Cygnet Hospital Clifton

Updated 6 September 2021

Cygnet Hospital Clifton is a specialist low secure mental health and rehabilitation service for men with a personality disorder. Patients may also present with complex mental health needs and challenging behaviours. The hospital has two wards, each of which can accommodate up to 12 patients.

Ancaria ward is the assessment and initial treatment ward; it offers a defined pathway through to Acorn ward which has a focus on rehabilitation. All patients are detained under the Mental Health Act 1983.

Cygnet Hospital Clifton is registered with the CQC to provide 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.

The CQC had previously inspected this service in October 2012, March 2013, October 2013, July 2015, April 2016, November 2016, August 2018, January 2020 and May 2021. Following the inspection in January 2020, the hospital was placed in special measures. We rated the hospital inadequate overall, with inadequate in the safe and well led domains, requires improvement for the effective and caring domains and good for responsive.

When we inspected in May 2021, we judged that enough improvement had been made to remove the provider from special measures. We rated the hospital as requires improvement, with requires improvement for the safe, effective and well led domains and good for the caring domains and responsive domains. Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified and requirement notices were issued under the following regulations:

• Regulation 12 – Safe care and treatment
• Regulation 13 – Safeguarding service users from abuse and improper treatment
• Regulation 17 – Good governance
• Regulation 18 – Staffing

The provider submitted action plans that described how it would make the required improvements. We did not assess progress in relation to these breaches as the report for that inspection had not been published at the time of this inspection.

At this inspection the hospital had 22 patients, 11 on Ancaria ward and 11 on Acorn ward.

What people who use the service say

We spoke with four patients. Two said that it was sometimes difficult to take escorted leave off the ward, with one saying he had been asking all day for leave but staff had not been able to facilitate it. One patient said that staffing levels were sometimes low and senior managers had to work on the ward.

One patient said the food was poor and another that he had not received a meal plan despite requesting one and had missed meals due to the service not meeting his dietary requirements. Another patient had raised issues about not being able to get a hot drink in the morning.

Updated 6 September 2021

Cygnet Hospital Clifton is a specialist low secure mental health and rehabilitation service for men with a personality disorder.

Cygnet Hospital Clifton was placed into special measures by the CQC Chief Inspector of Hospitals in May 2020. This followed findings of significant concerns about the safety and leadership of the service. Since then the CQC has continued to monitor the service closely and has found some improvement. We have judged that enough improvement has been made to remove the provider from special measures.

Our rating of this location improved. We rated it as requires improvement because:

• Although we found the service largely performed well, it did not meet legal requirements relating to good governance and staff support, meaning we could not give it a rating higher than requires improvement.
• The provider did not support newly qualified nurses through their preceptorship in line with their own policy. Preceptors did not have the required post qualification experience and preceptorship nurses did not receive regular supervision as stipulated.
• The provider did not ensure all nursing staff received regular, constructive clinical supervision of their work.
• Managers had not ensured preceptors had the skills and experience to manage preceptorship nurses effectively. Managers had not ensured these nurses had two years post qualifying experience, had a mentoring qualification or received robust supervision and specialist support from more experienced staff in order to undertake this task. When raised with them, managers did not ensure the whole group of preceptorship nurses received the support stipulated in the provider’s policy.
• Staffing levels were not always at the level stipulated by the provider on both wards.
• Patient risk was not always accurately handed between shifts. Staff had not completed risk assessment training consistently.
• Staff did not always feel supported and valued by hospital managers. Managers had not ensured there were regular and effective team meetings for nursing staff. Staff were not always offered a debrief after incidents. There was no system for reviewing minor incidents and giving feedback to staff where appropriate. Learning from incidents and staff feedback was not applied consistently across the service.

However:

• The service had addressed issues since the last inspection, including increased training for staff, increased staff competence for existing staff and improving patient safety. Staff now followed procedures when delivering care and treatment and protected the privacy and dignity of patients. They had ensured staff kept information confidential and maintained accurate records of patient care and treatment, including preparing advanced statements with patients, completing security checks and checking emergency equipment on the wards.
• The service provided safe care. The ward environments were safe and clean. The wards generally 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 planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• Governance processes ensured that most ward procedures ran smoothly.

Updated 22 July 2021