This inspection was undertaken by a pharmacist from the Care Quality Commission. The purpose was to follow up on the compliance action that was made in relation to medicines during the inspection of December 2013.

We looked at the processes, and records held by the service relating to the use and management of medicines.

We reviewed the supply process, supporting information and administration records. Medicines were obtained in a timely manner. Staff showed us where and how medicines were stored and the expiry date and temperature records they kept. Therefore we were assured that the medicines were safe to be administered.

We reviewed the prescribing and administration records including additional monitoring records that were required when a few medicines were administered. These records were complete.

We spoke to four people using the service. They explained to us how they were given their medicines, the written information they were given prior to stating medicines and if they had questions about their medicines the staff find the answers. The service users also told us how their medicines were looked after by the staff, parents or guardians when they were they went out or stayed away from the service.

People who use the service told us that staff look after them well, and that they feel safe living at the hospital. We were told that an external advocate group that are specific to females visit the hospital on a weekly basis, and other advocacies visit for all people who use the service.

They said they always received their medication on time and staff and the Doctors explained to them what their medication was for. They told us that they were consulted each time their medication is changed, and the reason for the change is explained to them.

People who used the service told us that they had been asked their views about the service, and they had recently completed a questionnaire for the hospital. They told us that staff often asked them for their views about the service.

People who use the service told us that staff look after them well, and although staff are generally busy, they do take time to talk to them. Staff are generally good listeners, and some are better than others. They stated that they would talk to certain staff if they felt unsafe, in particular health care assistants and psychology staff. They said that most staff will talk to them in a polite manner; however, some staff can appear to be rude.

They agreed that there are enough staff on duty, and they now have regular day staff on duty. There are quite a few agency staff working at night, but there are always two permanent staff on duty at this time.

Some people who use the service had made complaints and that these were addressed. They stated that it would be good if staff could support people through the whole process when they make a complaint.

During discussions staff told us that they knew what Safeguarding meant (their rights and responsibilities to protect people from harm and abuse), and they would not hesitate in reporting Safeguarding issues. They stated that they had received all the mandatory training as required in their induction, and regular refresher training is provided by the service. They thought their recruitment was fair, and that they considered that there was always enough staff on duty. We were told that there are some senior staff who have ‘attitude’ issues, and that some senior staff appear to be bullying the more junior staff.

We observed good interaction between people who use the service and staff who were on duty on the day of the site visit. Staff were observed supporting people in a calm manner and using preferred names to address them.

We rated Cygnet Hospital Woking as Good because:

• There were enough suitably qualified and trained staff to provide care to a safe standard. Skilled staff delivered care and treatment. Throughout the two wards, the multidisciplinary team was consistently and pro-actively involved in patient care and everyone’s contribution was considered of equal value. The staff were kind, caring and motivated and we saw good, professional and respectful interactions between staff and patients during our inspection.
• Patients’ risk assessments and plans were robust, recovery focused and person centred. The assessment of patients’ needs and the planning of their care was thorough, individualised and had a focus on recovery. Staff considered the needs of patients at all times. Physical healthcare assessments and associated plans of care were thorough and consistently delivered to a high standard.
• Patients had access to a variety of psychological therapies described as best practice in The National Institute for Health and Care Excellence guidance. This therapy was delivered either on a one-to-one basis or in a group setting, as part of the treatment programme. There was a varied, strong and recovery-orientated programme of therapeutic activities and treatment groups available every week.
• There was evidence of best practice in, and all staff had a good understanding of, the Mental Health Act 1983 (MHA), the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and the associated Codes of Practice.
• There were many examples of initiatives implemented to involve patients in their care and treatment. Patients told us that the staff consistently asked them for feedback about the service and how improvements could be made. Patients were appointed as ward representatives and a ‘people’s council’ met regularly and ensured good communication between patients, staff and managers. The service was responsive to listening to concerns or ideas made by patients and their relatives to improve services. Staff considered these ideas and used them when they could. Staff had developed pamphlets for children to explain why their parents had been admitted to a psychiatric ward. The pamphlets were presented as stories, were age appropriate and used pictures to get the information across.
• The service had clear guidance in place to report incidents and support staff learning when things had gone wrong.
• Ward staff provided clinical quality audits, human resource management data and data on incidents and complaints. The information was summarised, updated daily and presented in a key performance indicator dashboard. Staff had good access to robust governance systems, which enabled them to monitor and manage the wards effectively and provide information to senior staff in the organisation and in a timely manner.
• All staff had good morale and said they felt well supported and engaged with a visible and strong leadership team, which included both clinicians and managers. Staff were motivated to ensure they achieved organisational objectives. Without exception, staff spoke highly about the senior management team.

However:

• The senior management team had only been in post for four months and staff had concerns about the stability of this team, given the hospital had 11 managers over a ten-year period.