Cygnet Bury Dunes

Updated 8 December 2022

Cygnet Bury Dunes was registered with CQC on 11 February 2011 for the following regulated activities:

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

Originally the service was a large hospital providing services to children and young people, medium secure services and low secure services. However, from April 2021, the children and young people services, medium secure services and two of the low secure services have been registered as separate locations.

Cygnet Bury Dunes has 65 beds within the following wards;

• Lower West Side is a 12 bed low secure ward for both hearing and deaf women
• Bridge Hampton ward is a 13 bed low secure ward for men who are deaf
• West Hampton ward is a 10 bed low secure ward for both hearing and deaf men
• South Hampton ward is a 12 bed Psychiatric Intensive Care Unit (PICU) for men
• White House is an 18 bed acute ward for men.

There was a registered manager in post who was also the controlled drugs accountable officer.

This is the seventh inspection of this service. The last inspection of the service was in July 2020 and was a focused inspection, in relation to concerns raised about the service, we inspected Madison and Columbus wards which are no longer part of this location. We rated the service as good overall, with requires improvement for well led. This was due to recruitment and selection processes, training and supervision for staff, records and oversight of safeguarding and recruitment and selection.

There are two core services;

• Forensic and secure wards, where the findings for Lower West, Bridge Hampton and West Hampton will be reported on.
• Acute and PICU where the findings for South Hampton and White House will be reported on.

What people who use the Acute and PICU service say

We spoke with nine patients and seven family members.

Patients told us that they have improved since being in hospital. Staff were nice and treated them well. They had been given information about their medicines and introduced to the ward and given information about the ward. Patients said they felt safe in hospital. However, there were occasions where they felt the staffing levels were low. A patient on South Hampton ward told us they would like access to their own phone, another patient said they would like to go outside for a cigarette. Another patient whose first language was not English would like more information in their first language.

A patient on White House said soap dispensers were needed in the toilets and the communal toilets need repairing. Also, they would like to access the gym.

Family members told us the staff were very caring towards their loved one and did provide updates when contacted. They were involved in the ward rounds and felt listened to. If families have had to raise issues they said staff were responsive to this and they had been resolved.

However, they told us they had not received any information about the service, including how to complain. Also, at admission when loved ones were very unwell, staff told family they couldn’t provide updates without the consent of their loved one, who was too ill to give their consent at that time. Family members also told us it could be difficult to get through to the ward staff on the phone.

What people who use the Forensic and Secure service say

We spoke with 14 patients, eight family members and two advocates.

On Lower West patients felt well looked after. They spoke positively about drop-in sessions with multidisciplinary staff and said that most staff were respectful, polite and interested in their recovery. However, patients felt that the service was short staffed and described how it could be difficult to communicate with staff when signing staff were not available. Patients were unhappy that there was no internet access on the ward and said that the food quality varied.

On Bridge Hampton ward patients described the ward as a good community with strong relationships. Patients described trips out and how staff supported them when there was an incident. They said that some staff were good but that others did not always behave respectfully towards them. Some patients said the food as poor and that staffing could be improved. Patients were not always interested in the ward activities offered.

West Hampton patients felt safe and described events that took place including barbeques, trips to local towns and guitar lessons. They said that staff were mostly polite but felt that the ward could be short staffed. They described when staffing levels had affected planned trips and activities and said that food could be improved.

Families and carers felt their loved ones were safe and cared for on the wards. Most families praised how the service communicated with them and kept them informed. They were invited to and listened to at meetings about their relative’s care, and they described staff driving patients’ home to accommodate visits. Some families felt that alternative activities could be offered.

Advocates, who regularly visited the service, described the strong sense of community on the wards. They felt staff were caring and responsive. They acknowledged that patients would seek out deaf or British Sign Language staff and said the main issues raised were regarding food.

Updated 8 December 2022

We rated the service overall as requires improvement. We rated the forensic and secure wards as requires improvement. We rated the acute and PICU wards as good. This meant that overall, the rating for the location was requires improvement.

We rated the forensic and secure wards as requires improvement because:

• Staff had not minimised the use of restrictive practices. The rationale for some restrictions was unclear and not all restrictions were individually applied. Where a service has unnecessary restrictions that are not individually assessed and applied, there is an increased risk of a closed culture forming. Unnecessary restrictions placed on individuals offers no therapeutic value to patients.
• Staff did not provide the full range of care and treatment suitable for the patients in the service. Although they delivered clinical care in line with best practice and national guidance, the therapeutic activities offered did not meet the needs of all the patients. Activities were not tailored to the individual and offered seven days a week.
• The forensic and secure wards supported both hearing and deaf patients. Not all staff had completed British Sign Language training and compliance figures were lower than expected. Recent staff turnover had affected the availability of trained British Sign Language signing staff which had impacted on patient care and staff stress. There were multiple shifts that had no deaf or signing staff on shift.

In both core services:

• Staff did not fully understand how to safely dispose of spoiled medicines.
• There was limited oversight of the agency induction paperwork which meant staff may not receive an induction.
• Not all staff files reviewed contained full employment history.

However;

• 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 and families and carers in care decisions.
• The service was well led, and the governance processes ensured that ward procedures ran smoothly. Managers ensured that staff received mandatory 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.

Updated 21 September 2020

Updated 8 December 2022

Our rating of this service went down. We rated it as requires improvement because:

• Staff had not minimised the use of restrictive practices. The rationale for some restrictions was unclear and not all restrictions were individually applied. Where a service has unnecessary restrictions that are not individually assessed and applied, there is an increased risk of a closed culture forming. Unnecessary restrictions placed on individuals offers no therapeutic value to patients.
• Staff did not provide the full range of care and treatment suitable for the patients in the service. Although they delivered clinical care in line with best practice and national guidance, the therapeutic activities offered did not meet the needs of all the patients. Activities were not tailored to the individual and offered seven days a week.
• Not all staff had completed British Sign Language training and compliance figures were lower than expected. Recent staff turnover had affected the availability of trained British Sign Language signing staff which had impacted on patient care and staff stress. There were multiple shifts that had no deaf or signing staff on shift.
• Staff did not fully understand how to dispose of spoiled medicines.
• Two of the four gardens did not provide patients with a suitable environment and gardens were not able to be accessed independently.
• Governance processes had not identified and addressed all areas for improvement within the service. The provider’s system to capture patient activity was not accurate, the fire safety risk assessment was out of date, food quality feedback was poor and one staff file had not met the requirements of Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

However:

• 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 and followed good practice with respect to safeguarding.
• The ward teams included or had access to the full range of clinical specialists required to meet most of the needs of patients on the wards.
• The service was well led and there was clear quality assurance management and performance frameworks in place that were integrated across all organisational policies and procedures.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. Availability of placements was regularly reviewed, and staff acted in accordance with Ministry of Justice restrictions.
• Managers ensured that staff received mandatory 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 developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Staff engaged in clinical audit to evaluate the quality of care they provided.
• Staff mostly treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

Updated 8 December 2022

This is the first inspection of the acute and PICU core service as the wards opened since the last inspection.

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 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 and families and carers in care decisions.
• The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Patients did not have easy access to outside space on South Hampton ward.
• Staff did not fully understand how to safely dispose of spoiled medicines.
• There was limited oversight of the agency induction paperwork.