Cygnet Appletree

Updated 20 January 2023

Cygnet Appletree is an independent mental health hospital based in Durham. The hospital is split over two floors and has two wards. Bramley ward (15 bed acute ward), and Pippin ward (10 bed psychiatric intensive care unit) for females of 18 years and over. The service was last inspected in April and May 2021 and ratings for the service were suspended. Enforcement action was taken which prevented admissions. These had been removed at the time of the inspection and we found that the hospital had made significant progress.

The hospital had a registered manager and a controlled drugs accountable officer. Controlled drugs accountable officers are responsible for all aspects of controlled drugs management within their organisation. Cygnet Appletree has been registered with the CQC since 26 September 2012 and has been managed by two other providers during this time. In March 2018, the provider of Appletree became Cygnet Behavioural Health Limited.

Cygnet Appletree is registered to carry out the following regulated activities.

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

Updated 20 January 2023

Our rating of this service improved. We rated it as good because:

• The service provided safe care and the ward environments were clean and well maintained. The wards usually had enough staff who 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 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 managed beds well so that a bed was always available 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.

However:

• The design and layout of Pippin ward meant that there were areas accessible to patients that were out of sight of the nurse’s station.
• The hospital had some nurse vacancies which meant that not all shifts on Pippin had the required 2 qualified nurses.
• Care plans were repetitive and sometimes difficult to follow due to the amount of information in them.
• One patient did not have clear care plans outlining the use of pro-re-nata (PRN) medication and use of intra-muscular administration of medications or rapid tranquilisation. PRN medications are medicines that are used when needed.

Updated 20 January 2023