Cygnet Hospital Harrow

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence on how the service provided was responsive. During the inspection in May 2023, we rated this key question as requires improvement. At that inspection, the service was in breach of regulation 12 (safe care and treatment). At this inspection, the rating has changed to good. This meant that the service had taken action to improve its responsiveness, particularly regarding the provision of easy read information and improvements to the environment. We found no breaches of regulations in relation to this key question.

This service scored 71 (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 made sure people were at the centre of their care and treatment choices and decided, in partnership with them, how to respond to any relevant changes in their needs.

Patients received responsive, personalised care and support that met their needs and reflected their preferences. Patients were empowered to co-produce their own care and support plans with staff and these were reviewed and updated regularly.

Staff regularly met with patients to understand their views on care and treatment. These discussions took place in one-to-one meetings with their named nurse and in multidisciplinary team meetings. Staff monitored patients’ conditions and discussed any changes at handover meetings.

The service provided a variety of activities to meet the needs and interests of patients. Each ward had a timetable of planned activities. We saw patients participating in music sessions, sensory based activities and an in-house tuck shop. Patients also told us about the upcoming trip planned to Winter wonderland.

When appropriate, staff made sure patients had access to opportunities for education and work opportunities. The service had a variety of paid in-house opportunities for patients to get involved with. These included, co-facilitating a tuck shop, interviewing prospective staff, people’s council representative, gardening assistant and car wash assistant.

Staff helped patients to stay in contact with their families and carers. One patient told us that they were supported to visit their family every weekend. Carers told us that they found the communication from staff wonderful, and that they felt comfortable to contact the ward at any time.

Staff encouraged patients to develop and maintain relationships in the service and the wider community. Patients across the hospital could interact in the hospital’s social hub. The hospital celebrated seasonal and religious occasions, allowing patients in the service to come together and form friendships.

The service provided appropriate, accurate and up-to-date information in formats that were tailor to individual needs.

Staff made sure patients could access information on treatment and local services, in formats tailored to individual needs. There were notice boards on the ward with easy read information about things like activities, the social hub, exercise, diabetes, items not allowed on the ward, safeguarding, the Mental Health Act, infection control, the independent mental health advocacy service and a list of mental health solicitors.

During the inspection, there were building works going on across the site. There were information boards for staff and patients about this and what it may involve, particularly loud noises, and different layouts of the hospital. Across the site, we saw easy read signs that said what each room was. At reception there was easy read information about the food in the cafeteria that day.

Staff had access to the equipment and information technology needed to do their work. However, the nurses’ office in Springs Wing was quite small and cluttered and it was not always possible for staff to access a computer terminal when they needed one. We did see staff using laptops, but this was often used whilst in the patient’s communal areas. The nurse’s office in Springs Centre was larger, but cluttered and staff said they couldn’t always sit in a comfortable position when using the computers, due to the large number of items being stored under the desks.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. This information was presented and discussed in clinical governance meetings.

Staff made notifications to external bodies as needed. The service submitted notifications to the Care Quality Commission in accordance with the requirements of their registration. The service submitted safeguarding referrals to the local authority.

The service made it easy for people to share feedback and ideas or raise complaints about their care, treatment and support.

Patients, relatives and carers knew how to complain or raise concerns. Patients said if they had any complaints, they would speak with nursing staff, their doctor or the ward manager in the first instance. There was information on the wards in easy read format about how to make a complaint and who the two advocates were for each ward. This included picture of all staff that they might meet.

Staff understood the policy on complaints and knew how to acknowledge and handle them. All complaints for the hospital were passed to the compliance officer who facilitated the investigation.Patients received feedback from managers after the investigation into their complaint. Staff received feedback on the outcome of investigation of complaints and acted on the findings.

In the last 12 months, the hospital had received 42 complaints. Of these, 38 were completed within the provider’s response timeframe. Only one complaint was completed outside of the time frame. Three complaint outcomes were still due but were within the response time frame. On Springs Wing, one patient told us they had given feedback about staff and changes were made as a result.

The provider employed an expert by experience lead that visited the site every week. The expert by experience lead met with patients, co-chaired community meetings on wards, was involved in staff training and met with the hospital director regularly to provide feedback. They also produced a monthly report for the Lived Experience Advisory Board which supported patient voice in service development and improvement. Patients and experts by experience leads were involved in decisions about the design and decoration of the hospital.

The service made sure that everyone could access the care, support and treatment they need when they need it.

The services met the needs of its patients. Both wards were based across two levels. Springs Centre had a lift to ensure patients with mobility impairments could have equity in access. Springs Wing’s second floor were patient bedrooms, which could only be accessed by stairs. The service mitigated this by having a ground floor bedroom, that was kept for people with mobility issues.

Staff understood the needs of autistic people and people with a learning disability and worked hard to ensure that typical barriers faced by people were removed or mitigated against. As a result, peoples experience had improved since the inspection in May 2023.

For example, staff were meeting patients’ specific communication needs. We saw welcome packs, information sheets and psychology resources available in a variety of communication methods, including easy read and talking mats.

The service admitted patients from diverse religious and cultural backgrounds. Staff asked patients about their religious and cultural needs when they were admitted to the ward. The quiet room was used as a religious space for patients who wanted to pray. We saw a range of religious texts available for patients in the quiet rooms. The service provided food to meet the dietary requirements of religious and ethnic groups.

The service also employed staff from diverse backgrounds. This meant the service was able to utilise the ability of staff to speak to patients in their first language whenever this was possible.

Managers ensured that patients and carers had easy access to interpreters and/or signers. Carers had access to Cygnet’s carer advocacy service. Each carer was provided with an email address set up by the hospital social worker. This allowed carers to email the social worker directly and receive news about carer events and local carer forums.

Information displayed on the wards was in a form accessible to the patient group (for example, in easy-read form on wards for people with a learning disability). However, all information leaflets at reception and information displayed on the ward were written in English and no other languages.Senior leaders were aware of this and told us how they are in the process of implementing this for common languages used in the hospital.

The service has recently celebrated a variety of religious celebrations and seasonal traditions, such as Diwali, Black history month, Halloween and Romanian Independence Day.In Springs centre, over 96% of staff had completed mandatory training in equality and diversity.In Springs Wing, 93% of staff had completed the training.

Patients told us about, how staff had supported them to access community facilities. For example, one patient told us staff supported him to visit his preferred clothes shop which was over an hour away. People told us they were not discriminated against, and staff worked to ensure that reasonable adjustments were in place for people who needed them to live a fulfilling life and participate in the running of the service. For example, patients could become a peoples council representative, which discussed the running of the service.

Patients were supported to understand and make decisions about their future care and support, including those relating to potential medical and psychological needs.

The multidisciplinary team worked collaboratively with patients and their carers when planning for each patient’s discharge and return to their local area. Staff ensured that appropriate arrangements were in place to sustain the patient’s mental health. This included liaising with health and social care professionals in the patient’s local area to ensure they had appropriate accommodation to be discharged to and that a package of care was provided by the local mental health services.