Cygnet Hospital Harrow

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence on how the service provided was caring. At the last inspection in 2023, we rated this key question as inadequate. At that inspection, the service was in breach of regulation 9 (person-centred care).The service had made improvements and is no longer in breach of regulations. At this inspection, the rating has changed to good. We observed positive and caring interactions between staff and patients. We found no breaches of regulations in relation to this key question.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service treated people with kindness, empathy and compassion and respected their privacy and dignity.

During an inspection in May 2023, the provider had the following breach: the provider must ensure that people using the service are supported by staff in an appropriate and supportive manner, treat them with kindness and understand their individual needs. During this inspection, we found the ward had improved greatly.

Staff attitudes and behaviours when interacting with patients showed that they were friendly, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. We also observed positive and kind interactions between staff.

Staff supported patients to understand and manage their care, treatment or condition. Staff provide one-to-one sessions with patients to go through their risk assessments, care plans, and options for therapeutic activities. Staff supported patients to engage in meaningful therapeutic activities. For example, we saw one patient enjoying a music session. He told us that staff supported him to attend the session, which helps his mental wellbeing.

Most patients said staff treated them well, were kind and supportive. Some patients gave examples of how staff supported them with difficult situations, for example when two patients were experiencing regular difficulties with each other.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. Staff supported patients to maintain and develop their social skills and meet their sensory needs, through various activities and tools. Staff provided various group sessions, such as interpersonal skills and boundaries; chat café- games and social interactions; and a zen zone and sensory lab group, which involved mindfulness practice. Staff also supported patients with social stories, to help reduce anxiety around the routine of specific events.

Staff followed policy to keep patient information confidential. Information held on electronic systems was protected. Staff entered a personal username and password to access this information. Patient information recorded on paper was held in locked filing cabinets.

The service treated people as individuals and made sure their care, support and treatment met their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff within the service had a very good understanding of each patient’s mental health, their risk history and their social circumstances outside hospital. Occupational therapists and activity co-ordinators supported patients to pursue their interests and hobbies. For example, some patients enjoyed basic cooking skills, playing musical instruments and exploring different scents and sounds in the sensory lab.

Patients came from diverse cultural backgrounds. Staff recognised this and provided facilities and celebrated important events, to meet patients cultural and religious needs.

The service promoted people’s independence, so they knew their rights and had choice and control over their own care, treatment and wellbeing.

People are supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. We saw that patients and staff had co-produced their care plans, and patients were provided with a variety of therapeutic and recreational activities to join, to support their skills and well-being. One patient told us about how staff had supported them to learn new skills and enrol in a remote basic accountancy course.

Staff made sure patients could access information on their rights and how to complain. Information about the Mental Health Act and making complaints was displayed on a notice board.People are supported to understand their rights by using different ways to communicate. Their understanding is reviewed throughout their care and treatment.

In Springs Wing, patients could make their own hot drinks and snacks from food and drinks available in the kitchen and were not dependent on staff to access these or support them. On Springs Wing, patients were able to store their own personal food and snacks in cupboards in the communal kitchen. These kitchen cupboards were kept locked so that patients could not access each other's food. Staff opened them when patients requested. In Springs Centre, the kitchen was locked and had been locked since January 2022. The community meetings indicated that this restriction had been reviewed and discussed amongst patients. During our inspection we saw patients asking staff to access the kitchen to make a drink. Some of the patients’ snacks, such as pot noodles and soup, were kept in the nurse’s station. Staff told us, this was to prevent patients taking more than one at a time. However, patients only have supervised access to the kitchen, so keeping snacks in the nurse’s station would prevent patients from having all available food in the kitchen to choose from. The provider should consider how blanket restrictions around the locked kitchen and locked kitchen cupboards, will be reduced over time.

The service offered a variety of good quality food. Most patients said they enjoyed the food. Some patients said the food at the weekend can vary in quality.

The service listened to and understood people’s needs, views and wishes. They responded to these and acted to minimise any discomfort, concern or distress.

Patients told us that staff were mindful of their privacy and confidentiality. We observed interactions between staff and people who used the service and saw that these relationships were caring and compassionate, enabling staff to anticipate and meet people’s needs quickly and in ways that reduced and mitigated people’s discomfort and distress.

People told us they felt listened to and their feelings were respected. Patients felt able to approach staff with concerns, and able to voice their feelings and feedback in the daily planning meeting and weekly community meetings.

The service employed an expert by experience who had previously used inpatient services. They had facilitated patients’ involvement in the redesign of the hospital. For example, they engaged patients in choosing colour themes for the ward to create a more therapeutic, less clinical environment. Patients were keen to have double beds installed so they could sleep more comfortably. The service purchased these.

The service cared about and promoted the wellbeing of staff and supported and enabled them to deliver person centred care.

Staff told us that morale across the hospital had been very low after the service received an inadequate rating following the inspection in May 2023. However, this had improved significantly following investment and support. Staff and managers said the new hospital director was approachable, supportive and engaged with staff on the wards.Staff and managers said they found senior managers at the hospital to be very supportive.

The service considered and promoted the well-being of its staff. The service had recently employed a well-being lead, whose role was to help and support all staff members. We saw a variety of events had recently taken place, and many more events that were scheduled. During the inspection there was a well-being event in the social hub that we saw several staff attending. There was a positive and supportive atmosphere. The lead also ran well-being clinics for staff, including a clinic for staff working on night shifts. Information about these clinics was displayed in the nurses’ office.

There were other seasonal and cultural events celebrated in the service. For example, during the inspection we saw an event arranged by Romanian staff to share information with their colleagues about Romania.

An employee assistance programme was available to staff.The provider also offers an employee reward programme.

Some nursing offices and administrative offices were small, and some staff said there was not enough space to comfortably carry out their work. We raised this with the provider during our inspection and asked the service to carry out workstation assessments for staff. There were limited spaces for staff to keep coats and belongings. On Springs Wing, we saw the nursing office required a declutter on high surfaces to maintain health and safety standards.