- Independent mental health service
Cygnet Hospital Harrow
Report from 20 December 2024 assessment
Contents
Ratings - Wards for people with learning disabilities or autism
Our view of the service
The assessment of Springs Service took place on 4 December to 11 December 2024. Springs Servicecomprised of two wards: Springs Wing and Springs Centre, which are wards for people with learning disabilities or autism who may also have a co-existing mental health condition. Springs Wing had capacity for 10 patients, and Springs Centre had capacity for 14 patients. On the day of our inspection, there were 7 patients on each ward. Springs Service only admitted male patients.
We conducted this comprehensive assessment to follow up concerns raised at an inspection in May 2023. The overall rating for the service is nowgood, with notable improvements since the inspection in May 2023, which identified multiple breaches of regulations. These improvements reflect significant efforts by the service to address identified gaps and enhance care quality. During this inspection we found one breach of regulation.Springs Centre was using a vacant bedroom for the seclusion of one patient, that did not meet seclusion room specification. The provider must ensure that rooms used for seclusion are fit for purpose, as detailed in the Mental Health Act (MHA) Code of Practice 2015. We have asked the provider for immediate assurances around how they will ensure this room is fit for purpose.
Springs Service mostly provided safe care.The ward environments were safe and clean. The wards had enough nurses and doctors. Staff anticipated and managed risks to patients. Improvements were noted in incident reporting, staff training and safeguarding practices. However, the use of a vacant bedroom as a seclusion room on Springs Centre did not comply with national guidance and posed safety risks. Site refurbishment noise also impacted the atmosphere of the wards, though some mitigation efforts were in place.
The service provided personalised care plans, regular multidisciplinary reviews, and tailored therapeutic interventions. Staff compliance with mandatory training, including autism-specific modules, was high, supporting better patient outcomes. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
Staff treated patients with compassion, empathy and respect, promoting positive interactions and person-centred support. Patients reported feeling understood and supported by staff, who provided tailored activities and communication aids. The service had a pro-active ‘experts by experience’ programme to engage patients in developing the service.
The service provided person-centred care. Patients benefited from co-produced care plans, meaningful activities, and efforts to maintain family connections. Staff supported patients to meet their religious and cultural needs. Some challenges remained in evening activity engagement and reducing blanket restrictions, such as the locked kitchen in Springs Centre.
Leaders at all levels were knowledgeable, experienced and capable. Leaders had a clear vision for quality improvement and a proactive governance framework, enabling senior leaders to have good oversight of the service. Staff reported improved morale and confidence in senior management, reflecting a positive cultural shift.
We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
The service admitted patients under the Mental Health Act 1983. At the time of the inspection, all 14 patients in Springs Service were detained in hospital for treatment. Patient’s observation levels by staff varied from general observations, one-to-one, two-to-one and four-to-one.
Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice. Staff could describe the Code of Practice guiding principles. This training was initially provided as part of the induction process and thereafter staff had regular refreshers. In Springs Service, 94% of staff were compliant with their training in the Mental Health Act.
Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from the Mental Health Act manager, based at the hospital.During the morning staff huddle, we saw that the Mental Health Act Manager identified actions or paperwork that was required for specific patients on different days. This included flagging important upcoming meetings such as patient tribunals.
The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s notes each time. This was recorded in the patient's record. The multidisciplinary team explained patients’ rights to them during ward rounds. This included discussions about the right to appeal against detention.Information on the Mental Health Act and independent mental health advocacy was available in easy read formats on the ward notice boards.
Staff stored patients’ detention papers and associated records correctly and staff could access them when needed. The original copies of detention papers were held in locked filing cabinets in the Mental Health Act office. Copies of these documents were held on the ward.
Staff ensured that patients were able to take Section 17 leave (permission for patients to leave the ward or hospital) when this has been granted. The use of leave from the ward or hospital was discussed and agreed with the multidisciplinary team. Arrangements for leave were made at the wards’ daily planning meeting.
Mental Capacity Act
Staff received and kept up to date with training in the Mental Capacity Act. Staff had a good understanding of the five principles. Training on the Mental Capacity Act was mandatory for staff. This training was initially provided as part of the induction process and thereafter staff had regular refreshers. In Springs Service, 94% of staff were compliant with their training in the Mental Capacity Act.
Springs Service had a dedicated hospital social worker. Their role involved reviewing patients’ mental capacity assessments and legal status prior to discharge. They could detail upcoming discharges, and who would require a deprivation of liberty safeguards application for their new placement.
Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. Staff took all practical steps to enable patients to make their own decisions. Staff completed an assessment on admission of each patient’s capacity to consent to admission and treatment. Further assessments took place during reviews by the multidisciplinary team.
Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards. Staff told us that they found the social worker and safeguarding leads to be approachable and responsive.
People's experience of this service
During this inspection, we spoke with 9 patients. Feedback from patients was mostly positive. Patients said that staff were kind, helpful and responsive to their needs. Patients told us about the activities they were involved in, including therapeutic groups and recreational activities. These included music sessions, sensory based sessions, social skills groups, painting, managing the tuck shop and educational short courses.
Two patients were less positive about their experiences, saying there were still some communication issues with staff, food and activities available at the weekend are variable, and that the building works were noisy and disruptive to the ward environments.
Throughout our inspection, we saw positive interactions between staff and patients. We saw staff communicate with patients in a way that was suitable for their communication needs.
Cygnet Health Care actively incorporates experts by experience, individuals with lived experience of inpatient services, into its operations to enhance patient care and service development. For example, experts by experience visited the wards weekly to talk to patients about their experiences on the ward and areas for improvement. They had also been instrumental in co-producing projects such as the social hub and the redesign and development of the new wards in the hospital.