The Care Quality Commission
  • Mental Health
  • Independent mental health service

Cygnet Hospital Wyke

Overall: Good read more about inspection ratings

Blankney Grange, Huddersfield Road, Lower Wyke, Bradford, West Yorkshire, BD12 8LR (01274) 605500

Provided and run by:
Cygnet Health Care Limited

All Inspections

During an assessment of Acute wards for adults of working age and psychiatric intensive care units

Cygnet Hospital Wyke is an independent mental health hospital provided by Cygnet Health Care Limited, situated in West Yorkshire. The hospital is registered with the Care Quality Commission to provide care and treatment for up to 46 patients and the following regulated activities:



• Treatment of disease, disorder or injury

• Assessment or medical treatment of persons detained under the Mental Health Act 1983.



The hospital has a registered manager and accountable controlled drugs officer. We have inspected this location 14 times previously.



This assessment took place between 26 - 28 November 2024 and we announced it on 25 November 2024. The location was previously assessed in January 2024, rated as inadequate and placed into special measures. There were concerns about medicines management, quality of care records, monitoring patients with physical health conditions, checks of medical equipment, compliance with the Mental Health Act, infection control, blanket restrictions, autism awareness and completion of patient risk assessments.



The majority of the concerns related to the long-stay rehabilitation ward, Adarna. The provider had taken the decision to discontinue this service, so this latest assessment only relates to the acute wards for adults of working age and psychiatric intensive care unit. There were 2 acute wards (Kingfisher, Phoenix) and 1 psychiatric intensive care unit (Bennu).

We gathered information from people using the service, their loved ones, staff and other external stakeholders. We observed the care being provided and reviewed a range of documents relating to the running of the hospital.

We rated the service as good. The service had made improvements and was no longer in breach of regulations.



The provider has demonstrated improvements that have been made. The service is no longer rated as inadequate overall or in any of the key questions and is, therefore, no longer in special measures.

During an assessment of the hospital overall

Cygnet Hospital Wyke is an independent mental health hospital provided by Cygnet Health Care Limited, situated in West Yorkshire. It has been registered with CQC since November 2010. The hospital is registered to provide care and treatment to up to 46 patients and the following regulated activities:



• Treatment of disease, disorder or injury

• Assessment or medical treatment of persons detained under the Mental Health Act 1983.



We conducted an onsite assessment of the location from 26 - 28 November 2024. The assessment was announced on 25 November 2024. The location was assessed as we rated it as inadequate and placed in special measures following an assessment in January 2024 due to concerns about medicines management, quality of care records, monitoring of patients with physical health conditions, checks of medical equipment, monitoring of compliance with the Mental Health Act, infection control procedures, blanket restrictions, autism awareness and completion of patient risk assessments.



The majority of the concerns related to the long-stay rehabilitation ward, Adarna within the hospital at the time. The provider, Cygnet Healthcare Limited, had taken the decision to discontinue this service, so this latest assessment only relates to the acute wards for adults of working age and psychiatric intensive care unit.



The acute wards for adults of working age and psychiatric intensive care unit comprised 3 wards for male patients; Kingfisher and Phoenix were the two acute wards and Bennu was the psychiatric intensive care unit.



The hospital had a registered manager and an accountable controlled drugs officer. We have inspected this location 14 times previously. At this inspection, we inspected all five key questions across all three wards.



We gathered information from people using the service and their loved ones, staff and other external stakeholders. We observed the care being provided and reviewed a range of documents including care records and policies and procedures relating to the running of the hospital.

We rated the service as good. The service had made improvements and was no longer in breach of regulations. The quality of care records had improved. Risk assessments were up to date and were being regularly reviewed. The medicines management processes in the hospital were in-line with good practice. The provider now had enough staff to ensure people’s safety and meet their needs.



The provider has demonstrated improvements that have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures.

15, 16, 17 January 2024

During a routine inspection

Our rating of this location ​went down​. We rated it as ​inadequate​ because: 

  • We have taken enforcement action against the provider to make sure they improved their governance systems. This normally limits the rating for that key question to inadequate.

  • The service was not always well led and the governance processes did not always ensure that ward procedures were effective. There were gaps in governance processes that failed to identify areas of concerns.

  • The service did not provide safe care. It did not manage medicines, medicine fridges and medical supplies safely and risk assessments were not always complete. Medicine records were found to have been filled in retrospectively by staff when gaps were identified at our inspection. Prescribed medicines were not always in stock and available and that accurate records of medicines were not always made. Medicines were not always lawfully prescribed prior to administration.

  • The service was using both a paper and electronic records system, we found that paper records did not contain the most up to date risk assessments for people in 4 out of 4 records we reviewed on Adarna ward.

  • Staff on Adarna ward were not all bare below the elbow in accordance with the provider’s own policy.

  • The environment was not always clean, we found food on the floor, staining on furniture, cigarette ends in the lounge and some of the furniture was ripped.

  • Staff on Adarna ward did not always understand the individual needs of people. They did not always actively involve families and carers in care decisions. Care plans on Adarna ward did were not always of sufficient quality and detail to meet the needs of people

  • Physical health was not always managed safely on Adarna ward in respect of bowel monitoring, particularly for people taking medication that caused a risk of bowel obstruction.

  • The ward environment on Adarna ward was still too noisy and steps taken to reduce the level of noise for people since our last inspection had not been fully effective.

  • On Adarna ward Staff restricted people’s access to items on the ward and this was not always based on individual needs.

However:

  • There was enough staff working on the wards to keep people safe with low levels of vacancies. The wards had enough nurses and doctors. Staff followed good practice with respect to safeguarding and complaints. Use of restrictive practices was minimised.

  • Mandatory training compliance rates were high and managers had oversight of when training was due to be renewed.

  • Staff provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.

  • 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 and the Mental Capacity Act 2005.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity.

  •  Therapeutic activities took place and people described things they enjoyed doing both on and off the ward.

  • Staff worked well with external stakeholders and professionals to support people’s discharge plans.

Letter from the Chief Inspector of Healthcare, Dr Sean O’Kelly:

"I am placing the service into special measures. This is because the service has had two inadequate ratings against any key question on two consecutive inspections. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration."

6-9 September 2022

During a routine inspection

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

  • The service did not always provide safe care. The ward environments were not always safe, clean or well-maintained. Medicines were not always managed safely. Emergency equipment was not always accessible.
  • A high proportion of patients on all three wards had experienced violence or aggression from a peer and the provider was not taking sufficient action to work towards reducing this.
  • Ward teams did not always have access to the full range of specialists required to meet the needs of patients on the wards. Staff were not always receiving regular training updates or appraisals.
  • Staff on the specialist rehabilitation ward had not always had training to support them in meeting the specific needs of the patient group on this ward and as a result were not always able to meet patients’ needs.
  • Staff did not always actively involve patients and their families and carers in care decisions.
  • Patients were not always well supported in relation to their cultural and spiritual needs.
  • We identified blanket restrictions which were not justified on the basis of risk and these had not always been recognised by the provider.
  • Governance processes were in place but these did not always ensure that wards ran smoothly.

However:

  • The wards had enough nurses, doctors and support staff. Staff assessed and mostly managed clinical risks well. They minimised the use of restraint and seclusion and followed good practice with respect to safeguarding.
  • 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 and the Mental Capacity Act 2005.
  • Staff usually treated patients with compassion and kindness, and respected their privacy and dignity.

24 to 25 February 2021

During a routine inspection

In June 2019 we placed Cygnet Hospital Wyke into special measures following a comprehensive inspection of the service; including one ward for older people with mental health problems and the acute and psychiatric intensive care service.

We inspected Cygnet Hospital Wyke in February 2021 because we received information giving us concerns about the safety and quality of the services currently provided. We inspected one new service, a high dependency rehabilitation ward for men suffering a mental illness with an additional diagnosis of Autism Spectrum Disorder. In addition, we also inspected the existing acute and psychiatric intensive care wards.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Our rating of this location improved. We rated it as requires improvement because:

  • Since our last inspection, the provider had taken action to increase patient safety and improve the quality of care. However, at this inspection, we identified issues with governance and some areas of practice had deteriorated due to the re-prioritisation of resources during the Covid 19 pandemic.
  • Across both core services, staff did not receive regular supervision and all the mandatory training elements required. The climb risk assessments relating to outside space across the hospital did not contain completion dates and the ligature risk assessment for Adarna ward was incomplete.
  • Staff on Adarna ward did not always regularly check the resuscitation equipment.
  • Staff did not always monitor patients’ physical health after administration of medication by injection in line with providers policy and national guidance. On Bennu and Phoenix wards, seclusion records were not in line with the provider’s policy or Mental Health Act code of practice.
  • Staff and managers did not use the full clinical audit process effectively to identify issues and improve the quality of care.
  • On Adarna ward, the understanding and application of the model of care was inconsistent, staff did not plan for patient discharges effectively and did not always record the views of relatives and carers.
  • The care environments were not always fully therapeutic. The environmental noise from Bennu ward impacted on patients below on Adarna ward. Patients on Bennu and Phoenix wards had limited dedicated activity and therapy space in the hospital.
  • The seclusion room required decoration and repair. On Bennu ward, there was a protruding hinge on a bedroom door.

However:

  • Staff provided patients with compassionate and respectful care. Staff had effective de-escalation skills and there was a commitment to reducing restrictive practices.
  • Across the hospital, the multi-disciplinary teams were newly established and developing working relationships internal and external to the hospital.
  • Leaders were visible and supportive. Staff could raise concerns confidently without fear.
  • The hospital was clean and mostly well maintained. Staff followed infection prevention and control measures very well.
  • Staff involved patients in their care and treatment and recorded their views in their care plans. Staff completed comprehensive patient risk assessments and ensured these were regularly updated.
  • On Bennu and Phoenix wards, staff managed the beds available well and there were no discharges delayed other than for clinical reasons.

31 October 2019

During an inspection looking at part of the service

  • Staff were positive about the changes at the hospital. Staff had received additional training in observations and in ligature risks. Staff knew what the current risks for the patients were. Staff were clear about the observations policy and how observations were recorded.
  • Patients had risk assessments and risk management plans in place. Risks were discussed daily and updated in progress notes. Patients had care plans.
  • The hospital had adequate staffing levels and there was no use of bank or agency staff.
  • Managers were visible on the ward and were providing support to staff. Governance systems had been implemented.

2 to 4 June 2019

During a routine inspection

The Care Quality Commission are placing this service into special measures.

Due to the concerns we found during this inspection, we used our powers under section 31 of the Health and Social Care Act to take immediate enforcement action and placed conditions on the provider’s registration in relation to regulation 12 (safe care and treatment) and regulation 17 (good governance). Because of the enforcement action we have already taken, the ratings for the safe and well led key questions are limited to a rating of inadequate.

The enforcement action has concluded, and we are continuing to review this service with the provider in relation to the areas of improvement identified in this report.

We rated Cygnet Hospital Wyke as inadequate because:

  • The provider was not delivering safe care. People were not safe and were at high risk of avoidable harm. Staff had not undertaken risk assessments of the care environment or mitigated those risks. For patients who were at a higher level of risk, staff did not follow processes and procedures to mitigate these through appropriate monitoring. The service used restrictive interventions that were not always proportionate to the risk posed, and staff did not keep proper records of restrictive interventions.
  • There were blanket restrictions in place which were not proportionate to the risks presented, such as the monitoring of patients’ mail and procedures relating to takeaway food and visiting arrangements.
  • The provider was not delivering effective care. Not all patients had care plans which were holistic, and goal orientated, and none of the patient care plans we reviewed contained a detailed, goal orientated discharge plan. The provider did not offer sufficient therapeutic activity to patients such as clinical psychology and occupational therapy. Not all patients had the required physical health observations undertaken on admission to the service. The provider did not adhere to the Mental Health Act and Mental Capacity Act Codes of Practice. In patient files we reviewed we did not see evidence of staff undertaking and documenting any decision specific capacity assessments or best interest discussions with patients who staff had noted lacked capacity to make specific decisions. When these had been undertaken, the principles and guidance in the related Code of Practice had not been followed. Staff did not always make timely referrals for a second opinion doctor.
  • The care provided was not always kind and respectful. During the inspection we observed behaviour from staff towards patients which was antagonistic and not always respectful and dignified. The carers and families of patients did not feel involved in the care of their relative.
  • The service was not always responsive to the needs of individual patients. There was a lack of activity available for patients on Austen and Branwell wards.
  • The service was not well led. When risks were highlighted to the service via external bodies, the provider did not act in a timely manner to make the required improvements. Processes and practices were not always taking place according to the provider’s policies. There was little understanding or management of risks, and there were significant failures in performance management and audit systems and processes. Ward level audits were either not effective at identifying these issues or action did not take place to address the issues identified at all, or in a timely way.

19 June 2019

During a routine inspection

Due to the concerns we found during this inspection, we used our powers under section 31 of the Health and Social Care Act to take immediate enforcement action and placed conditions on the provider’s registration.

We continue to take enforcement action against this service and will produce a supplementary report once this is completed.

We also continue to use our powers to undertake criminal investigations.

We did not re-rate this service following this focussed inspection:

  • The provider was not delivering safe care. People were not safe and at high risk of avoidable harm. Staff had not undertaken risk assessments of the care environment and mitigated those risks. Where patients demonstrated higher levels of risk staff did not follow processes and procedures to mitigate these via appropriate monitoring and recording of observations. Staff did not report all incidents to allow risks to be acted upon. The service had a poor track record of safety and had not learnt lessons when things had gone wrong. Staff were not all trained in observation and engagement.
  • The service was not well led. When risks were highlighted to the service the provider did not act in a timely manner to make the required improvements. Processes and practices were not always taking place according to the provider’s policies. There was little understanding or management of risks and issues, and there were significant failures in performance management and audit systems and processes. Ward level audits were either not effective at identifying these issues or action did not take place to address the issues identified at all, or in a timely way. There was a culture at the service which leaders had not addressed where staff continued to not follow the procedures in place to ensure the delivery of safe care.

8 and 9 November 2018

During an inspection looking at part of the service

The inspection of Cygnet Hospital Wyke commenced on 8 November 2018 and was unannounced. The inspection was prompted by notifications of seven incidents following which two patients using the service sustained serious injuries. These incidents may be subject to criminal investigation by the Care Quality Commission and as a result, this inspection did not examine circumstances of the incidents. However, the information shared with CQC about these incidents indicated potential concerns about the management of risk such as falls from height, ligature risks, environmental risks, observation and engagement and staffing, this focussed inspection examined those risks.

We found the following issues that the provider needs to improve and have already taken urgent enforcement action to ensure improvements are made to the safety and management of the hospital. The service has begun to work on these improvements, and are engaging with the Care Quality Commission in this process.

  • People were not safe and were at high risk of avoidable harm. This was because the safety systems, processes and standard operating procedures in place were not fit for purpose. This had caused unacceptable levels of serious incidents and incidents of harm to patients. There was limited measurement and monitoring of safety performance. Staff did not recognise concerns, incidents or near misses and missed opportunities to prevent and minimise harm.
  • Staffing levels were not adequate, agency staffing was not well managed, staff had not completed all mandatory training, did not assess risk adequately, and did not carry out observations of patients as prescribed, which had all had a direct impact on patients
  • The service did not give sufficient priority to safeguarding patients. Staff did not report all incidents to the local safeguarding authority and did not notify the Care Quality Commission of all incidents as per their registration regulations. This meant that other professionals could not be aware of the risks and issues to enable them to protect patients from harm.
  • The hospital was not well led. The governance systems and process were ineffective because they had not identified the issues and risks for the service. There was a lack of ward level clinical leadership, this meant that the expectations of senior managers were not being met but there were no checking processes in place to identify this. There was little evidence of learning from events or action taken to improve safety. The culture of the hospital was poor, staff had low levels of morale and were highly stressed, they felt unable to raise concerns. The provider had failed to act on early indicators of this

.

21 to 23 February 2018

During a routine inspection

We rated Cygnet Hospital Wyke as requires improvement because:

  • We had concerns about the use of physical interventions, because staff delivered intra-muscular medications to patients while using planned prone (face down) restraint which is high risk and against national guidance. The recording of restraint holds and some seclusion records did not contain sufficient detail to assure the service that practices were safe and delivered in line with management of aggression and violence training.
  • Staff did not always follow infection prevention and control principles or guidance.
  • Care and treatment did not always reflect current evidence-based guidance because we could not see evidence in patient care plans that staff always implemented the service’s methods of positive behaviour support planning with patients who presented with behaviours which were challenging. The care plans we reviewed did not demonstrate the involvement of patients and their carers or relatives.
  • On Fairfax ward staff did not always record consent in line with relevant legislation because there was a lack of consistency in how staff assessed people’s mental capacity.
  • Some patients who used the service and their carers had concerns about the way staff treated them in the acute and psychiatric intensive care services.
  • The service did not always provide care to patients on Fairfax ward which was dignified because there was a paternalistic approach to care on the ward which had led to a number of blanket restrictions being in place. These blankets restrictions did not allow patients to have autonomy and independence. Patients on this ward had limited opportunities to give feedback. Patients did not always have somewhere to hang their clothing and not all patients had somewhere safe in their bedroom to store their possessions
  • The service did not always manage complaints well. Responses were not always satisfactory and the service did not use complaints as an opportunity to learn and improve.
  • On Fairfax ward there was limited information available about how to make complaints and there were no admission leaflets available for patients or carers that explained the purpose of the service and the facilities available. Fairfax ward did not meet the needs of all people using the service because it was not a dementia friendly environment.
  • The approach to monitoring risks and the quality of the services did not always identify all risks and concerns. Where issues were identified, the management team did not always take action in a timely manner, and give those issues high priority.
  • Time limited action plans were not in place for all areas of concern. Managers did not always discuss and record all areas of their governance agenda such as serious incidents and complaints outcomes. This meant that there was limited opportunity for learning, improvement and monitoring. Where the service had begun to take action on areas of concern relating to restraint techniques and recording and specialist training for Fairfax ward staff plans had not been recorded. The governance structure that the service had in place did not take into account the outcomes of ward level audits and there was a lack of firm and time limited action plans in place to improve areas of low compliance.

However

  • Staffing levels and skill mixes were planned, implemented and reviewed to keep people safe at all times. The service responded quickly to staff shortages and ward managers managed the use of temporary staff with care. There were effective handovers and shift changes, to ensure staff could manage risks. The service monitored, assessed, and managed individual patient risk thoroughly and on a day-to-day basis. There was a clear incident reporting system in place which all designations of staff used, and staff were encouraged to report incidents and near misses.
  • Since the time of our inspection in November 2017 staff had made significant improvements to environmental safety on Fairfax ward. The service managed medicines well, and there were clear audits in place to monitor this which evidenced improvement. Staff knew and understood their responsibilities to report and prevent abuse and the service was working closely with partners in the Local Authority.
  • Patients had comprehensive and holistic assessments of the entirety of their needs and the service gave high priority to the monitoring and management of patients’ physical health needs.
  • There were clearly defined processes in place for the management of the Mental Health Act.
  • A detailed clinical audit system was in place which all designations of senior staff were involved with to improve and monitor patient care. The service had a varied and skilled multi-disciplinary team who worked together to provide holistic care and treatment plans for patients and offered therapies in line with national best practice guidelines.
  • Patients had access to advocates who supported them to raise complaints or concerns. Advocacy services formed part of the governance meeting each month to ensure the service embedded the importance of their use.
  • Patients had discharge plans in place on the acute and psychiatric intensive care wards, and the service was discharged focussed. The acute and psychiatric intensive care services worked with patients on developing their skills for independence in preparation for discharge. Patients on all wards had access to a variety of activities and therapies to support their recovery. There were adjustments on Fairfax ward to support the needs of patients with mobility needs such as hoist and tracking equipment.
  • The senior leadership team at the service were knowledgeable, experienced and qualified. The governance structure was well established and was important to the service. Staff in all areas of the service knew and understand the vision and values of the organisation. The service was open and transparent and worked well with its partners. Staff said that they felt valued and supported and the outcome of staff surveys was important to the organisation, who had put immediate action plans into place to address concerns.
  • The acute and psychiatric intensive care services had implemented safe wards methodology as part of an ongoing programme to reduce restrictive practice. Austen ward had achieved accreditation of inpatient mental health services. To achieve accreditation, a psychiatric intensive care service has to demonstrate that the quality of care they provide to service users meets or exceeds the national guidelines and standards.

16 November 2017

During an inspection looking at part of the service

This was a focussed inspection based on concerns we had received about the safety of Fairfax ward. Ratings have not been given for this inspection.

We found the following issues that the provider needs to improve:

  • The management of environmental risks was poor and we had concerns about the management of medication. Not all staff were trained in areas, which would help to ensure that patients were cared for safely and which reduced the risk of harm. There was not a clear process in place for staff to assess and manage patients’ risks in areas such as their mobility, eating and drinking and in relation to needs for the use of restraint. When risks were identified, staff had not taken action to reduce risks and prevent harm.

  • Staff did not record whether they had used de-escalation techniques with patients prior to the use of restrictive physical interventions. Staff did not record exceptional circumstances for the use of prone restraint.

  • The governance systems in place did not ensure the delivery of safe and high quality care. Staff did not always follow guidance and procedures set by the provider. Internal audit and governance systems had not highlighted concerns we identified on inspection such as the poor recording of restraint and the increased falls taking place on the ward. We had made previous recommendations to the provider, which they have not acted upon to improve, the safety and quality of patient care.

However, we also found the following areas of good practice:

  • The provider responded quickly to our concerns and made immediate improvements to enhance patient safety.

  • Patients were engaged in activities during our inspection.

25 July 2016

During an inspection looking at part of the service

We inspected the safe domain on Fairfax Ward at Cygnet Hospital Wyke

We also inspected the seclusion facilities in relation to the previous Care Quality Commission inspection on the 22 – 25 June 2015, where we found Cygnet Hospital Wyke to be in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the seclusion room did not fully meet national guidance requirements. At this inspection, we found that improvements had been made at Cygnet Hospital Wyke.

We also reviewed the incidents of restraint, including the use of face-down floor (prone) restraint on Fairfax Ward at Cygnet Hospital Wyke. This was because at the previous Care Quality Commission inspection on the 22 – 25 June 2015, we found Cygnet Hospital Wyke to be in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because they had not introduced measures to reduce the use of face down floor (prone) restraint by staff on all three of its wards. Face down restraint can put patients at risk of asphyxiation. We found that improvements had been made on Fairfax Ward where we completed this inspection.

22 - 25 June 2015

During an inspection looking at part of the service

We gave an overall rating for Cygnet Hospital Wyke as good because:

The registered manager visited the wards most days.

The ward managers:

  • Had clinical audit and governance in place to help provide a quality service.
  • Reviewed and increased the number of staffing to meet patients’ needs.
  • Monitored and reviewed staff compliance with completing patients’ physical assessments.
  • Reviewed national guidance to ensure best practice.
  • Produced and reviewed hospital and corporate risk registers, which had recommendations and timescales.
  • Listened to patients’ concerns and complaints, and responded to them.
  • Had procedures in place to make sure staff assessed patients’ needs on admission and discharge.

Staff:

  • Understood the management structure and saw it as supportive.
  • Said they liked working at the hospital – morale was generally good, they worked well as a team and their direct line, clinical, and hospital managers supported them.
  • Followed good practices for the control, and spread of infections.
  • Completed training to gain the skills to care for patients safely.
  • Reported and investigated incidents, and learned from them.
  • Routinely increased how closely they observed patients and responded promptly to any changes in the patients’ presentation to keep patients safe.
  • Following their admission staff completed comprehensive and timely assessments of the patient’s needs.
  • Reviewed and monitored patients’ care and treatment needs at multidisciplinary team meetings.
  • Made sure patients could take part in activities that the occupational therapists led on weekdays.

      However,

  • The seclusion room did not fully meet National Institute for Health and Care Excellence (NICE) guidance and Mental Health Act code of practice 2015. For example, from either of the two observation panels one member of staff could not see the whole of  the seclusion room.
  • The provider had not introduced measure to reduce the use on patients of face down floor (prone) restraint by staff. Face down restraint can put patients at risk of asphyxiation.
  • The wash basin taps in bedrooms and communal bathrooms were a risk for patients who may have self-harmed by hanging. The provider had agreed plans to replace the taps, but the action plan had no starting date and the completion date was in 2017 or sooner.
  • Staff had not completed the patient’s physical observations after giving rapid tranquilisation, for two patients out of 11.
  • On Austen and Branwell wards, most patients said staff involved them in their care and treatment, but patients’ records did not reflect this.
  • Staff had not always completed documentation relating the Mental Health Act to a satisfactory standard.

8, 10 January 2014

During a routine inspection

The inspection took place over two days. The inspection team consisted of two inspectors and a specialist adviser who looked specifically at the use of restraint and what actions staff had taken to safeguard patients from abuse. A second specialist adviser reviewed how the provider monitored and assessed the quality of the service they provided.

A Mental Health Act Commissioner also visited Austen ward and looked at whether the service had detained patients appropriately and followed the Mental Health Act 1983 Code of Practice.

During the inspection, we visited three wards. Austen ward, a 14 bed psychiatric intensive care unit. Fairfax ward, a 17 bed locked ward for older males with challenging behaviour and Branwell ward a 15 bed acute admission unit. We talked with approximately six patients, ten staff and we looked at patients care records.

We found patient's needs were assessed and care and treatment was planned and delivered in line with patients' individual needs.

There were systems in place which had helped to ensure patients were safeguarded from abuse.

The provider had made improvements to patient records and the records we looked at had been monitored by the manager to make sure they were appropriate and accurate.

However we found improvements were needed because the provider did not have robust arrangements in place to monitor and assess the risks to the patients and the service.

28 November 2012

During a routine inspection

Our expert by experience talked with five patients on Bronte ward and four patients on Shelley ward. Six patients told us they had attended meetings with the health professionals (multi-disciplinary team and community programme approach meetings) where they had been able to contribute to how they would like their care and treatment planned. One said 'I put my own points of view forward'.

Seven patients told us they were aware of the advocacy service and were able to provide us with the name of the worker who came to the wards. One said 'yes, talk to them quite a lot but still cannot get out'.

We asked seven patients if they felt their needs were met, four said 'yes' and three told us 'fifty, fifty'. Six told us staff responded promptly if they needed help.

Four patients told us there was enough staff and four told us there was not enough staff to meet their needs. When we asked why one patient told us 'there are not enough staff to take us out on visits', and another patient told us 'today at dinner time there were no staff around'.

Despite the positive comments people made, we found improvements needed to be made to ensure the records were maintained to a sufficient standard to ensure patients received the care and treatment they needed.

29 February 2012

During an inspection looking at part of the service

We carried out a visit to Austen ward at Cygnet Hospital in Wyke on 29th February 2012 to follow up compliance actions made following our last review of compliance at Cygnet Hospital in November 2011. Because we needed specific information from the management to demonstrate their compliance with the essential standards, we did not need to speak directly with patients from the wards.

24 November 2011

During an inspection looking at part of the service

We carried out a visit to Cygnet Wyke on 24 November 2011 to follow up compliance actions made when we last visited this service in August 2011. The compliance actions related specifically to Austen ward. Because we needed specific information from the management to demonstrate their compliance with the essential standards, we did not need to speak directly with patients from the ward.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.