inspected Dragon ward during the day and during the night. All the young people receiving treatment on Dragon ward were detained under the Mental Health Act 1983. There were 5 patients admitted to the ward when we began this inspection, 1 of whom was away on overnight home leave. A new young person was admitted to the ward during our inspection, bringing total patient numbers to 6.

The hospital had a registered manager and there was an Ofsted registered school on site.

What people who use the service say

We spoke with 4 young people using the service. We received a mixture of positive and negative feedback.

A young person was very positive about the service. They told us that staff were kind, listened to them and were very supportive, understanding what worked best for them. They told us Dragon ward was the best, mainly because staff were kind, more caring, understood them well and supported them when they were distressed, without putting them straight into seclusion and without over sedating them. They told us the hospital was clean and tidy, there was plenty of good food and there were enough activities to get involved in.

Two young people told us they worried about the wellbeing of staff. All the young people we spoke with told us they observed staff falling asleep while carrying out their safe and supportive observations during the night. One told us this was rare, but another told us it had happened often. We looked at incident records and patient community meeting minutes. We also reviewed CCTV footage. We found that when young people reported staff had been asleep on duty, managers investigated their claims. We were not able to conclude that staff regularly fell asleep whilst on duty. There had been 1 proven recent incident and following investigation by hospital managers, the provider took action in line with their policy.

Two young people told us they would prefer to have more female staff working on the ward. One of them told us if their safe and supportive observations were carried out by male staff, they would need to tell staff when they needed to use the toilet, so a female escort could be found. The young person found this embarrassing.

A young person told us “Some staff are lovely, and I owe them a lot” but different staff delivered different responses, which the young person found inconsistent. They told us they believed some staff overreacted when young people physically pushed them, falling to the ground when the force used to push them didn’t warrant it.

Young people told us they understood their care plans and there were low levels of physical restraint and seclusion on Dragon ward. They told us that not being put into restraint on a regular basis was preferable for them. However, some young people interpreted the lack of physical restraint as an indication that staff did not care when they tried to hurt themselves.

A family member told us their relative was safer on Dragon ward than they had been in other hospitals. They were secluded less, physically restrained less, were no longer over-medicated and were subject to less rapid tranquilisation than in the other hospitals. They approved of all these things. Another family member told us they “find it hard to fault” Dragon ward but think some support workers would benefit from additional training to understand the nuances of language and impact, for example, of a glance away, a smile at the wrong moment or a misjudged greeting. They also told us support workers sometimes shared information about themselves, which the family member felt was unprofessional.

Updated 28 September 2023

Our rating of this location stayed the same. We rated it as requires improvement because:

• Not all staff were discreet, respectful, and responsive when caring for children and young people. We identified one incident of staff not treating a young person with dignity and respect on Pixie ward. Children and young people said staff did not always treat them well and behave kindly. Six young people across Mermaid and Pixie wards raised concerns about how staff treated them.
• Staff did not always follow best practice in managing distressed and agitated behaviours. We were concerned about the frequency of use of rapid tranquillisation for one young person which meant the young person was being sedated on an almost daily basis. When a child or young person was placed in seclusion, staff kept clear records but did not always follow best practice guidelines. We reviewed six seclusion records across Mermaid and Dragon wards and identified three concerns in relation to the use of seclusion.
• Not all wards were safe. We identified potentially risky items on Pixie ward and issues with the seclusion rooms on Dragon and Mermaid wards. Staff on Dragon ward did not always complete weekly emergency bag checks and did not always complete cleaning records for the clinic room.
• Our findings from the other key questions demonstrated that governance processes did not always operate effectively. Service governance systems failed to identify one concern relating to prolonged seclusion. Managers had not applied sufficient scrutiny, sought external assurance or a second opinion to support the care and treatment of a young person with complex needs who was frequently administered rapid tranquilisation medication.

However:

• Staff involved children, young people and their families in care planning and risk assessment. Staff made sure children and young people could access advocacy services. We observed effective advocacy involvement on all wards. Staff supported, informed and involved families or carers.
• Staff assessed the physical and mental health of all children and young people on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed.
• The service had enough nursing and medical staff, who knew the children and young people. Staff completed and kept up-to-date with their mandatory training.

Updated 24 April 2023

Our rating of this service stayed the same. We rated it as requires improvement. See summary above for details.