Cygnet Churchill

Updated 2 December 2022

Cygnet Churchill is an independent hospital providing mental healthcare for adult men.

The hospital has four wards.

Juniper Ward is a 17-bed acute ward. The ward provides care for patients experiencing an acute episode of mental illness and requiring an emergency admission.

Maple Court, Mulberry Court and Elm Court are wards providing inpatient rehabilitation services for patients requiring recovery-orientated care.

At this inspection, we inspected the acute ward for adults of working age. We also reviewed the reporting of statutory notifications for rehabilitation services for patients requiring recovery-orientated care.

All of the beds on Juniper Ward were commissioned by a local NHS mental health trust. All of their referrals were from the trust’s local boroughs.

The service is registered to provide:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983

• Treatment of disease, disorder or injury.

The hospital director is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service.

The hospital was last inspected in October 2019. The service was rated good overall and for all the key questions apart from Well-Led, which was rated as requires improvement. The hospital was issued 1 requirement notice at the time. This notice was to ensure the CQC was kept informed of all statutory notifications.

What people who use the service say

Most patients were very complimentary about their stay in hospital and the staff team. Patients told us staff always had smiles on their faces, that staff were friendly, and they were supported to attend external appointments and activities. A patient told us this was the best hospital they had been in. Another patient said there was mutual respect between staff and patients, and he felt they treated him as an individual.

However, some patients reported there were not enough staff. One patient said there was poor communication between staff when it came to their leave plans, and another said they had not been offered any 1:1 sessions.

Twelve patients responded to a patient survey carried out in September 2022. The survey showed most patients felt safe on the ward and felt staff were caring. Most patients felt involved in their care and treatment, and felt the ward supported their individual diverse needs.

However, some patients reported the food was poor, some felt there were not enough staff, and some were not aware of the advocacy service available to them.

Updated 2 December 2022

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

• We rated acute wards for adults of working age as good overall with requires improvement for the safe domain. We rated long stay or rehabilitation mental health wards for working age adults as good for well-led. The hospital remained good overall.
• The ward environment was clean, well equipped and well furnished. The ward 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. Staff assessed the physical and mental health of all patients on admission. 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.
• Staff supported patients with activities outside the service, such as work, education and family relationships.
• The ward teams had access to a range of specialists to meet the needs of patients on the ward. Managers ensured that these staff received training. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each patient’s mental and physical health.
• 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.
• The service was well led, and the governance processes ensured that ward procedures ran smoothly. The service informed CQC of all statutory notifications.
• Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the service they managed and were visible in the service and approachable for patients and staff. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Staff could raise any concerns without fear.

However,

• Whilst the ward had a ligature risk assessment, the risks were not as well mitigated as they could have been. Staff did not always know where ligature risks were on the ward.
• Some staff did not ensure that they varied when they checked patients. When patients were checked 4 times per hour for their safety, the checks were not always carried out at 4 random times throughout the hour.
• The ward had introduced fans onto the ward following a risk assessment. However, routine oversight of the fans’ use had not yet been incorporated into ward systems, such as the daily environmental checklist.
• Handover documentation and daily allocation sheets were completed each day; however, they were not always completed in full to include staff members’ allocated roles.
• Controlled drugs were not always checked by 2 registered nurses as per hospital policy. The ward was not able to provide assurances that their blood glucose monitor was fit for use.
• Restraint documentation within incident reports did not always show which staff were involved or the role they played in the restraint.
• Patient awareness of the advocacy service and the complaints procedure was patchy.
• Staff had regular appraisal and managerial supervision, but staff were not having regular monthly clinical supervision and monthly reflective practice sessions for staff were poorly attended.
• The team meeting did not routinely cover matters such as incidents, safeguarding and the learning from these.

Updated 2 December 2022

Updated 2 December 2022