People spoken with told us they were involved in activities on their ward and that the staff were supportive. This and the other evidence inspected showed us that people’s privacy, dignity and independence were respected.

We noted that staff engaged with people in a positive way and this was reflected in those care records reviewed. This demonstrated to us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A current safeguarding of vulnerable adults policy and a staff training programme to support this were in place. This meant that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We noted that each person who required support or enhanced levels of observation received this in a prompt and supportive way. Staff were up to date with their mandatory training and had received recent clinical supervision. This meant that people were being cared for by adequate numbers of qualified, skilled and experienced staff.

We saw that a clinical assurance framework was in place. This, and the other evidence inspected, showed us that the provider had an effective system to assess and monitor the quality of service that people received. We looked at nine people's care and treatment records. These were well kept and reflected individual treatment needs. This showed that accurate and appropriate records were maintained by the service.

People who use the service were positive about the service and the staff who cared for them. A person commented, “Staff are good at their jobs. They are respectful. They are great, not horrible, just right.” This was echoed by another person who said, “Staff are all right. They are all polite and approachable. One of the best hospitals that I have been in. We get survey questionnaires about the service.” A person commented, “Staff are all right and respectful. Some staff get a bit impatient with me but I was abusive to them sometimes. I can’t help it.” Another person said, “Staff are OK. This place is far better then the other place.”

When asked about choices over menu and meals served, a person said, “There is a choice of menu. The food is fine.” This was echoed by another person who said, “We have choices everyday. Evening meal is served hot. Plenty to eat.” Another person commented, “We get hot soup and a choice of sandwiches at lunchtime. The evening meal is served hot. There is a choice of menu. Yesterday we had grilled chicken, potatoes and carrots. At around 9pm we can have crumpets or toast.”

We rated Cygnet Hospital Stevenage as good because :

• The clinic rooms on all four of the forensic wards contained emergency equipment and emergency drugs which were checked regularly.
• Shifts were covered by a sufficient number of staff at the right grades. Many qualified nurses were short term contracted agency staff due to the high number of vacancies
• Psychological therapies recommended by the National Institute for Health and Care Excellence (NICE) were provided to patients.
• The GP attended the hospital on a weekly basis to provide appointments for patients. The service had a full time physical health care nurse who had undertaken additional specialist training in order to effectively support patients with specific long term illnesses.
• Staff used Health of the Nation Outcome Scales (HoNOS) and HCR-20 which is a risk assessment for managing violence.
• The carers’ forum was held on a six monthly basis on a Saturday whereby patients’ carers, friends and families were able to come into the hospital and discuss their involvement. There was a quarterly newsletter which was sent out to all carers and carers were invited to contact the social work department to ask questions and give feedback.

However:

• On Peplau ward the couch in the clinic room was dilapidated, torn and needed to be replaced. The fridge was dirty and needed defrosting and cleaning. We found two boxes of two different types of medication in the clinic room on Peplau ward which were out of date (dated November 2017).

• We examined three seclusion records for the forensic wards. We found that the seclusion template limited what was documented. The forms were not fully completed. One form omitted the time the doctor arrived, another did not provide details of therapeutic activities offered and the final form did not provide details of when food was offered.

• Two out of six wards supervision documentation was poor. The manager on Orchid ward was unable to provide all records of individual supervision meetings. The manager on Chamberlain ward provided some evidence that supervision had taken place but these records were incomplete. During the inspection we reviewed a further seven records and found gaps in the documentation

  The provider used newsletters and governance meetings to share lessons learned. However, two of the staff that we spoke with had not received feedback from incidents and complaints. They were not aware of the lessons learned processes in place.