Cygnet Hospital Stevenage

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We rated the service as good for safe because: The service worked with people to understand what being safe means to them as well as with partners on the best way to achieve this. The service concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. People were safe and mostly protected from bullying. Some patients had witnessed racial abuse from other patients or had witnessed distressed behaviours from other patients. However, managers had taken action to address this and to support patients and staff wellbeing. Ward areas and clinic rooms were clean, well maintained, well furnished and fit for purpose. Patients were supported to make choices that balanced risks of harm with positive choices about their lives. Managers regularly reviewed the use of blanket restrictions and discussed these with patients in weekly community meetings. Leaders ensured there were enough skilled people to deliver safe care that promotes choice, control and individual wellbeing. Since the last inspection, vacancy rates had improved and mandatory training and supervision compliance was good.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

During the assessment, we saw evidence that there were effective systems, processes and practices to make sure people were protected from abuse and neglect. The service had a comprehensive local safeguarding procedure which was updated in March 2023 and was available to all staff. All staff completed mandatory safeguarding training and compliance was at 100%. The hospital had a Safeguarding Lead and a Deputy Safeguarding Lead and information about how to contact them was displayed around the hospital. Information, including a safeguarding information booklet outlining the six principles of safeguarding, was given to staff during induction. The Safeguarding policy also gave details of other key contacts including the Executive Safeguarding Lead for Cygnet Healthcare. During the assessment, we viewed the hospital safeguarding log which was up to date and included details of the safeguarding incident, the investigation lead and the outcome of any investigation, including the outcome of any Local Authority actions, including Section 47 enquiries. (A S.47 enquiry is initiated by the Local Authority to determine whether any further action is required to safeguard and promote the welfare of a vulnerable adult). All patients had access to an Independent Mental Health Advocate (IMHA) during their stay at the hospital. Information about how to access the advocate was displayed around the wards and given to patients on admission. All patients were asked at community meetings if they wished to make contact with the IMHA. .

During the site visit we observed that the ward felt safe, and staff were visible and engaging with patients. We observed information posters displayed on the ward giving details of the safeguarding lead for the hospital and information about how to contact the Independent Mental Health Advocate, the Care Quality Commission and the Freedom to Speak up Guardian. We saw information about patients rights displayed on the hospital wards and patients told us they were given information about their rights under the Mental Health Act upon admission to hospital and on a regular basis afterwards.

During the assessment we spoke with 6 members of staff including a doctor, nurses, support workers and members of the multi-disciplinary team. All the staff we spoke with demonstrated a good knowledge and understanding of safeguarding and how to take appropriate action when they had concerns about the safety of other people. All the staff we spoke with showed a commitment to taking immediate action to keep people safe from abuse and neglect and felt comfortable and safe to do so. At the time of the assessment, 100% of staff had completed mandatory safeguarding training.

We spoke with 12 patients. Ten patients told us that they felt safe on the ward. One patient told us that they found it difficult to trust staff and 2 patients said they did not always feel safe because of other patients distressed behaviours. Patients we spoke with told us they felt supported to understand safeguarding, what being safe meant to them and how to raise concerns when they didn’t feel safe or they had concerns about the safety of other people. Two patients told us that they had witnessed instances of racist abuse at the hospital. We saw evidence that the hospital had implemented a quality improvement action plan to address racial abuse from patients towards staff and other patients and had improved monitoring and implemented actions to reduce the number of incidents. The hospital had a 'Police Liaison and Involvement Protocol' and a memorandum of understanding was in place with local police for reporting crime. Patients were encouraged to report any incidents where they were the victims of a crime or harassment to the police and were supported where necessary. If a patient did not have capacity to make a report to the police, this was done on their behalf by an appropriate staff member or the Safeguarding Lead. We spoke with 5 carers. All the carers we spoke with told us that they felt their loved one was safe at the hospital and they knew how to raise concerns if they needed to. During the assessment, we saw evidence that a community meeting for all patients and staff was held on each ward on a weekly basis. These meetings had a set agenda and included discussion about getting on with each other, environmental issues, blanket rules and a check in with each patient attending to ask if they wished to contact or meet with the Independent Mental Health Advocate (IMHA) or wished to make a complaint or give a compliment. The community meeting minutes also showed what actions had been taken following previous meetings.

The Provider had a Positive and Safe Care: Reducing Restrictive Practice policy which included procedures and policy for restraint, enhanced observations and blanket restrictions. Patients told us they understood why they had observations and that observations were carried out properly and in a respectful way. However, 2 patients told us that they found observations carried out at night could be disruptive. Patients had the opportunity to discuss blanket restrictions during community meetings and at the Patient Council. We viewed copies of community meeting minutes for all 3 forensic wards. We saw evidence that in February 2024, for example, patients and staff discussed the task and finish group which was reviewing whether patients could have smartphones on the ward assessed on an individual basis. We viewed MDT ward round reviews and Care Planning Approach meeting minutes for 6 patients. We saw that patients were able to attend these meetings and there was a section for patient views in all domains including ‘My Safety Planning’ . We saw that patients were involved and informed about their risks and how to keep themselves safe. A Quality Network for Forensic Mental Health Patients review was undertaken in May 2023 by an independent assessor. One of the areas of achievement reported was that patients gave good feedback about their care plans. Patients explained that they felt involved in the development of their care plans and expressed that care plans are realistic and clear. They reported that the mental health team were open to discuss different treatment options based on their preferences. Care plans observed were personalised and contained many quotes that demonstrated good patient involvement. One patient described care plans as a “pathway to independence”. Carers were also supported to get involved in the care planning process.

The Provider had a Positive and Safe Care: Reducing Restrictive Practice policy which included procedures and policy for restraint, enhanced observations and blanket restrictions. This policy was comprehensive and up to date – last reviewed and updated in December 2023. We viewed the minutes from the last 6 months of clinical governance meetings. Safety and risks were reviewed in detail at these meetings and included discussion about patient safety and a review of incidents including current issues/themes/trends/patterns/improvements and deterioration. Staff and managers participated in monthly positive and safe care meetings which discussed in more detail the implementation of the reducing restrictive practise strategy, CCTV audits of care and restraint and seclusion audits. The meeting minutes from January 2023 reflected that even though incident numbers increased, the number of restraints decreased with most incidents recording the use of verbal de-escalation techniques with restraint being used as a last resort. Incidents were reported via Datix and we saw evidence of investigation of incidents and staff told us that lessons learnt were shared with staff by way of emails from the quality department, discussions in hand over meetings, and twice monthly staff meetings. We viewed minutes from staff meetings on all the wards and saw that there was an agenda item for lessons learnt including discussion of themes and learning from complaints, serious incidents and CCTV restraint reviews. Ensuring that debriefs occurred after all incidents was a issue noted as needing improvement. We viewed 11 care plans. Care plans were person centred and provided guidance to staff on how best to support people. Risk assessments, completed on admission, and after incidents, helped to mitigate the risks to people by providing guidance to staff on how to provide safe support.

During the assessment we saw evidence that when people communicated their needs, emotions or distress, staff could manage this in a positive way that protected the rights and dignity of patients and maximised learning for the future about the causes of their distress. We spoke with 6 members of staff. All the staff we spoke with told us that staff undertook a comprehensive risk assessment for each patient on admission and after incidents. Staff demonstrated a good understanding of the management of risk and reducing restrictive interventions. Staff told us that restraint is only ever used as a last resort and only when a patient was causing harm to themselves or others.

People were cared for in safe environments that were designed to meet their needs. Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care. During the assessment we undertook a tour of all three forensic wards. We observed that all wards were clean and well-maintained, well-furnished and fit for purpose. This is an improvement since the last inspection. Staff could not observe patients in all parts of the ward. However, the service had fitted mirrors and closed-circuit television to monitor communal areas and used enhanced observations to support patients with additional risks. The ward complied with guidance and there was no mixed sex accommodation. Staff knew about any potential ligature anchor points and mitigated the risks to keep patients safe. Staff had easy access to alarms and patients had easy access to nurse call systems. Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly.

Although we observed that ward areas and clinic rooms were all very clean and well-maintained and patients and staff told us that the ward was clean, there were not cleaning rotas available for us to view during this inspection. The service had a local risk register which included actions and mitigation for risks such as major IT failure, serious incidents pertaining to the environment, risks of patients barricading themselves in rooms, outbreaks of communicable disease, E-cigarette fire risk and loss of power.

We spoke with 12 patients and 5 carers. Patients and carers we spoke with told us that people were cared for in a safe, clean environment that was designed to meet their needs and that facilities and equipment were well-maintained.

There was appropriate staffing levels and skill mix to make sure that patients received consistently safe, good quality care that met their needs. We looked at the staffing figures for the service. Vacancies had reduced from the last inspection . At the time of this assessment, the staffing establishment was 60 registered nurses and 125 health care workers. There were 55 registered nurses employed as permanent staff and 127 health care workers. There were 5 vacancies for registered nurses, with recruitment of 1 registered nurse in the pipeline, I vacancy for a practice nurse assistant and no vacancies for support workers. The Multi-disciplinary team was fully staffed apart from 2 social workers and a tutor. The service used regular bank nurse and agency nurses to cover annual leave and sickness absence. These staff were familiar with the service, treated exactly as other permanent members of staff and included as part of the staff team. Managers made sure all bank and agency staff had a full induction and understood the service before starting their shift. Levels of sickness were low. The sickness rate at the time of inspection was 2.9%. Managers supported staff who needed time off for ill health. Staff received the support they needed to deliver safe care. This included supervision, appraisal and support to develop and improve services. Staff received training appropriate and relevant to their role. All mandatory training across three forensic wards, as of February 2023, was above 94% compliance apart from: Saunders Ward: PMVA initial teamwork which was 88.2% and Tiffany Ward - ILS training which was 87.5%. Across all wards most mandatory training compliance was at 100% Staff had excellent compliance with supervision and appraisal. Clinical and managerial supervision compliance was 100% across all forensic wards.

During the assessment, we observed that wards were fully staffed and there were enough staff to make sure people received consistently safe, good quality care that met their needs.

We spoke with 6 members of staff. All of the staff we spoke with told us that there was appropriate staffing levels and skill mix to make sure patients received consistently safe, good quality care that met their needs. All the staff we spoke with told us they felt valued and respected. One staff member told us they had worked at the hospital for 3 years and felt respected and valued, and had a good rapport with the patients. Another staff member told us it was a very happy team, supportive, everyone worked well together and feedback from managers was positive in supervisions. It was noted in the May 2023 Quality Network for Forensic Mental Health Services review that staff spoke positively about the support offered to them. They confirmed that they received annual appraisals, in which personal development plans were discussed and supported. They also explained that they had access to regular reflective practice sessions, which they described as “very useful”. They spoke about a positive work culture in the team and a good relationship with managers. There was an open-door policy, encouraging open communication between staff and managers, and staff reported that they felt able to challenge decisions. Additionally, staff described various wellbeing processes that were in place, including free counselling, gym use and walking groups.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.