Cygnet Hospital Harrow

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence on how the service provided was effective. During an inspection in May 2023, we rated this key question as inadequate. At that inspection, the service was in breach of regulation 18 (staffing). At this inspection, the rating has changed to good. This means that the service had taken action to improve the effectiveness of its care and treatment, particularly regarding the upskilling of staff, and the provision of evidence-based care and treatment. 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 maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Staff regularly reviewed and updated this assessment at regular time points during their stay at the service.

Staff assessed patients’ physical health needs in a timely manner after admission and this was regularly reviewed, at least weekly, during their time at the service. This included checks of patients’ temperatures, pulse, oxygen saturation and blood pressure. Staff carried out an electrocardiogram on patients, prior to the first administration of antipsychotic medication, and thereafter as national guidelines advised.

People’s needs were met by staff who had individualised training. We saw high quality training programmes completed by the different therapy teams. For example, we saw a comprehensive bespoke training around sensory needs, created by the occupational therapy team.

During an inspection in May 2023, the provider had the following breach: the provider must ensure that people have appropriate personalised care plans in place to support their behaviour and ensure they receive a copy. During this inspection, we found the service had improved and were no longer in breach. Staff now developed care plans that met the physical health, mental health, and communication needs identified during assessments. Care plans were personalised, holistic and recovery oriented. Plans for treatment set out the patients’ goals, as well as arrangements for risk management, speech and language therapy, occupational therapy and psychology. Patient’s history was considered in all of their care planning. Patients had a communication passport, communication grab sheet and general grab sheet available in easy read formats. These informed staff how to communicate effectively with patients. Patients’ felt staff understood how to effectively communicate with them.

Staff updated care plans, when necessary, but at least two weekly. Patients and those involved in their care took part in assessments and reviews. Patients’ preferred communication style was used so they could take part in reviews of their care. This enabled people to have their views, opinions and feedback captured and acted on. Their views and opinions were respected, listened to and implemented as part of the day-to-day support.

The audit lead for the service checked care plans and risk assessments each day to ensure these were up-to-date. We saw during the morning huddle that they identified any care plans that staff needed to update that day.

The service planned and delivered people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the patient group. Patients admitted to the Springs Service had a primary diagnosis of an autism spectrum disorder, and a secondary diagnosis of mental illness, including psychosis, personality disorder, bipolar affective disorder, post-traumatic stress disorder and depression. The care and treatment interventions the Springs Service offered to autistic patients, predominantly involved psychosocial interventions, antipsychotic medicines, positive behaviour support and an activity programme.

Staff delivered care in line with best practice and national guidance. The National Institute of Health and Care Excellence (NICE) recommends that services supporting autistic people should have access to psychosocial interventions for support with managing the core features of autism and building upon life skills. For example, patients should have a group or individual based social learning programme and/or a group or individual activity programme. Where the patient may also have behaviour that challenges, positive behaviour support plans should be used. The service offered combined interventions of antipsychotic medication in conjunction with psychosocial interventions when there had been limited response to psychosocial interventions alone, as NICE guidance advises. Most patients in Springs Service, did have coexisting mental disorders. In this case, the service offered psychosocial interventions in combination with pharmacological interventions informed by existing NICE guidance for the specific disorder. Doctors and the Autism Lead ensured that the service kept up-to-date with national guidance.

Springs Service provided therapeutic activities and support with life skills, facilitated by occupational therapist, psychologists, speech and language therapists, activity co-ordinators and peer support workers. We found patients to be engaged in activities throughout the day.

During an inspection in May 2023, the provider had the following breach: the provider must ensure that people using the service have access throughout the week including the weekend to therapeutic activities which provide structure and meet their individual needs. Although there had been an improvement in activities offered in the evenings, we did not see evidence of them taking place, during our evening visit of Springs Centre. On this night shift, there were 13 staff on duty, of whom 4 were in the office, and other staff were based in the corridors. We observed in the evening visit that most patients were residing in their bedrooms although 3 patients did spend time in the corridor. One patient was sitting independently, and 2 patients were talking occasionally with staff. One person was supported briefly to make a cup of tea in the kitchen. No staff were in the living/activity room, quiet room, kitchen or dining area for patients to engage with them in the evening. The grab and go activity boxes for the evening activities were located behind the locked main door of the ward, so patients couldn’t access them independently. We did not see these activity boxes in use. TheEbyEalso reported low usage of the social hub. During our evening visit, another ward was scheduled to use the social hub, but we did not observe it to be in use. The provider should ensure that staff proactively engage patients in activities during the evenings.

Some patients were living a long way away from family or the area they grew up in, because of a lack of available placements close to home, rather than by their own choice. Where this was the case, staff and leaders had planned with the patient and the people who were important them, about how they could facilitate visits and support important relationships. For example, we saw that staff used technology to include families and community staff in ward rounds, where this was appropriate for patient care and engagement. Staff and leaders were actively collaborating with stakeholders to support the person to move to an area they wanted to live in.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. The service conducted monthly audits of medicines, patients’ records, observations and engagement (including a review of CCTV). The service had scored above 85% for all these audits. The service also conducted a quarterly hand hygiene audit and a quarterly simulation of an incident involving resuscitation.

Managers used results from audits to make improvements. For example, when the service scored below 85% in an audit, the audit was repeated until sufficient improvements had been made.

Staff held regular and effective multidisciplinary meetings. There were professionals involved in the assessment and review of patient’s health, care and treatment, wellbeing and communication needs. Professionals were engaged in reviews and assessments to ensure relevant information was incorporated into patient’s care plans. For example, care plans detailed patient’s sensory needs, and how different sensory based activities could be tailored to support them. We saw staff facilitating a scent exploration session for an autistic patient who sought out and enjoyed sensory stimuli.

Staff shared information about patients at effective handover meetings within the team. Nurses and health care assistants shared information at the end of each shift. The multidisciplinary team met each day to review risks and incidents.

Ward teams had effective working relationships with other teams in the organisation. Communication across the hospital worked well. A meeting for senior staff across the hospital was held each morning, typically lasting for half an hour. At this meeting, staff shared information about staffing, maintenance, incidents, enhanced observations, patients’ physical health, safeguarding, discharges, referrals and plans for the day. Discussions in this meeting were calm and friendly. Everyone in the meeting was fully engaged in the conversations and gave their feedback.

Ward teams had effective working relationships with teams outside the organisation. For example, the local safeguarding team and commissioners who placed patients at the service.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives. For example, there was a gym instructor that worked with each patient, discussed healthy eating advice, and supported patients to change their eating and exercise habits. The instructor was included in ward rounds, where they discussed patient’s physical health and how exercise was being promoted.

The expert by experience lead for the site would take patients for ‘walk and talk’ meetings, where they would offer one to one conversation and support physical exercise at the same time. We saw that staff understood individual patient behaviour and preferences and developed strategies to support healthier choices.

Staff made sure patients had access to physical health care, including specialists as required. Patients could access healthcare appointments that were unplanned, such as accident and emergency, because staff and leaders had devised plans that worked for each individual. Plans were created with patients, their representatives, health professionals and social care professionals.

Staff continuously monitored patients’ health, their mental state and well-being. At twice daily handover meetings, staff noted details of patients’ sleep, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities. Any changes in a patient’s presentation were discussed at the daily multidisciplinary team meeting.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. For example, doctors used the Global Assessment of Progress (GAP) to measure patients progress and outcomes. The Glasgow Antipsychotic of Side-Effects Scale (GASS) was used to measure any adverse effects of medicines.

Staff introduced new ideas to people to enhance their quality of life, such as new activities, skills, work and education opportunities. Patients could now access a variety of sensory based activities, short courses, and work opportunities, in the service. Patients were actively supported and empowered to develop new skills. Staff used technology to support patients. For example, staff were exploring how they could use virtual reality equipment to benefit patients with sensory needs, anxiety and phobias. The service had computers for patients in their living or activity room. We did not see evidence during the inspection of staff supporting patients to use the computers, for example, in supporting online access to self-help tools.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff assessed each patient’s capacity to consent to admission and treatment. Staff assessed patient’s capacity for specific decisions throughout their care and treatment. Records included information about people’s capacity and how through their preferred method of communication, they were able to refuse or give consent for specific decisions. If patients lacked capacity to make a specific decision, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

Staff took all practical steps to enable patients to make their own decisions. Patients made their own choices and decisions on a day-to-day basis about what they did, what they ate and how they filled their time. However, some patients on Springs Centre did struggle to engage in meaningful evening activities.

We observed staff mainly communicating with patients about their choices, using simple sentences. The speech and language therapist told us that some patients can use talking mats to aid communication, however all patients could communicate verbally too.