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Cygnet Hospital Harrow, Harrow.

Cygnet Hospital Harrow in Harrow is a Hospitals - Mental health/capacity and Rehabilitation (illness/injury) specialising in the provision of services relating to assessment or medical treatment for persons detained under the 1983 act, caring for adults over 65 yrs, caring for adults under 65 yrs, caring for people whose rights are restricted under the mental health act, eating disorders, learning disabilities, mental health conditions, substance misuse problems and treatment of disease, disorder or injury. The last inspection date here was 8th January 2019

Cygnet Hospital Harrow is managed by Cygnet Health Care Limited who are also responsible for 18 other locations

Contact Details:

Ratings:

For a guide to the ratings, click here.

Safe: Requires Improvement
Effective: Good
Caring: Good
Responsive: Good
Well-Led: Good
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2019-01-08
    Last Published 2019-01-08

Local Authority:

    Harrow

Link to this page:

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Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

21st February 2014 - During a routine inspection pdf icon

We spoke with four people who were detained under the Mental Health Act 1983 and with four informal patients. People told us that the staff treated them well and respected their privacy and dignity. One person said, “This place is fantastic. (Named doctor) is the best consultant. All the staff are so friendly, when you have problems there is always someone to approach.”

There was a daily programme of therapeutic groups and individual therapy sessions for each person. All the people we spoke with said that the groups were “really good”. One person told us, “Therapy helps me to understand the cause of my illness and coping strategies that I can use.” Another person said, “Group therapy is invaluable. It helps you deal with your emotions.”

Accurate records were maintained of the care provided for each person, and of how each person set and monitored their own goals. Staff records and other records relevant to the management of the services were accurate and fit for purpose.

We checked the records of physical restraints and noted that all incidents of restraint were fully recorded and that the restraints were used appropriately.

12th December 2012 - During a routine inspection pdf icon

All the care plans that we saw contained clear information on each person’s needs, and on their rights under the Mental Health Act 1983. The people who we spoke with told us that they had a copy of their care plan, and that they were treated well. One person said, “I am ready to go home now. I was down when I came in, but I’m much better now.”

We spoke with the family of one of the informal patients who had been admitted voluntarily for treatment. They told us that they had been informed of their relative’s admission, and they were having a meeting to discuss the planned treatment.

An independent advocate visited the hospital each week to discuss any concerns with patients. We saw evidence that the advocate supported people to make complaints when they had concerns about their treatment or choices in the hospital.

We spoke with both informal patients who were admitted voluntarily for treatment and with patients who were detained under the Mental Health Act1983. We checked the records of their consent to treatment. We saw evidence that care and treatment plans were discussed with informal patients, and that mental capacity assessments were carried out when appropriate. However the records for detained patients showed that the provider did not follow the code of practice of the Mental Health Act 1983 for obtaining a second opinion when medicines were prescribed for urgent treatment.

12th October 2011 - During a routine inspection pdf icon

Patients told us that they felt safe in the hospital. They felt that their views were taken into account and respected and their dignity upheld. They told us that staff were approachable and listened to them.

Where patients had experienced restraint they felt that it was carried out in an appropriate way and for the right reasons.

Patients told us that they understood why their medicines had been prescribed.

Everyone we spoke with said that they were happy with the care they had received.

13th December 2010 - During an inspection in response to concerns pdf icon

People told us that they are happy in the service. They said that they feel involved in their care and are aware of and attend reviews. They told us that they find the staff friendly, helpful and approachable and that they have regular contact with their consultant, key workers and other staff and know who to speak to about their care and choices and how to complain. They said that they make decisions about the activities in which they take part. They told us that they are aware of the medication they are taking and why they are taking it. They told us "I'm happy here"; and "my medication makes me feel better".

1st January 1970 - During a routine inspection pdf icon

Our overall rating for the hospital improved. We had previously rated the service as requires improvement. During this inspection we rated the service as good because:

  • The provider had taken action to address breaches of regulation and best practice recommendations made at a previous inspection in July 2017. Safeguards were now in place to protect patients on Byron Ward from defacto seclusion and excessive restriction when they were nursed on one-to-one observations. Patients with a primary need for substance misuse detoxification were no longer admitted to Byron Ward. Staff on this ward had now received training in substance misuse issues and were able to safely support patients with a dual diagnosis.

  • We also saw that staff on the Springs Unit discussed, shared and implemented learning from serious incidents. Stock control of medical items on Springs Wing had improved and expired items were removed in a timely fashion. All wards were now undertaking a comprehensive range of audits that fed into governance processes. There had been improvements in how the Mental Health Act was managed, for example, where patients were entitled to statutory aftercare this was outlined in their care plan. In addition, robust systems were in place to monitor patients leave.

  • We also saw that patients on the Springs Unit were now supported to maintain appropriate levels of cleanliness and that on the Springs Wing, physical health interventions were now carried out in accordance with patients care plans.

  • Governance systems to monitor the safety, quality and effectiveness of the service had improved. On Bryon Ward, a system to listen to and act upon staff concerns had been implemented. Overall, the hospital collected, analysed, managed and used information well to support all its activities.

  • The service had enough staff with the right qualifications, skills and experience to keep people safe and to provide the right care and treatment.
  • Patients had their holistic needs assessed on admission and care plans to address these were in place. Robust arrangements to meet patients’ physical health needs were also in place. Patients received the right medication at the right dose at the right time.
  • Staff assessed individual patient risk and put plans in place to keep them safe. Restrictive interventions were only used as a last resort, when staff attempts at de-escalation had failed.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service managed patient safety incidents well. The service treated concerns and complaints seriously. The hospital was committed to improving services by learning from when things go well and when they go wrong.
  • The service provided care and treatment based on national guidance. The service monitored the effectiveness of care and treatment and used the findings to improve them.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care. Staff received annual appraisals. Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff involved patients and those close to them in decisions about their care and treatment.
  • People could access the service when they needed it. Waiting times from assessment and arrangements to admit, treat and discharge patients were in line with good practice. Staff were working with partners to reduce delayed discharges for patients ready to move on. Clients were not moved between wards unless there was a clinical need for this.
  • Ward environments were comfortable and well looked after. The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • The service took account of patients’ protected characteristics and addressed these in the care and treatment provided. Patients were able to access the hospitals recovery college and a range of meaningful activities were provided both on and off the wards.
  • The hospital had managers at all levels with the right skills and abilities to run a service providing good quality sustainable care. Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose based on these values.
  • The hospital had effective systems for identifying risks, planning to eliminate or reduce them. The service planned for emergencies and staff understood their roles if one should happen.
  • The hospital engaged well with patients, staff, carers and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

However;

  • On all wards, robust systems were not in place to ensure that equipment used to monitor patients’ physical health was calibrated and maintained.
  • On Byron Ward, controlled drugs were not safely and appropriately stored. Many medicines on this ward were overstocked. We raised this at the time of inspection and the provider subsequently told us that a larger medicines cabinet was ordered and fitted by the end of November 2018.

  • At the Springs Unit, appropriate measures were not in place to identify, mitigate and manage potential ligature anchor points. However, the provider told us there was a works programme planned to further reduce ligature points for completion by the end of June 2019. The ligature map was updated by the provider at the time of inspection to reflect the ligature points that had been identified during this inspection.
  • Whilst the providers overall compliance rate for staff take up of mandatory training was above its target of 80%, there were some key mandatory training courses where take up was considerably lower, including some that could impact upon patient safety. The provider did not have up to date training records available at the time of our inspection due after a recent change to the database they were using.
  • Since the last inspection the provider had made improvements to Byron Ward to make it safer as it accommodated both male and female patients. However, further improvements were needed to comply with national guidance on mixed sex accommodation. Whilst building works were planned, no date for these had been fixed.
  • The four wards were not connected by a single alarm system. To summon the hospital wide emergency response team, staff used a radio. The provider had planned works to address this issue, but no date for the works had been set. In addition, on Springs Unit and Springs Centre, patients did not have access to call alarm systems they could use to summon staff in an emergency.
  • An inappropriate blanket restriction was in place on Springs Wing rehabilitation unit, where patient toilets in communal areas were locked, preventing patients from using them.
  • Whilst the provider had made progress since the last inspection in ensuring that staff on Springs Unit, Springs Centre and Springs Ward received regular supervision and that supervision records were securely stored, this remained an issue on Bryon Ward. Staff on Byron ward were not receiving regular supervision that provided them with support and monitored their performance.
  • Whilst overall, the range of facilities on each ward meant that patients could have their treatment needs met, further improvements were needed at the Springs Centre to ensure the ward was an appropriate environment. For example, a sensory room was planned for the ward, but no date for the work to commence had been fixed. Subsequently the provider told us building works were due to commence between January and June 2019.
  • Some further strengthening of governance systems was required to ensure that on each ward and across the hospital, governance systems effectively identified all areas where quality, safety and effectiveness could be improved. For example, the calibration of physical health monitoring equipment across all wards and storage of medicines on Byron Ward.

 

 

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