Cygnet Hospital Beckton

Updated 20 May 2022

We undertook this unannounced, focused inspection of Hooper Ward at Cygnet Hospital Beckton to follow up on whether improvements had been made since our inspection in March 2021.

The inspection in March 2021 was of the learning disability ward and Hooper Ward. At the time of that inspection, Hooper Ward was a psychiatric intensive care unit. We found instances of unjustified restraint, use of unauthorised restraint techniques and the physical abuse of a patient. The ward was rated as inadequate overall, and inadequate in the key questions, ‘are services safe, caring and well led’.

We served a Notice of Decision under section 31 of the Health and Social Care Act 2008, which placed a number of conditions on the provider’s registration, including that the hospital could not admit any more patients until further notice. The Chief Inspector of Hospitals also put the hospital into special measures.

In October 2021, CQC granted permission to admit further patients to the hospital. This permission was withdrawn in December 2021, following concerns and whistleblowing reports about staffing on the wards.

In March 2022, the CQC gave permission for the hospital to reopen Hooper Ward for up to six patients requiring care and treatment for acute episodes of mental illness. The ward reopened on 28 March 2022.

Cygnet Hospital Beckton is registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983. There was a registered manager in post at the time of the inspection.

What people who use the service say

Some patients said that the care and treatment they received was good and that staff behaved kindly towards them. Other patients found it difficult to express their views about the quality of care.

Updated 20 May 2022

Hooper Ward at Cygnet Hospital Beckton provides psychiatric intensive care for adults of working age. Our rating of this service improved. We rated it as good.

• The service provided safe care. The ward environments were safe and clean. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. This included prescribing oral antipsychotic medication in conjunction with psychosocial interventions. 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, including nurses, doctors, a clinical psychologist, an occupational therapist and a social work assistant. 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 most of 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, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Some patients said that the care and treatment they received was good and that staff behaved kindly towards them, although others patients found it difficult to express their views about the quality of care.
• The service managed access to beds well and patients were discharged promptly once their condition warranted this.
• The service was well-led and the governance processes ensured that ward procedures ran smoothly. Leaders had clear oversight of the safety and quality of care provided.
• Staff felt respected, supported and valued. They said the service promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

However:

• The service did not have enough permanent registered nurses but was in the process of recruiting to vacancies.
• Staff did not dispose of all out-of-date dressings and saline solutions in accordance with manufacturer's instructions
• Documents relating to patients’ care and treatment are were stored in different places and on different systems. The meant it could be difficult to access essential information quickly.
• Assessments of patients’ mental capacity were not complete on all the records.

Updated 3 March 2022

The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.

Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

Updated 20 May 2022

Our rating of this service improved. We rated it as good. See the summary above for details.

Updated 3 March 2022

Staffing on the personality disorder wards fell below the minimum required for safe nursing. The wards vacancy rate for registered nurses was 40% on New Dawn and 31% on Upping. Since August 2021, there had been 37 staff shifts short by more than one member of staff, placing patients and staff at risk. The provider was recruiting more staff, but further progress was required.

The service used agency staff to cover many shifts, which meant there was less consistency in the staff caring for patients. In the three months prior to the inspection, there had been 11 incidents in which patients were involved in self-harm while on one-to-one continuous observations. Whilst the service had taken steps to improve the quality of observations, including improvements to the accuracy of records, the service recognised there needed to be better communication between staff and more engagement with patients during these observations.

However:

Staff minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding. Staff completed risk assessments for each patient on admission using a recognised tool, and reviewed this regularly, including after any incident. Staff had completed and kept up-to-date with their mandatory training. Ward areas were clean, well maintained, well-furnished and fit for purpose.