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

Cygnet Hospital Stevenage

Overall: Good read more about inspection ratings

Graveley Road, Stevenage, Hertfordshire, SG1 4YS (01438) 342942

Provided and run by:
Cygnet Health Care Limited

All Inspections

Other CQC inspections of services

Community & mental health inspection reports for Cygnet Hospital Stevenage can be found at Cygnet Health Care Limited. Each report covers findings for one service across multiple locations
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During an assessment under our new approach

Cygnet Hospital Stevenage is part of the Cygnet Health Care group which offers a range of services for individuals with mental health needs and learning disabilities. Cygnet Hospital Stevenage opened in May 2006 and consists of 6 wards. We carried out this assessment in February 2024 as we had received information giving us concerns about the safety and quality of the forensic wards. During this assessment we looked at the 3 forensic wards and undertook a site visit on 6 February 2024. Peplau Ward – Men’s Medium Secure 14 bed ward Saunders Ward – Men’s Low Secure 15 bed ward Tiffany Ward – Women’s Low Secure 15 bed ward. The last comprehensive inspection of Cygnet Hospital Stevenage took place in June 2021. At that inspection, the provider received an overall rating of good. Safe was rated as requires improvement as some of the areas of the hospital were visibly unclean and the hospital had vacancies for support staff. We found improvements in both of these areas at this inspection. The service provided safe care. The ward environments were safe and clean. The wards had enough staff and ward teams had access to the full range of specialists to meet the needs of patients. Staff minimised the use of restrictive practices and followed good practice with respect to safeguarding. Staff completed thorough risk assessments of wards and individualised risk assessments with patients and updated these regularly and/ or when risk presentation changed. Managers ensured that these staff received training, supervision and appraisal, celebrated staff successes and had developed strategies to boost staff wellbeing and reduce instances of racist abuse towards staff and patients. Feedback from patients and carers about the service was overwhelmingly positive. Patients told us they felt safe and that staff were caring and treated them with kindness and respect.

22 June 2021 and 23 June 2021

During an inspection looking at part of the service

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

  • The service provided safe care. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Observation records were completed fully, and included thorough reviews.
  • Staff had completed and kept up-to-date with their mandatory training. The mandatory training programme was comprehensive and met the needs of patients and staff.
  • Staff engaged in clinical audit to evaluate the quality of care they provided.
  • Managers ensured that staff received training, supervision and appraisal.
  • The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • Some areas of the hospital were visibly unclean. The processes in place to monitor cleaning schedules were not robust enough to ensure that all patient areas had been fully cleaned.
  • The hospital had vacancies for support staff and could not always find bank and agency staff to cover shifts. The provider had put in place steps to mitigate the risk to staff and patients.

07 and 16 January 2020

During an inspection looking at part of the service

We did not rate this inspection. The ratings from the inspection which took place 14 to 16 May 2019 remain the same. This was a focused, unannounced inspection to follow up on specific concerns we had relating to the safe domain.

Following our inspection, we served a Notice of Decision because of the immediate concerns we had about the safety of patients. We told the provider they must not admit or readmit any further patients until further notice; they must submit a complete weekly log of the last seven days of incidents; they must undertake a complete, immediate and continuing review of all patients’ risk assessments and care plans; they must undertake a complete and immediate review of all patient observation levels and they must carry out a weekly review of all medication errors and how the risk of the error being repeated is being addressed. We told the provider that they must provide CQC with an update relating to these issues on a weekly basis.

We found the following during our focussed inspection:

  • The service relied heavily on agency and bank staff to ensure safe staffing numbers on the wards. Overall, there was a 56% vacancy rate for qualified nurses and support workers.
  • Staff were not consistently updating patient risk assessments following incidents of violence or self-harm. Overall, 43% of risk assessments had not been updated adequately following an incident.
  • Staff had not reflected patient risks within patients care plans.
  • We looked at 20 patient’s observation records across wards. On most records the date of next observation review was incomplete, and we saw no evidence that reviews had taken place. Details on the front sheet showing levels of observation, reasons for enhanced observation and date of next review were missing on multiple dates.
  • The provider internally reported 130 incidents of self-harm across wards within a two-month period. Of those 130 incidents of self-harm, many patients were being supported by enhanced observations. We could not be assured staff carrying out observations were doing so in accordance with policy.
  • There was a high number of medication errors on Orchid ward. We could not be assured that managers had taken appropriate steps to monitor and investigate the number of discrepancies.
  • Overall, 42% of incidents that were notifiable to CQC had not been submitted by the provider.

14-16 May 2019

During a routine inspection

We rated Cygnet Hospital Stevenage as requires improvement because:

  • The provider had not ensured that agency staff providing care or treatment to patients had the qualifications, competence, skills and experience to do so safely. Mandatory training compliance for agency and bank staff was low. Managers had not carried out Disclosure and Barring Service (DBS) risk assessments when agency staff had criminal records.
  • The hospital relied heavily on agency staff. At the time of inspection, the hospital had 78% vacancy rate for qualified nursing staff.
  • The provider had not ensured that adequate governance systems were in place. Systems had not been fully effective to ensure that actions from meetings had been completed within the required timescale. The hospital risk register was not being updated and reviews were not documented thoroughly, some historically completed items were still documented on the risk register.
  • The provider had not ensured it was using current policies. Overall, 42% of policies were out of date or were past the indicated date of review.
  • Staff on acute wards had increased the use of physical restraint from our previous inspection in January 2018. The use of prone restraint on acute wards had also increased.
  • Staff we spoke with knew the hospital had a Freedom to Speak Up Guardian but were not sure who it was.
  • Some care plans on Orchid ward were not person centred, individualised or completed within the provider’s timescale. We found one record which had been duplicated from another patient care plan.
  • Patients on Saunders ward told us the ward was short staffed on a regular basis and leave could be cancelled or delayed.
  • We found discrepancies in three sets of detention paperwork we reviewed.
  • Patients gave varying reviews about the quality of food provided. Most patients said the food was okay. However, some patients said that food choice was repetitive, poor quality and choice was limited.

However:

  • Staff assessed risks to patients and themselves using a recognised risk assessment tool. Staff updated risk assessments regularly. Patients’ risks were reviewed twice daily.
  • Staff reported all incidents that required reporting, including raising safeguarding concerns.
  • Patients and staff received a debrief after incidents. in addition, staff had access to weekly reflective practice sessions.
  • Staff assessed the mental health of patients within 48 hours of admission and offered a physical examination to all patients on admission.
  • Patients had access to a range of activities, groups and one to one sessions delivered by the occupational therapy team, psychology team and sessional workers as recommended by the National Institute for Health and Care Excellence. Patients had access to weekend activities, including gym, football, snooker tournaments, film nights and pamper sessions.
  • The percentage of staff across the hospital that had had an appraisal in the last 12 months prior to inspection was 100%. The percentage of ward staff that had received regular clinical supervision between January and December 2018 was 93%. The mandatory training compliance rate for permanent staff was 92% on acute wards and 89% on forensic wards.
  • Staff attitudes and behaviours when interacting with patients showed that they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. We observed caring interactions between staff and patients. Patients told us most staff were helpful, supportive and they spent time talking to them. Patients told us they felt informed about decisions and well cared for.
  • Staff were open, honest and transparent. Staff explained to patients when things went wrong and referred to advocacy to help with this. We saw evidence in complaints records that staff had fed back openly to patients about complaints.
  • Staff felt respected, supported and valued. Staff felt positive and proud about working for the provider and their team. We saw good joint working within the hospital between teams.
  • The hospital responded to concerns raised by staff about pay, facilities and vacancy rates by introducing clear pay scales and hourly pay rates, refurbishing the hospital and introducing a recruitment strategy and reward system for registered nurses.

08 to 10 January 2018

During a routine inspection

We rated Cygnet Hospital Stevenage as good because :

  • The clinic rooms on all four of the forensic wards contained emergency equipment and emergency drugs which were checked regularly.
  • Shifts were covered by a sufficient number of staff at the right grades. Many qualified nurses were short term contracted agency staff due to the high number of vacancies
  • Psychological therapies recommended by the National Institute for Health and Care Excellence (NICE) were provided to patients.
  • The GP attended the hospital on a weekly basis to provide appointments for patients. The service had a full time physical health care nurse who had undertaken additional specialist training in order to effectively support patients with specific long term illnesses.
  • Staff used Health of the Nation Outcome Scales (HoNOS) and HCR-20 which is a risk assessment for managing violence.
  • The carers’ forum was held on a six monthly basis on a Saturday whereby patients’ carers, friends and families were able to come into the hospital and discuss their involvement. There was a quarterly newsletter which was sent out to all carers and carers were invited to contact the social work department to ask questions and give feedback.

    • However:

  • On Peplau ward the couch in the clinic room was dilapidated, torn and needed to be replaced. The fridge was dirty and needed defrosting and cleaning. We found two boxes of two different types of medication in the clinic room on Peplau ward which were out of date (dated November 2017).

  • We examined three seclusion records for the forensic wards. We found that the seclusion template limited what was documented. The forms were not fully completed. One form omitted the time the doctor arrived, another did not provide details of therapeutic activities offered and the final form did not provide details of when food was offered.

  • Two out of six wards supervision documentation was poor. The manager on Orchid ward was unable to provide all records of individual supervision meetings. The manager on Chamberlain ward provided some evidence that supervision had taken place but these records were incomplete. During the inspection we reviewed a further seven records and found gaps in the documentation

    The provider used newsletters and governance meetings to share lessons learned. However, two of the staff that we spoke with had not received feedback from incidents and complaints. They were not aware of the lessons learned processes in place.


26-28 July 2016

During a routine inspection

We rated Cygnet Hospital Stevenage as requires improvement because:

  • Communal corridor areas throughout the hospital were not included in the ligature audit.
  • We found out of date equipment and medication stored within the clinic room on Orchid ward and equipment that had not been calibrated.
  • The emergency grab bag on Tiffany ward was not dated.
  • The hospital had access to two seclusion rooms. One seclusion room had been damaged by a patient and was out of use at the time of inspection, leaving one seclusion room available. The available seclusion room toilet door was broken, meaning that if a patient was high risk and they needed to use the toilet, they would be required to use a disposable container.
  • Staff were not consistently recording seclusion. Times and names of professionals conducting reviews were not always clear. It was unclear when multidisciplinary team reviews took place and who was involved.
  • Physical health records were not consistently recorded across wards, we saw missing entries and boxes left unticked. Some entries were illegible. Patient physical health was not being monitored regularly on acute wards.
  • Care plans on Orchid ward were not individualised or person centred and we saw three patients with the same care plan goal that had been copied and pasted.
  • Management and clinical supervision was not being carried out regularly in line with the provider’s supervision policy.
  • The time allocated by the provider across the hospital for handover between staff shifts was insufficient at 15 minutes.
  • Patients had delays in having their rights under the Mental Health Act 1983 explained to them.
  • Patient’s capacity to consent to treatment was not being routinely recorded.

However:

  • Staff across the hospital were trained in safeguarding adults and knew how and when to contact the hospital safeguarding lead.
  • Cygnet hospital Stevenage had a clear incident management process; incidents were investigated by managers and effectively fed back to both staff and patients.
  • Patients told us ward activities were rarely cancelled and they had access to activities both on and off the ward.

29 November 2013

During a routine inspection

People spoken with told us they were involved in activities on their ward and that the staff were supportive. This and the other evidence inspected showed us that people's privacy, dignity and independence were respected.

We noted that staff engaged with people in a positive way and this was reflected in those care records reviewed. This demonstrated to us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A current safeguarding of vulnerable adults policy and a staff training programme to support this were in place. This meant that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We noted that each person who required support or enhanced levels of observation received this in a prompt and supportive way. Staff were up to date with their mandatory training and had received recent clinical supervision. This meant that people were being cared for by adequate numbers of qualified, skilled and experienced staff.

We saw that a clinical assurance framework was in place. This, and the other evidence inspected, showed us that the provider had an effective system to assess and monitor the quality of service that people received. We looked at nine people's care and treatment records. These were well kept and reflected individual treatment needs. This showed that accurate and appropriate records were maintained by the service.

15, 27 March 2013

During a routine inspection

During our inspection in March 2013, we saw staff engaging with people in group and one to one activities and discussions. People using the service were happy to approach staff to make requests, and people generally seemed relaxed and settled during our visit. We saw that staff engaged with people in a sensitive and calm manner, reassuring them and speaking respectfully with them. However, we found that people were not always involved in their care and treatment as they should be and that their privacy and dignity was not always maintained.

People's care plans did not always include physical health checks, risk assessments, care plan reviews, or evidence that they had been informed of their rights or involved in decisions about their treatment and care. Areas used for seclusion posed risks to people's welfare and to maintaining people's dignity.

Staffing levels were not sufficient to meet people's needs and not all staff had received the necessary training to support people using the service. Staff had received appraisals and received informal and formal supervision from their line managers to support their professional development, although other work pressures sometimes stopped these from taking place.

The provider had not taken steps to address identified risks to people using the service, and people's records were not fit for purpose.

11 October 2011

During an inspection in response to concerns

People who use the service were positive about the service and the staff who cared for them. A person commented, 'Staff are good at their jobs. They are respectful. They are great, not horrible, just right.' This was echoed by another person who said, 'Staff are all right. They are all polite and approachable. One of the best hospitals that I have been in. We get survey questionnaires about the service.' A person commented, 'Staff are all right and respectful. Some staff get a bit impatient with me but I was abusive to them sometimes. I can't help it.' Another person said, 'Staff are OK. This place is far better then the other place.'

When asked about choices over menu and meals served, a person said, 'There is a choice of menu. The food is fine.' This was echoed by another person who said, 'We have choices everyday. Evening meal is served hot. Plenty to eat.' Another person commented, 'We get hot soup and a choice of sandwiches at lunchtime. The evening meal is served hot. There is a choice of menu. Yesterday we had grilled chicken, potatoes and carrots. At around 9pm we can have crumpets or toast.'

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.