- Independent mental health service
Cygnet Victoria House
All Inspections
6-8 September 2022
During a routine inspection
Our rating of this location improved. We rated it as good because:
- 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. 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. 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. 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 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 in care decisions.
- Staff managed patient admission to the service effectively.
- The service was well led, and the governance processes ensured that ward procedures ran smoothly.
However:
- We observed a seclusion review taking place and were concerned that there were 10 members of staff outside of the room which caused some anxiety for the patient, particularly when the staff members were talking about them. We were also concerned that a staff member who the patient had threatened to harm was present.
- The acoustics of the seclusion room caused speech to echo and distort over its communications system and this posed potential issues if voices became raised due to heightened behaviours or for people with communication difficulties.
- Two of the five carers we spoke with said they felt communication from staff was poor although one did not know if this was because their loved one did not want them to be involved.
- There were no systems in place to enable patients to have the ability to speak with managers above hospital director level.
21 April 2021
During an inspection looking at part of the service
We have identified areas the registered provider must improve in relation to our concerns about this location. However, we did not re-rate Cygnet Victoria House following this focused inspection. This is because the service type had changed since our previous inspection in October 2018.
- The ward environments were impacting on patient safety. The limited communal space on Albert ward was contributing to conflict on the ward and the ward's environmental risk assessment did not reflect their current ward environment. Victoria ward was very large, and the layout meant that staff were unable to have oversight of patients in all areas of the ward. There were also instances when staff did not uphold Covid-19 infection control principles.
- The service's governance processes did not always ensure that ward procedures ran smoothly. There were errors, inconsistencies and omissions in multiple forms of documentation, including incident recording and frequent touch cleaning records. The monthly incident review meetings had not identified all areas for improvement in the use of restraint or the errors in incident documentation.
However:
- The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
- The acting hospital manager had a good understanding of the services they managed and were visible in the service and approachable for patients and staff.
29 30 October 2018
During a routine inspection
We rated Victoria House as requires improvement overall because:
- There had been a negative impact on the rehabilitation ward since the opening of the acute ward. Managers and staff had raised concern about the timeframe in which the ward had been opened. Patients raised concerns about the restrictions placed on the environment after the opening of the acute ward. There had been a significant increase in the use of agency staff to cover the acute ward.
- Blanket restrictions were in place which did not meet the ethos of a rehabilitation environment.
- Care plans did not always reflect patient needs. Where significant risks had been identified there was not always a risk management plan or care plan in place to mitigate these.
- Although a timetable was in place there was little uptake of structured activity and many patients described being bored.
- Staff were not up to date with all mandatory training and were not trained in immediate life support. Supervision rates had decreased since the acute ward had opened.
- Discussions were taking place around discharge but these were not documented in an easily identified format.
- The hospital worked between paper and electronic records and it was not always clear which were the current documents.
- Medicine was not always authorised in line with the Mental Health Act.
However:
- There were enough staff on each shift to ensure the safe running of the hospital. The hospital was in the process of recruiting permanent staff and used regular bank staff where possible. Staff were supported by managers who were visible and approachable.
- Incidents were reported and investigated and lessons were learnt from and shared with staff. Staff were trained in safeguarding and protected patients from abuse.
- Patients had up to date risk assessments and care plans. There was good multidisciplinary working, daily handover meetings were effective and well-structured and attended by all staff.
- The hospital had a full range of disciplines to support patients care and treatment, which included adequate medical cover, psychology, nurses, support workers, occupational therapy and activities. A programme of activities was in place and offered to patients.
- The provider had appointed an experienced hospital manager.
21 November 2016
During an inspection looking at part of the service
We rated Cambian – Victoria House Hospital as good in the effective domain. We did not give an overall rating for the service because this was a focused inspection. We rated the effective domain as good because:
- Mental Health Act training was mandatory for all staff working at the hospital.
- Ninety two percent of staff had received training in the Mental Health Act and the revised code of practice.
- Staff had been trained in managing actual and potential aggression as part of the hospital’s efforts to reduce the use of restraint and rapid tranquillisation.
- Policies and procedures had been reviewed and updated to take account of the revised Mental Health Act code of practice.
- Patients were able to access an advocacy service which provided independent mental health advocacy.
The hospital had a process in place for the ongoing review of restrictive practices and was involving patients in this process.
9-10 February 2016
During a routine inspection
We rated Cambian Victoria House Hospital as good because:
- The environment was clean and well maintained. Patients had access to a range of rooms and equipment to support care and treatment. The clinic room was in good order and staff tested all equipment in line with manufacturer’s recommendations.
- Compliance with mandatory training was high at 98%. Staff worked well together as a multi-disciplinary team and felt supported by their managers.
- Patient records contained comprehensive assessments and staff used standardised outcome measures to monitor progress and inform treatment planning. Patients had access to a range of activities and therapeutic interventions recommended by NICE guidance.
- Patients felt fully involved in the planning of their care. Staff assisted patients to maintain contact with their families and worked well alongside other organisations involved in the patients’ care.
- Staff treated patients with kindness and respect. Interactions between staff and patients were natural and genuine. Staff spoke about patients with care and concern.
- Staff undertook regular audits to ensure they met the required standards. Victoria House Hospital took part in national accreditation schemes and supported staff in innovative research.
However:
- Victoria House Hospital did not have an implementation plan in place for the revised Mental Health Act Code of Practice. Only 54% of staff were trained in the revised Code of Practice and not all policies and procedures had been updated in line with the changes.
- At the time of inspection staff conducted randomised searching of patients that was not based on an individual assessment of risk and need or in line with hospital policy. Victoria House Hospital was in the process of developing a restrictive practice policy. Some blanket restrictions were in place following consultation with patients, although there was a lack of clear documentation as to why and when staff would review them.
- Staff did not actively encourage patients to engage in necessary physical healthcare monitoring if they refused regular checks. At the time of inspection, staff were not delivering evidence based psychological treatment for patients with substance misuse problems.
8 October 2013
During a routine inspection
The multidisciplinary team developed care plans and we saw that patients were involved in all aspects of the assessment and planning of their care. This included patients completing a self assessment on admission and weekly meetings with their key worker and named nurse to discuss their progress and any issues.
The service had actively listened and positively responded to previous CQC recommendations from our last visit in 2012 and had made relevant changes. This had included unlocking the payphone area, giving risk assessed key access to patients for the therapeutic kitchen and enabling the gym to be open when supervised by Occupational Therapy staff. The other area of recommendation was to open the laundry room but we were told and saw records that stated patients had discussed this in a meeting and decided they wanted to keep the door secure in case any of their belongings were tampered with or removed. There was an on-going quality assurance programme in place by the hospital.
There was a catering team who worked closely with patients to provide a healthy and balanced diet and who also worked alongside patients teaching them cooking skills. 94% of patients in a survey in 2013 which 18 patients completed said they were offered a choice of food and drink and were able to make or access their own food and drinks.
The premises were in good order, clean and well maintained. It had recently benefited from redecoration in the first floor communal areas which had brightened the area from our last visit. There was also the addition of a therapeutic garden which included chickens, rabbits and guinea pigs which the patients cared for. This was really popular with many patients.
11 January 2013
During an inspection in response to concerns
On this visit we spoke with five staff and four patients regarding their experience of the service and in particular we discussed whether they had ever been bullied, had ever witnessed any poor practice and felt supported to raise any concerns. We also looked at records regarding incidents, complaints and restraint as well as meeting records for both patient and clinical governance meetings.
The nursing and support staff we spoke with did not raise any concerns about the management of the service. Staff told us they felt able to raise any concerns within the service or to external agencies. Staff told us; “I have never seen any bullying of anyone, the nursing and management staff are very supportive” and “if we need to talk we can talk anytime. They listen and support you”.
Patients we spoke with were also positive about their experience of the service and no-one said they had ever witnessed any untoward use of restraint. Patients said the staff were “Spot on” and commented, “It’s alright here, you can talk to anyone”.
30 October 2012
During a routine inspection
We saw patients engaged in a variety of activities and staffing engaging with patients in a positive and friendly way. We saw from a recent patient survey in October 2012 that 95% of patients stated they enjoyed the activities at the hospital. All 22 patients who responded to the survey said they were given information in a way they understood from staff.
We looked at care plan records and staffing recruitment records, these were all up to date and showed that people were involved in their own care and the provider had a robust recruitment system in place.
We spoke to the hospital manager about addressing some areas of restrictive practice such as locked areas and internet access so that there was a clearer policy for both staff and patients.
22 November 2011
During a routine inspection
One patient told us: 'Its really good here' and 'I get on great with the staff'.
The patients using the service appeared confident when approaching staff, and the patient/staff interactions we saw were positive and respectful. Talking with staff whilst we watched activities, it was clear they had a good knowledge of the patients and staff gave encouragement and praise.
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.