Cygnet Lodge Kenton

Updated 2 May 2023

Cygnet Lodge Kenton is registered with the CQC as an independent mental health hospital. The service provides assessment and treatment of patients including those detained under the Mental Health Act.

Cygnet Lodge Kenton is a rehabilitation unit for adult female patients with a diagnosis of mental illness. Mental health commissioners from across England refer patients to the service. The service aims to provide a care pathway for patients who have been in hospital for some time and require support to develop their independent living skills and prepare for discharge to the community. The average length of stay for patients is about 18 months.

CQC last inspected the service in April 2022. We rated the service inadequate for safe, requires improvement for effective and well-led and good for both caring and responsive. We rated the service requires improvement overall. The service has a registered manager who has been in post since 2019 and is responsible for ensuring the service complies with health and social care regulations.

At the time of the inspection there were 11 patients using the service. All patients were detained under the Mental Health Act 1983.

The service is registered to provide the regulated activities:

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

What people who use the service say

During the inspection we spoke with 4 patients and most of the feedback we received was positive. Patients told us that staff were kind and respectful and responded to their needs. One out of 4 patients told us that they did not feel safe and that there was not enough to do on the weekends. Patients were able to provide feedback and had opportunities to voice their opinions about the running of the service. Patients reported that the quality of food was good and that they knew how to make a complaint.

Updated 2 May 2023

We carried out this unannounced, comprehensive inspection in line with our inspection methodology. At our last inspection visit in April 2022 we rated Cygnet Lodge Kenton as requires improvement overall. Safe was rated inadequate, effective and well-led was rated requires improvement and caring and responsive were rated good. This inspection included a follow up on our last inspection to see if improvements had been made.

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

• The service had addressed the areas of improvement we outlined in our April 2022 inspection.
• Staff had improved how they monitored, recorded and escalated patients’ physical health results. Staff ensured they used the correct forms, completed them appropriately and audited their use. Staff escalated their findings when required. Staff and patients told us that physical health monitoring was a priority.
• The service had put a system in place to regularly monitor side-effects of medicines experienced by patients. All patients received a swallowing risk assessment and side-effect monitoring assessment if they were prescribed anti-psychotic medication. For example, patients prescribed clozapine received a routine bowel movement assessment. Patients who were prescribed lithium received a regular blood test.
• Staff improved how they recorded and carried out observations of patients in line with the provider’s policy. Staff checked on individual patients four times per hour. The checks were carried out at random times within the hour, with a maximum of 15 minutes between each check.
• Staff ensured that they had improved their responsibilities under the Mental Health Act (MHA) 1983 and the Mental Capacity Act 2005 in a timely way. Patients detained under the MHA had their rights explained to them as often as required by the provider’s policy. The service had ensured that they had requested a second opinion appointed doctor (SOAD) and had issued a Section 62 of the MHA around the same time. The use of a Section 62 should only be used for urgent treatment, for several months. The service kept in regular communication with the allocated SOAD until the required paperwork had been issued.
• Since our last inspection in April 2022, the service had ensured that the number of registered nurses deployed on night shifts was in line with the provider’s staffing matrix and decisions in respect of safe staffing levels.
• The management of medicines had improved. Staff undertook a regular audit that monitored and assessed all aspects of the medication room including medicines and clinical equipment. Clinical equipment was in working order and within date. Medication was stored and managed safely.
• Staff we spoke with had a better understanding of how to escalate a safeguarding concern to the local authority safeguarding team. Staff had access to a policy that guided them in how to respond to a concern out of hours.
• The governance systems that were in place had improved and were more robust. The service had implemented an auditing system that monitored aspects of clinical care. This had led to patients receiving safe and effective treatment. For example, staff carried out a monthly physical health monitoring audit, a care record audit, a risk assessment tracker and also an audit that monitored whether patients had been read their rights under the MHA.
• Whilst patient information continued to be stored both electronically and on paper, and across different systems, the record systems were better organised since our last inspection in April 2022. Staff we spoke with understood how to access all information required to carry out their role effectively. In the last six months, no incidents had occurred as a result of the various electronic and information management systems used within the service.
• The service had improved how they promoted smoking cessation within the service. The speciality doctor led on smoking cessation and had completed a smoking cessation session with a small number of patients who consented. The patients had received nicotine replacement therapy. Records of the fortnightly ward rounds showed the impact of smoking on individual patients’ physical health.

However:

• Staff had not always ensured that the level of patient risk and the management of those risks were clearly recorded. In 1 care record, there was no care plan in place that clearly showed how the staff were managing the patients choking risk. Staff we spoke with were able to tell us how they managed the risk, but this was not reflected within the care record. The provider addressed this during the inspection. Another patient’s risk level varied between the different patient record systems used. At the time of the inspection, the provider told us that this was an IT error and would be fixed promptly.
• Whilst staff understood patients’ individual needs and involved them in their care, care plan records did not always reflect this. Care plans were not always person-centred and did not always link to a patient’s rehabilitation. The care plans did not consistently demonstrate that the patient had been involved in the decision making. This was a record keeping issue. During our inspection, we observed that staff included patients in their care and the multi-disciplinary team had a comprehensive understanding of patients’ individual needs. The service had also identified this in January 2023 through their own audits and had started to make improvements.
• The service had implemented restrictions on some aspects of the service due to the risks that they presented to some patients. Patients did not have free access to tea, coffee and sugar throughout the day and the garden door was locked due to the risks it posed to patients. The provider told us that they had put these restrictions in place to mitigate the risks and regularly reviewed them. Senior leaders told us that the restrictions in place would be removed once it was safe to do so. During a post-inspection feedback meeting with the provider, the CQC advised the service to continue to regularly assess the restrictions in place to ensure they were appropriate.

Updated 2 May 2023

Our rating of this service improved. We rated it as Good. Please see the overall summary for further details.