Cygnet Sherwood House

Updated 26 April 2019

Cygnet Healthcare Limited owns Sherwood House Hospital. It provided high dependency rehabilitation services for up to 30 male patients with mental health problems who may be informal or detained under the Mental Health Act (MHA). Some patients had a mild learning disability and some features of autism spectrum conditions.

Sherwood House has been registered with CQC since 17 November 2010. Since our previous inspection the provider has changed to Cygnet Healthcare Limited.

There were 24 patients receiving care and treatment at the time of our inspection and another two patients were admitted during the inspection.

Sherwood House is registered with the CQC to provide the following regulated activities:

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

There have been six previous inspections to Sherwood House. The latest was on 7 November 2016. We rated Sherwood House as good overall and good in all five key questions.

The last Mental Health Act review visit was on 23 May 2018. Concerns included:

• Staff did not consistently record discussions around informed consent between the patient and responsible clinician where a patient was being treated on the authority of a consent to treatment form. In one patient’s file, we saw the responsible clinician did not complete the T2 form following the discussion with the patient around informed consent.

• None of the patient care plans we saw contained the patients' views. The care plans we reviewed were task-focussed and not based on individual needs. We saw no evidence of patients’ participation, goals, aspirations and opinions written in their care plans.
• Staff did not always record a risk assessment before and after patients took section 17 leave. In three out of the five patient files, staff did not complete risk assessments before and after the patients’ section 17 leave. The responsible clinician had not indicated whether a copy of the leave form had been given to the patient.

The provider submitted an action statement to CQC detailing how they planned to address the concerns raised. We saw these issues had been addressed at this inspection.

Updated 26 April 2019

We rated Sherwood House as outstanding because:

• There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Staff actively involved patients, families and carers in care decisions to make sure patients were active participants in their care and treatment.
• Feedback from patients, relatives and stakeholders was continually positive about the way staff treated patients. Patients told us that staff went the extra mile and their care and support exceeded their expectations.
• The service was tailored to meet the needs of individual people and was delivered in a way to ensure flexibility, choice and continuity of care.
• There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that meets these needs and promotes equality. This included patients with complex needs.
• The service provided safe care. The environment was safe and clean. There were 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 cared for in a mental health high dependency rehabilitation ward and in line with national best practice guidance. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The hospital team included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. The staff worked well together as a multidisciplinary team and with those outside the hospital 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 planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason
• The service worked to a recognised model of high dependency mental health rehabilitation. It was well led, and the governance processes ensured that hospital procedures ran smoothly.

However:

• There had been four consultant psychiatrists in the last two years and the current one was also leaving. Patients said this affected their wellbeing as they thought they had to explain how they felt repeatedly to a new doctor.
• One medication prescribed to a patient for the side effects of their mental health medication was not included on their consent to treatment form.

Updated 26 April 2019