Cygnet Hospital Harrow

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 7 quality statements in the safe key question and found areas of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection, which was inadequate. Though the assessment of these areas indicated areas of good practice since the last inspection, our rating for the key question is requires improvement. We found that incidents were reported and investigated appropriately, resulting in changes that improved patient care. Records were organised and easily accessible to staff to ensure they had access to essential information. Restrictive practices were recognised, regularly reviewed and reduced appropriately. There were some improvements to the sensory environment, however, refurbishment to the ward was still ongoing. Staff had received and were up to date with mandatory training, which included autism training. Leaders had implemented a new starter induction programme. Patient’s physical health was checked appropriately and recorded following rapid tranquilisation. However, the service did not always ensure infection controls principles were maintained.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff feedback, as part of this assessment, highlighted there had been an improvement in staff’s attitude and approach to their roles since the introduction of training specific to autism and learning disabilities. Staff told us that when there are reports of poor staff attitude, they are encouraged and supported to raise these concerns with management and that managers and the team have been proactive in addressing these quickly.

There was a service specific training strategy in place. Staff now received autism specific training and training completion rates were high.

Staff we spoke to, felt they could feedback about the service through daily staff meetings. Some staff felt that some patients were not appropriate for the ward. Some staff reported that some nurses were now involved in assessing new admissions to the ward. However, some ward staff felt that this was more of a token role. Staff felt there could be more conversations with the team around the reasons why their input in an assessment was not considered, to ensure that the views of all staff are listened to and considered before accepting admissions.

In the previous inspection, the provider had the following breach: The provider must ensure that the number of paper and electronic record systems that are used in practice are organised and easily accessible so staff can find essential information. We found the ward had implemented sufficient improvements to comply with the requirement notice we issued at the last inspection. The service used both paper and electronic records. All information needed to deliver patient care was available to all relevant staff when they needed it. It was in an accessible format, detailed, within date and had patient voice throughout. This included communication passports, positive behaviour support (PBS) plans, and communication and PBS grab sheets. Senior leaders told us that in the next six months, the service will be using a new electronic system, in which 95% of their records will become paperless.

Patients we spoke to felt safe on the ward. Patients told us when they raised concerns that related to safeguarding, staff were proactive to ensure their safety.

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. Staff had received training in safeguarding, knew how to recognise safeguarding concerns and report them. Staff we spoke to were aware of how to identify adults and children they can in contact with at risk of suffering harm and knew how to refer on as necessary to the ward safeguarding lead and local authority safeguarding team.

People are appropriately supported when they feel unsafe or experience abuse or neglect.

In the previous inspection, the provider had the following breach: The provider must ensure that restrictive practices are appropriately recognised, reported, and reviewed to ensure they are only used if absolutely needed. We found the ward had implemented sufficient improvements to comply with the requirement notice we issued at the last inspection. Staff applied restrictions on patient’s freedom, but they were justified. At the time of our assessment the provider had six blanket restrictions in place. These were: patients’ kitchen is kept locked; limited access to the garden and grounds; the tv remote is kept in the nurse’s station; lighters are kept in lockers; limited internet access on the ward; and the gym was not facilitated on the ward. The provider had an easy read version of the blanket restrictions in place, explaining what the restriction is, why it’s in place, and what patients can do. The provider held fortnightly ‘Reducing restrictive practice plan review’ meetings. We reviewed one meeting document and could see evidence that patients and staff attended the meeting and various topics were discussed in detail. These topics included why the restriction is necessary and what actions are being undertaken to reduce this restriction. We could see evidence that the provider was about to reduce some of the restrictions. For example, a gym instructor was about to commence employment therefore the gym could be accessed by patients with their support.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients told us they felt safe on the ward. However, patients we spoke to said that staff used the patient’s living room during the night for their breaks and felt that staff should instead use their own staff room, so that patients have a space to use if patients cannot sleep.

Staff had identified safety pods and a sensory room as part of patient’s risk management plans; however, the ward used the sensory room as a storage facility. We raised this during the assessment and staff reported that the sensory room had been cleared and was in use again. The service had plans to refurbish 2 of the bedrooms into a new sensory room. The refurbishment was discussed in the daily patients’ meeting. Patients were encouraged to choose what they wanted to be included in the sensory room.

We observed that the ward was generally quieter during this assessment, compared to the previous inspection. Patient told us alarms did not ring as often as they used to. Patients told us alarms where typically triggered by showers and smoke from vaping. Patients had easy access to nurse call systems. There was always an additional staff member in communal areas to ensure the safety of the ward and so that patients could access rooms with locked doors like the kitchen. At the time of the visit, staffing levels were adequate to appropriately respond to alarms and manage risks to patients, staff and visitors. Staff had access to radios. They used earpieces to reduce the noise.

In the previous inspection, the provider had the following breach: The provider must ensure the ward’s fire alarms do not go off unnecessarily to avoid distress for the patients and to also prevent people from becoming accustomed to alarms sounding and therefore not responding in the event of a real fire. We found the ward had implemented sufficient improvements to comply with the requirement notice we issued at the last inspection. We reviewed the service’s maintenance logs. These were detailed and completed appropriately. For the Spring’s Centre, there were eleven entries for the month of January. There were no logs pertaining to the fire alarms, or fire equipment, or any environmental issues for the ward.

Staff felt listened to by the new hospital’s director and director of nursing. Staff told us they receive regular supervision and support to develop their professional knowledge and skills.

In the previous inspection, the provider had the following 2 breaches: The provider must ensure that staff on all wards for autistic people are adequately trained and skilled to make sure that they can meet the care and treatment needs of autistic people. This must be in line with good practice and support the staff to communicate effectively with people using the service. Secondly, the provider should ensure that the new staff induction checklist for people working on the wards for autistic people, includes a prompt to show them the environmental risks such as ligature points. We found the ward had implemented sufficient improvements to comply with the requirement notices we issued at the last inspection. Staff had received and were up to date with appropriate mandatory training, which includes training in learning disabilities and autism. Overall, staff in this service had undertaken 97% of the various elements of training that the provider had set as mandatory. All staff had completed The Oliver McGowan mandatory training on learning disabilities and autism. Staff were trained in safeguarding, at various levels of qualifications, dependent upon their role. The lowest training compliance rate was 68.6% & 74.3% for Prevention and Management of Aggression (PMVA). However, the provider was aware of the staff who had not yet carried out this training, and a plan was in place for them to complete it. Managers now provided new staff with a formal comprehensive induction programme. Managers also provided two-day long autism specialist service focus days. The service had a service specific training strategy for Cygnet Hospital Harrow for 2024. This incorporated various training sessions throughout the year, including reducing restrictive practice, activities, occupational therapy, seeing the whole person and sensory tool kits.

Staff understood and followed infection control guidelines, including handwashing guidance and access to appropriate personal protective equipment.

The ward was visibly clean and tidy. Some furnishings were in good condition and appeared well maintained and fit for purpose. However, staff did not always store food in line with, food safety standards which could pose a food safety risk. For example, we saw sandwiches and dairy products stored in a room with a waste bin for PPE and hot food on a counter in the kitchen. We told the provider about this during our on-site assessment, and they resolved the issue.

In the previous inspection, the provider had the following breach: The provider must ensure that the environment for autistic people is clean to ensure infection control principles are maintained. We found the ward had implemented sufficient improvements to comply with the requirement notice we issued at the last inspection. The ward kept up-to-date cleaning records that showed the ward areas were cleaned regularly. Staff had completed food hygiene and food safety training. There was a comprehensive food safety, management and hazard analysis policy, in place for all Cygnet locations, which provides guidance around safe food storage. There were daily and monthly audits for the specific food hygiene tasks e.g. opening and closing checks in the kitchen, COSHH and a utensils check.

Staff involved patients in reviews of their medicines in ward rounds with the MDT. Patients had weekly side effects review scales completed with staff.

Staff followed good practice in medicines management, to safely prescribe, administer, record and store medicines. The service had introduced a PRN protocol, which focused on physical health monitoring and side effects of PRN medicines. This was reviewed in the MDT meetings. Staff we spoke to knew what was on the PRN protocol. They felt it helped all staff know how to respond to patients who were experiencing side effects. Staff informed us that there had been a reduction in the use of rapid tranquilisation on the ward. Staff utilised a variety of techniques when supporting difficult situations with patients such as de-escalation techniques, distractions, sensory rooms and implementing PMVA training techniques to diffuse incidents.

In the previous inspection, the provider had the following breach: The provider must ensure that patients’ physical health is checked appropriately and recorded consistently after they have received medicines via rapid tranquilisation, in line with national good practice guidelines and the provider’s own policy. We found the ward had implemented sufficient improvements to comply with the requirement notice we issued at the last inspection. Patients records demonstrate that appropriate processes are followed following the administration of PRN/ rapid tranquilisation. Physical health checks were carried out and appropriately recorded, and patients were debriefed. The ward had associate specialist doctors carrying out weekly physical health clinics and had recruited a physical health lead (RGN). All patients were offered routine annual health checks.