The interactions we observed between people using the service and staff were friendly and respectful. The people we spoke with on Saltwood Ward (low secure unit) were mostly positive about the service. We were told the ward was “good” and “okay”, and that the staff were “always obliging with assistance if needed.” The people we spoke with on Knole Ward (child and adolescent mental health unit) said they felt they got something out of being in the hospital. They told us that some of the staff were very good. They told us they thought that one-to-one therapy was really good, but would like more time with nursing staff.

There were processes for safeguarding people from the risk of abuse. The people we spoke with told us they felt safe in the service.

People using the service had their own room with ensuite facilities. People could make their own drinks, and there was an interview room for one-to-one sessions and small meetings. The rooms contained anti-ligature furniture. Routine maintenance and safety checks were carried out.

There were adequate numbers of nurses and healthcare assistants on Saltwood Ward. The staffing levels on Knole Ward were maintained, but people told us that there were often agency staff who they did not think were familiar with the ward. People had care and treatment provided by medical and therapy staff.

The service reviewed and took action following incidents and complaints, and looked at ways of improving care within the hospital.

Patients felt involved in their care and part of the treatment process. They felt the staff treated them with dignity and respected their privacy.

Patients were pleased with the quality of care they received. Comments included, “… they are nursing me back to mental health” and “… (staff) have been extremely good to me”. Some staff were seen as, “marvellous” whereas others were,” … just doing their job”.

Some patients expressed concerns that there was a lack of activity at the weekends. One patient said weekends were, “vacant”.

Cygnet Hospital Godden Green has an integrated Tier 4 (inpatient wards) child and adolescent mental health service alongside a Department for Education, Ofsted -registered school, the Knole development centre. Its specialist pathway offers an open acute admissions service (Knole ward), and a pre-discharge ward (Littleoaks ward) to allow for a smooth transition for young people returning home to their families.

We last inspected this service in February 2018. This was a planned, announced comprehensive inspection and we rated the service as good overall and good in all domains.

Prior to this, we had undertaken a focussed inspection in November 2017, due to concerns about the safety of young people at the service including the number and severity of incidents and the lack reporting externally to relevant bodies. At this inspection we told the provider it must improve. From this inspection, we found the provider to be in breach of regulation 12, safe care and treatment, regulation 13, safeguarding service users from abuse and improper treatment and regulation 17, good governance. We also issued the provider with fixed penalty notices under sections 87 and 87 of the Social Care Act and Regulation 28 and Schedule 5 of the Health and Social Care Act20118 (Regulated Activities) Regulations 2014. The fixed penalty notices were issued in relation to multiple failures by the provider to make required notifications to the Care Quality Commission.

On the 2 and 3 January 2019, the Care Quality Commission carried out an urgent, focussed inspection on Knole ward and Littleoaks ward. Concerns had been raised with us, including the leadership of the service, number and severity of incidents affecting the health, safety and welfare of young people on the wards and the safety of the ward environment. We looked at Knole ward, a 15 en-suite bedrooms admission ward, and Littleoaks ward, which comprises seven en-suite bedrooms, both for males and females aged between 12-18 years of age. At the time of the inspection there were 12 young people on Knole ward and 6 young people on Littleoaks ward.

Cygnet Hospital Godden Green is registered for the following regulated activities: assessment or medical treatment, for persons detained under the Mental Health Act 1983; treatment of disease, disorder or injury.

The service had a registered manager at the time of the inspection. However, following the inspection we were informed the registered person no longer worked for the service. The provider informed the Care Quality Commission they had identified a new person to take over as registered manager and the necessary paperwork will be completed.

From November 2017 to October 2018, the service was under enhanced surveillance by relevant stakeholders to ensure that the quality and safety of the service made sufficient improvements.