Cygnet Bury Forestwood

Updated 15 August 2022

Cygnet Bury Forestwood has been registered with the Care Quality Commission since 30 April 2021.

Cygnet Bury Forestwood has 44 beds for children and young people aged 13 to 18.

There are four wards;

Mulberry ward- Low secure ward for females, with 12 beds

Primrose ward- PICU for males and females, with 12 beds

Buttercup ward- Low secure ward for females, with 8 beds

Wizard House – General adolescent ward for males and females, with 12 beds

Children and young people were admitted from across the United Kingdom due to the demand for beds.

Cygnet Bury Forestwood is registered to provide the following regulated activities:

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

The service has a registered manager and a controlled drugs accountable officer.

This is the first inspection of this registered location.

What people who use the service say

We spoke with 19 children and young people and 13 family members for feedback about the service.

Children and young people

Young people had mixed views about the service. Ten young people said staff care and provide good support. Five young people talked positively about their doctors, who were approachable and listened to them and they could see them in between ward rounds.

Ten people talked about easy access to advocacy and valued the support of the advocate.

All young people said their families were involved in their care and updated on their progress however, one young person did not want contact with family and staff respected this.

Three young people talked positively about their access to psychological therapies of dialectal behavioural therapy and family therapy. However, seven young people said they did not have access to psychological therapies.

Following incidents two young people said how helpful it was to reflect following incidents and be supported through this.

Areas for improvement from young people’s perspectives included 11 young people told us there were no activities at a weekend and they got bored.

Twelve young people said there was not enough staff, especially at nights where there is more agency staff who may not know the ward. This has led to activities and leave being cancelled or postponed. However, two young people said when there were regular agency staff working, they had the opportunity to get to know them and feel more comfortable.

Nine young people said that some bank and agency staff don’t knock before entering their rooms.

Four young people did not know how to complain to the service.

On Buttercup ward young people said the décor was childish in parts and they had ideas to improve the décor and would like to be involved.

Eight young people said the food was unhealthy, with chips available at most meals. Two young people on Wizard House had found ants in their food. Young people also said there was limited vegetarian and vegan food choices.

Four young people said the wards were not clean.

Families

Families we spoke with had mixed experiences of the service.

Things that they said the service did well was; four family members received information about the service when their relative was admitted to the hospital.

They valued the input of the speech and language therapy provision in relation to assessments and making information more accessible for young people.

Families all received information about their relative, usually with a daily phone call for an update.

However, five family members said the information was not always that accurate, with them not being informed of incidents within the updates. This included from staff that didn’t work at the service regularly, therefore they did not know their relative well.

Six family members told us there was not enough psychological therapy for their relative, with there being staff vacancies and trainees and other staff from adult services providing cover, this meant children and young people were not receiving the therapy they thought they would receive in hospital. This included staff’s understanding of autism and trauma informed care.

Family members told us at times there had been a mix up with planning to visit and a room wasn’t available when they arrived. Families also told us that the increase in petrol costs meant families could not visit as often as they would like due to the cost of the journey as several families lived a long distance from the service.

Updated 15 August 2022

We rated it as requires improvement because:

• The service did not always provide safe care. The ward environments were not all well maintained and clean. The ligature risk assessments did not include the action that staff should take to mitigate the risks. The service did not manage medicines safely and staff were not following the provider’s dress code policy in relation to being bare below the elbow and staff having long, manicured nails Young people told us that they had been hurt when receiving care because staff had long nails.
• On Buttercup ward we saw that staff did not always maintain appropriate professional boundaries and were talking about their personal lives and ignoring the young person.
• The governance processes did not always ensure that staff were following policies and procedures in relation to dress code and professional boundaries. Learning from organisational whistle blowing’s had not been implemented fully. For example, the policy relating to resuscitation had not been updated to include paediatric resuscitation. The recommendations from pharmacy audits has not been sustained and medicines were still not being labelled appropriately which meant that staff may administer medicines incorrectly to young people.

However:

• Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Managers ensured staff received induction, training, supervision and appraisal. The ward staff worked well together as a team and with those outside the ward who would have a role in providing aftercare.
• The service provided a range of treatments suitable to the needs of the young people and in line with national guidance and best practice.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
• Staff treated young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs of young people. They actively involved young people and families and carers in care decisions.
• Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

Updated 15 August 2022