Cygnet Hospital Taunton

Updated 13 July 2022

Cygnet Hospital Taunton is an independent mental health hospital near Taunton in Somerset, providing a range of specialist mental health services. This can include people detained under the Mental Health Act and those with challenging behaviour, as well as patients with long-term mental illness and additional physical health conditions. There are five wards within the hospital at the time of inspection. Sycamore 1 ward and Sycamore 2 ward are male acute inpatient wards, with nine and 17 beds respectively. Peacock ward is a four bedded step down, pre-discharge ward. Redwood Ward is a nine bedded locked ward for men with a mild to moderate learning disability or autistic men. Swift ward is a 15 bedded ward which supports older people both male and female with mental health difficulties.

At the time of this inspection the hospital had a registered manager in post. The hospital is registered to provide two regulated activities; treatment of disease, disorder or injury and assessment or medical treatment of persons detained under the Mental Health Act 1983.

The older adult ward and the learning difficulty wards were last inspected in March 2019 and was awarded a rating of good. The acute wards were inspected in December 2019 and was rated as requires improvement.

During our inspection in March 2019 we told the provider that they must make improvement to ensure that the dignity and privacy of patients was maintained.

During our inspection in December 2019 we told the provider that they must make improvement to:

ensure that the ward areas are clean, that there is always sufficient staff to ensure safe, good quality care, that patients are observed appropriately, that risks are clearly documented in patients notes, that capacity assessments are undertaken in a timely manner, staff receive appropriate induction, support, training, professional development and supervision and that there are effective governance systems in place to monitor and support the development of staff.

During this inspection we were satisfied that the above requirements were met.

What people who use the service say

Most patients we spoke with told us most staff were caring and treated them with respect and kindness. We observed staff engaging with patients in a kind and caring way. Patients on Redwood ward reported that “staff always support us with our care, they helped us understand what was happening”.

One carer told us that all the staff on the wards were friendly and that their relative knew every member of staff working on the ward. However, one carer told us they did not feel included in their relative’s care and treatment. For example, they said they had not been given any information about why their relative had been admitted, what their diagnosis was or what medication was prescribed and why. One carer told us the clinical team did not have the right information about their relative and was dismissive of their concerns. Carers whose relatives were from the acute inpatient ward expressed their frustration with contacting the wards via telephone regarding visiting access during Covid-19 outbreaks at the hospital. Carers told us that it could sometimes take multiple phone calls in one day to get through to ward staff and get conflicting messages regarding visit access.

Updated 13 July 2022

Cygnet Hospital Taunton is an independent mental health hospital near Taunton in Somerset, providing a range of specialist mental health services. This can include people detained under the Mental Health Act and those with challenging behaviour, as well as patients with long-term mental illness and additional physical health conditions.

Our rating of this location stayed the same. We rated it as good because:

• There had been significant improvements on the acute inpatient ward since the previous inspection in 2019. The hospital had separated the acute inpatient ward into two wards; namely Sycamore 1 and Sycamore 2.
• There was a new leadership team since our last inspection in 2019 who had a clear plan in place for the site and had started to make progress. The new hospital manager was aware of the risk areas and performance issues facing the service. They had reviewed the site improvement plan and had developed this in response to the identified areas for improvement, and progress with this was already evident. Staff said there had been a positive shift in culture.
• The service provided safe care. All ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed environment and individual risk well. They minimised the use of restrictive practices such as the use of seclusion and restraint, 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 such as National Early Warning Score (NEWS2). NEWS2 is based on a simple aggregate scoring system in which a score is allocated to physiological measurements, these are recorded in routine practice, when patients are in hospital. Staff engaged in clinical audit to evaluate the quality of care they provided such as The National Audit of Dementia (NAD).
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. These included Speech and Language Therapy (SALT) and Occupational therapy. Managers ensured that these staff received training, including specialist training to support them to meet the needs of patients, regular supervision and an annual 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 such as mental health community teams which is delivered mostly by the local NHS trusts.
• 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. Most patients we spoke with told us most staff were caring and treated them with respect and kindness. The hospital held daily reflection meetings, and weekly community meetings. Patients were encouraged to raise any issues, compliments and complaints during these meetings.
• The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
• The service was well led and the governance processes ensured that ward procedures ran smoothly. Staff we spoke with talked positively about their roles and were passionate about the service developing. Staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation.

However:

• Documentation around mental capacity was not always clear on Sycamore ward 1 and 2. It was difficult to identify mental capacity assessments in records. Some records identified that capacity was assessed and documented as patient having “insight” whilst other records identified that “patient had capacity” and these were recorded in different parts of the record keeping tool the hospital used. This meant it was not always clear if a patient had capacity to make a specific decision.
• Staff on Swift ward did not always carefully plan patients’ discharge. Staff did not always complete the fit to travel assessment documentation to ensure patients could travel safely once discharged.
• Carers that we spoke with expressed their frustration with contacting the wards via telephone regarding visit access during Covid-19 outbreaks at the hospital. Carers told us that it could sometimes take multiple phone calls in one day to get through to ward staff and get conflicting messages regarding visit access.
• The hospital lacked a robust assurance system to verify the training status of agency staff. Managers we spoke with told us they requested agency staff who had completed certain training but were not able to verify if this training actually took place.

Updated 13 July 2022

See the overall summary.

Updated 13 July 2022

See the overall summary.

Updated 13 July 2022

See the overall summary.