Cygnet Hospital Harrow

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• 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 looked for evidence on how the service provided safe care and treatment. During an inspection in May 2023, we rated this key question as inadequate. At that inspection, the service was in breach of regulation 9 (person centred care), regulation 10 (dignity and respect), regulation 12 (safe care and treatment) and regulation 13 (safeguarding). At this inspection, the rating has changed to requires improvement. The service had made a lot of improvements and was complying with these requirement notices. However, during this inspection we found one new breach of regulation in relation to this key question. The service was using a vacant bedroom for the seclusion of one patient, that did not meet seclusion room specification. The provider must ensure that rooms used for seclusion, are fit for purpose, as detailed in the Mental Health Act (MHA) Code of Practice 2015.

This service scored 62 (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 had a proactive and positive culture of safety based on openness and honesty, in which concerns about safety were listened to, safety events were investigated, reported thoroughly, and lessons learned to continually identify and embed good practices.

Staff now knew what incidents to report and how to report them. The service had improved this area of work since the last inspection and was no longer in breach of regulation. In the last 12 months, staff on Springs Centre had reported 454 incidents. Incidents included medicines, injury, facilities or staffing, consent, confidentiality or communication. Most incidents were classified as low or no harm. Less than 2% of incidents across the two wards were classified as moderate harm.

Staff were debriefed and received support after an incident. Patients were debriefed after incidents in ways that supported their communication needs. For example, we saw evidence of easy-read post incident debrief documents, that had been shared with and signed by some patients, where this was their preferred method of communication.

Staff reported serious incidents clearly and in line with trust policy. Staff recorded incidents on an electronic incident reporting system. All incidents were reviewed and signed-off by the ward manager. Incidents with a severity of moderate harm or above were escalated to more senior managers.

Managers investigated incidents thoroughly. Patients and their families were involved in these investigations. Each month, the ward manager and the safety and security lead reviewed closed-circuit television (CCTV) recordings of incidents.Action was taken to understand why a person had become distressed or why an incident occurred and what could be changed to prevent further occurrences. The safety and security lead had been in place when the service previously provided forensic services and now supported general safety of the environment.

Staff received feedback from the investigation of incidents, both internal and external to the service. Staff met to discuss that feedback, lessons learned and to continually identify and embed good practice. There was evidence that changes had been made as a result of feedback. For example, following one incident, the service put in place additional physical health checks to monitor and manage rare clozapine related side effects.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if things went wrong.

The service worked with people and partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. The service ensured continuity of care, including when people moved between different services.

The service received referrals from NHS trusts across England and Integrated care boards (ICBs). The provider had a team of national nurse assessors who carried out gatekeeping assessments and then signposted the referral to the most appropriate service across the UK. The multi-disciplinary team based at the service then reviewed the information to determine whether a further assessment is required or if the referral is appropriate based on a variety of factors. For Springs Service, all patients must have a diagnosis of an autism spectrum condition to be admitted.

During an inspection in February 2024, some staff did not always feel involved in discussions around referrals and admissions, and some staff felt their views were not always taken on board. During this inspection, staff told us this had improved. Most staff felt their views were now listened to and considered. Staff told us how they supported patients who were waiting to secure a more suitable placement. Senior leaders and staff worked collaboratively to support patients through their journey on the ward, whilst trying to ensure there was minimum disruption to other patients. The provider should continue to proactively seek alternative placements for patients who need to be transferred to a more suitable placement.

Staff tried to ensure that people did not stay in hospital for longer than was necessary. The target stay for patients in Springs Service was 18 months. The average length of stay was currently 25 months. There was a strong awareness of the risks to people across their care journeys. Senior leaders could comprehensively detail discharge plans for patients with complex needs, where bespoke future placements were proving difficult to secure and thus resulting in a longer length of stay in the service. Once a suitable next placement was identified, the service developed a transition plan. We saw a collaborative approach to discharge and transfer, where the views of patients, their carers and all relevant professionals were considered. Most patients on Springs Centre stepped down into Springs Wing for a short period of time, before being discharged from the service, as this ward focused on independent living skills and living in the community.

Staff ensured that patients were only discharged if they had a crisis plan, including contact details for their local community mental health team. The service had introduced a discharge checklist to ensure that all tasks relating to discharge were completed.

The service now had organised and accessible record systems in place. The service had improved this area of work since the last inspection and was no longer in breach of regulation. The service used two electronic record systems for its daily use. Each system had clear categories to identify what documents each stored. Some staff were very confident about using the two different systems. Some staff told us they found the two systems difficult to access and navigate, but were able to seek support from other colleagues, to solve any difficulties. We also saw these difficulties arising in practice during our inspection. The provider should consider providing further staff training in the use of its electronic record systems.

The service worked with people to understand what being safe means to them as well as partners on the best way to achieve this. The service concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff received training in safeguarding,at levels 1, 2 and 3, in line with the intercollegiate document which identifies competencies required for all healthcare staff. Staff kept up-to-date with their safeguarding training. Staff compliance with safeguarding training level 1 and 2 in the Springs Wing was 93%, and for Level 3 was 100% for online learning and 90% for the classroom learning. In Springs Centre, staff compliance with safeguarding training level 1 and 2 was 97%, and for Level 3 was 94% for online learning and 80% for classroom learning.

Staff knew who to inform if they had safeguarding concerns. Staff spoke very highly of their safeguarding lead and told us they made the safeguarding alerts for the whole hospital. Staff told us the safeguarding lead is conscientious and makes sure the ward receives the outcome of all safeguarding referrals. In the last 12 months, 10 safeguarding referrals had reached the threshold for investigation by the local authority in Springs Wing, and 25 had reached the threshold for investigation in Springs Centre. Most of these investigations related to violence and aggression between patients. Managers took part in serious case reviews and made quick changes based on the outcomes. Where safeguarding incidents involved staff members, managers took prompt action to ensure the incident was investigated thoroughly, and the patient remained safe and supported. Staff at the hospital worked alongside the local authority in conducting all safeguarding investigations.

Staff knew how to recognise adults and children at risk of or suffering harm and worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act 2010.

Staff followed clear procedures to keep children visiting the ward safe. Children were not permitted to visit patients on the wards. Visits from children took place at other areas in the hospital.

Use of restrictive interventions

During an inspection in May 2023, 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. In a focused inspection in February 2024, we found the ward had implemented sufficient improvements to comply with the requirement notice. During this assessment, we found continued improvement.

In the last 12 months in Springs Wing, there had been104instances of restrictive interventions.Of these, 84 had been resolved without a physical intervention. There had been two instances of rapid tranquilisation. Oral medication had been administered on 21 occasions to address the patient’s agitation. There had been 17 instances of restraint, with no instances of patients being restrained in the prone position.

The use of restrictive interventions was nearly four times higher in Springs Centre. In the last 12 months in Springs Centre, there had been 376 instances of restrictive interventions. Of these, 235 had been resolved without a physical intervention. There had been seven instances of rapid tranquilisation. Oral medication had been administered on 82 occasions to address the patient’s agitation. There had been 141 instances of restraint, including 6 instances of patients being restrained the prone position, which means facing down.

Staff participated in the provider’s restrictive interventions reduction programme. The security lead for the hospital trained staff in PMVA. The provider held regular ‘reducing restrictive practice plan review’ meetings. The meetings discussed why blanket restrictions were necessary and what actions are being undertaken to reduce this restriction. The restrictions were also discussed in weekly community meetings with patients.

Staff made every attempt to avoid using restraint by using de-escalation techniques and restrained patients only when these failed and when necessary to keep the patient or others safe. Patients’ care plans stated that additional medication (prescribed pro re nata (PRN) and medicines used for rapid tranquilisation should only be used as a last resort.

The service worked with people to understand and manage risks by thinking holistically so that care met their needs in a way that was safe and supportive and enabled them to do the things that matter to them.

Staff completed risk assessments for each patient on admission using a recognised tool, and reviewed this regularly, including after any incident. Risk assessments rated the level of risk on a scale of high, medium or low. Actions to address these risks were reflected in patients’ care plans.Risks were reviewed by the multidisciplinary team each day.

Staff involved patients in care planning and risk assessment. We reviewed six patient records from Springs Wing, and three patient records from Springs Centre. We saw evidence that risk assessments and care plans were co-produced with patients. Patients had signed their care plans and had a copy of it.

Where there were restrictions on patient’s freedom, these were discussed and recorded. At the time of our assessment the provider had 7 blanket restrictions on Springs Wing and 4 blanket restrictions in place on Springs Centre. Both wards had a list of prohibited items. The provider had an easy read version of the blanket restrictions and prohibited items in place, explaining what the restriction is, why it’s in place, and what patients can do. In Springs Centre, the kitchen was kept locked. This restriction was implemented in January 2022. We could see evidence that this restriction was discussed in community meetings, and during visits from the provider’s expert by experience. We observed that some of the patient’s snacks were kept in the nurse’s office.The service had outside space that patients could access. Patients did not have direct, unrestricted access to outside space. However, staff facilitated access to the garden during each shift.

Staff communicated with patients in their preferred communication method, to ensure that they understood their care and treatment. All patients had a communication passport, communication grab sheet and a generic grab sheet. These detailed person-centred information on how to support the patient’s communication needs, understand their likes, dislikes and triggers, how they present when they are well, how to support them to stay well and what helps them if they become unwell.

We saw a variety of documents available in a variety of communication methods. For example, we saw easy read formats of risk assessments, care plans and ward round feedback forms. There were also easy read versions of different conditions such as Autism and ADHD as well as information on different medical procedures such as blood tests. There were visual post-incident debriefs, which were available in three different formats to ensure visual communication needs could be met. One format included talking mats, which could be used with a psychologist. There were also easy read signs around the location to explain the current building works. The provider could access interpreters, who would join meetings such as ward rounds. However, there were no leaflets or information available in different languages used by patients or their carers. The provider should continue to develop patient documents and guidance across the hospital to meet the preferred languages of patients and their carers.

Staff enabled patients to give feedback on the service they received. The service had a weekly community meeting.

Staff ensured that patients could access advocacy. Patients could access two advocacy services. One service was commissioned by the provider, to ensure patients had easy access to advocates to promote their daily needs during internal meetings. One service was external and independent, who mainly supported patients during long term legal matters. We saw posters around the wards signposting patients to both advocacy services.

Staff completed and regularly updated thorough risk assessments of wards areas and removed or reduced any risks they identified. On one ward, a patient had a severe food allergy. We observed large visual signs in the ward and in the communal restaurant to alert staff and visitors to this.

Staff regularly reviewed the environment, identified and managed ligature risks, and mitigated any risks quickly to keep patients safe.

Both wards were based across two levels. Staff could not observe patients in all parts of the wards from one stationed position. However, staff told us that they mitigated this by ensuring staff were stationed on each level when the patients were using that floor.

The wards used CCTV in communal areas and could use this to review safety incidents. There was a sign at the front of the wards to let patients and visitors know about the use of CCTV. We saw evidence that CCTV footage was used to, review all incidents involving restraint, verify incident reports, and to highlight any improvements required in incident reporting.

The ward complied with NHS guidance Delivering same-sex accommodation, there was no mixed sex accommodation. The hospital only admitted male patients.

Staff had easy access to alarms and patients had easy access to nurse call systems. We saw during the inspection that when there was a technical issue this was identified and fixed quickly. The service was also in the process of installing silent alarms and noise reducing sound panels, to help support patients with sensory needs.

The service had policies to follow fire safety practices on site. There were fire escape plans and fire action notices on wards which showed the assembly point. Patients who would require supporting during an emergency evacuation, had personal emergency evacuation plans (PEEPS) in place.

Both wards were undergoing some extensive refurbishment. During the day the wards were quite busy and noisy. We saw multiple external contractors alongside Cygnet maintenance staff, using noisy tools, large pieces of equipment, and walkie talkies which could be distressing to patients with autism and sensory sensitivities. We observed the wards to be quiet and calm in the evening when the builders had left. Patients told us and had also provided feedback to the service, that it can be quite disruptive and noisy when the builders were working on the ward. We raised this with the provider on the day of the inspection. The provider detailed what the refurbishment plan was for each ward, how it would meet patient’s needs and how staff were trying to mitigate the negative effects of the building works for the patients. This included taking patients for activities in other parts of the hospital or off-site during noisy works on the ward. Although we did not see this in practice on the day, we did not observe any significant distress or impact for patients because of the noise. The provider should continue to proactively mitigate the noise of the building works for patients, in person-centred ways.

Seclusion room

The wards did not have a dedicated seclusion room. During the inspection we identified that on Springs Centre, staff were using a vacant bedroom as a seclusion room for one patient. This room did not meet the required standards for a seclusion room. We observed the room to have safety hazards such as breakable furniture fitted on the walls, exposed electrical sockets, and a large metal radiator cover. The room did not have equipment for easy two-way communication between patients and staff, had a door which opened inwards, and did not have a clock. The room did have an ensuite bathroom. We raised this immediately during the inspection and the provider told us what actions they would take to address this. This was a breach of regulation. The provider must ensure that rooms used for seclusion, are fit for purpose, as detailed in the Mental Health Act (MHA) Code of Practice 2015.

Facilities that promote comfort, dignity and privacy

Each patient had their own bedroom and en-suite bathroom, which they could personalise. Patients had a secure place to store personal possessions in their bedroom.

Wards had a range of rooms and equipment to support treatment and care. Wards had a quiet room and quiet areas that patients could use. Wards had rooms where visitors could come and meet patients. There were alternative rooms off the wards to use if a child was visiting. Both wards had a communal living room. Springs Centre had a large living room/ activity room with a pool table, football table and computer.

Each ward had a sensory room, but we saw these were not in use at the time of inspection because of the refurbishment taking place. However, we saw sensory activities taking place in other areas of the hospital. Until the building works were complete, patients could not benefit from a sensory room on the ward.

The service made sure there were enough qualified, skilled and experienced people, who receive effective support, supervision and development and worked together effectively to provide safe care that met people’s individual needs.

The service had enough nursing and support staff to keep patients safe. At the time of our inspection, Springs Service had capacity for 24 patients. Managers had calculated the number and grade of nurses and healthcare assistants required. During our inspection there were 14 patients in Springs Service: 7 patients in Springs Wing and 7 patients in Springs Centre. Managers told us the staffing establishment level was complete, with additional nurses and healthcare assistants assigned to cover enhanced observations and support the building works.

The service has had no vacancies since December 2023 following the closure of Springs Unit. The service was also scheduled to open a psychiatric intensive care unit (PICU) shortly after the inspection. Staff who had been recruited to work on the PICU were assigned to other wards in the meantime. This meant that the service had more staff than it would usually employ. Both staff and patients agreed that there were always sufficient staff on the ward.

The service had very low usage of bank and agency nurses. The high number of staff in the service, meant that use of bank and agency staff was very low. However, the service still occasionally used temporary staff to cover short-notice absence such as sickness. When agency and bank nursing staff were used, those staff received an induction and were familiar with the ward.

The service had a low turnover rate. For the last 12 months, staff turnover for the service was 2.66%. However, there was a high turnover for psychologists in the service, with four psychologists leaving since 2022. The Springs Service had low levels of staff sickness. Springs Wing had a staff sickness rate of 5.46% and Springs Centre had a rate of 3.78%.

The ward manager could adjust staffing levels according to the needs of the patients. Staffing needs were discussed in a daily morning meeting, and wards could identify if they needed more support. Whilst the building works were taking place, the ward assigned additional staff for security and to escort people between the ward and other areas of the hospital.

Staffing levels allowed patients to have regular one-to-one time with their named nurse. Patients rarely had their escorted leave or activities cancelled. Throughout the inspection we saw staff facilitating patient leave and activities on the wards.

There were enough staff to carry out physical interventions, such as observations and restraint safely and staff had been trained to do so. The hospital assigned staff from all the wards to form a response team who could attend any area of the hospital if a physical intervention was needed.

There was adequate medical cover day and night, and a doctor could attend the ward quickly in an emergency. The service operated an out-of-hours rota for consultants and specialty doctors. On-call doctors were required to be onsite within an hour of the ward calling them. The consultant psychiatrist said that most doctors lived quite close to the hospital and were able to attend promptly.Managers could call locums when they needed additional medical cover. For example, the hospital used locum doctors to cover the out-of-hours rota for specialty doctors. These doctors had worked at the hospital for many years and had a good understanding of the service.

Mandatory training

Staff had received and were up-to-date with appropriate mandatory training. Overall staff compliance with mandatory training was 93% on Springs Wing and 94% on Springs Centre. Staff compliance with training in Immediate life support was 100% on both wards.

During an inspection in May 2023, the provider had the following breach: 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. At this inspection we found the service had improved. Staff compliance with The Oliver McGowan Mandatory Training on Learning Disability and Autism was 94% for both wards. The service also had autism specific training days for staff, and different therapeutic teams had also created trainings in autism specific to their field. For example, we saw the occupational therapy team had created a high-quality training programme in sensory needs.

The mandatory training programme was comprehensive and met the needs of patients and staff. Managers monitored mandatory training and alerted staff when they needed to update their training.

Skilled staff to deliver care

The service had access to a full range of specialists to meet the needs of the patients on the ward. The service employed a ward manager, doctors, nurses, health care assistants, an autism lead, positive behaviour support lead, psychologists, speech and language therapists, occupational therapists, social workers and experts by experience.

Managers ensured staff had the right skills, qualifications and experience to meet the needs of the patients in their care, including bank and agency staff.Managers gave each new member of staff a full induction to the service before they started work.

All new staff attended a week-long induction programme. This included an introduction to the hospital and orientation to the wards. The hospital set up an email account for new staff and arranged for new staff to be able to access online training. New starters spent at least two shifts shadowing experienced staff before they were fully incorporated into the staff numbers. The service also ensured new starters had an allocated buddy. Buddies received written and verbal guidance on their roles as a buddy.

Managers supported permanent staff to develop through yearly, constructive appraisals of their work. In the Springs Centre, 93% of staff had received an appraisal in the year before the inspections. In the Springs Wing, 85% of staff had received their annual appraisal. Appraisals had been scheduled for the remaining members of staff. Appraisal meetings involved reviewing objectives, a review of knowledge and skills, training, professional registration, a summary of performance and setting objectives for the following year.

Managers supported staff through regular supervision of their work. The hospital’s policy states that staff should receive managerial and clinical supervision each month. At the time of our inspection, in Springs Centre, 97% of staff had received clinical supervision, and 94% had received managerial supervision. In Springs Wing, 88% of staff had received clinical supervision and 94% of staff had received managerial supervision. During supervision sessions, staff typically discussed their health and well-being, follow up from appraisals, workload, clinical care, training and development needs. However, there were no discussions about specific patients.

Managers made sure staff attended regular team meetings or gave them information from those they could not attend. The service held team meetings each month. During these meetings staff discussed lessons learned from incidents, admissions and discharges, safeguarding, security matters, health and safety matters, the risk register, audits, and administrations of the ward.

Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. Managers recognised poor performance, could identify the reasons and dealt with these.There were some concerns around some staff repeatedly cancelling their shifts last minute, without notifying the person in charge. The ward manager clarified how cancellations should be actioned going forward, and how this will be reviewed in the future.

At an inspection in May 2023, the provider had the following breach: theprovider 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 withgood practice and support the staff to communicate effectively with people using the service. During this inspection, managers made sure staff received any specialist training for their role. Staff had received training in Oliver McGowan training in learning disabilities and autism, and we saw evidence that staff understood autism, and used their knowledge in autism to support patients effectively.

Staff across the hospital could attend a variety of simulation trainings focusing on immediate life support. These included the simulation of incidents of choking, collapse, ligatures, drug use, and seizures. We saw a simulation training take place on the day of our inspection. Staff appeared engaged, motivated and well supported throughout the session.

The service assessed and managed the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

At an inspection in May 2023, 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. During this inspection, we found the ward had implemented sufficient improvements to comply with the requirement notice.

The ward areas were visibly clean, tidy and had good furnishings. Wards kept up-to-date cleaning records that demonstrated that the ward areas were cleaned regularly. Staff maintained equipment well and kept it clean. Any ‘clean’ stickers were visible and in date. The service followed infection control policy, including handwashing. The service carried out regular clinical audits, which included audits in handwashing and infection control.

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. Staff did daily and monthly audits for the specific food hygiene tasks. We saw that food was stored in line with food safety standards.

The service ensured that medicines and treatments were safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happened.

Staff followed good practice in medicines management (which include, transport, storage, dispensing, prescribing, administration, medicines reconciliation, recording, disposal) and did it in line with national guidance. There were specific systems in place for the management of controlled drugs and medicines that were liable to be misused.

Medicines were stored appropriately. Medicines cupboards and trolleys were locked when not in use. Medicines prescribed for individual patients were labelled and stored clearly. Staff kept up-to-date information about stock. Details of pharmacy contacts were displayed for staff to see easily. Staff knew how to dispose of medicines and associated equipment safely. Staff kept accurate records of the disposal of medicines. Sharp bins were available on the ward and were marked with the date of opening, as needed. Staff kept records of national medicines alerts and recorded what action they needed to take to improve practice. The service used an online version of the British National Formulary (BNF).

The service mostly ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines.None of the patients we reviewed were prescribed a high dose of antipsychotic medicines (HDAT), or any other medicines above the level recommended in the BNF. Stopping over medication of people with a learning disability, autism or both with psychotropic medicines (STOMP) is a national programme run by NHS England, to stop the inappropriate prescribing of psychotropic medications, an identified priority in the NHS Long Term Plan. The service followed STOMP principles when carrying out medicine reviews. We saw examples where two patients with autism, had their medicines reduced following a STOMP review.

The service reviewed each patient’s medicines regularly and provided advice to patients and carers about their medicines. Patients’ medicines were reviewed as part of an overall review of their progress at ward rounds. Staff provided information about possible side-effects. Patients were involved in discussions about medicines and care planning. Pharmacists carried out weekly medicines’ audits.

Staff completed medicines records accurately and kept them up-to-date. We reviewed the medicines charts for four patients. All records were clear and up-to-date. However, one patient record required more detail around their smoking habits, as they were prescribed a medicine called clozapine. Smoking can alter the amount of clozapine in the body and its therapeutic effect on the person taking it. The provider should implement a consistent approach to recording smoking habits for patients who are prescribed clozapine.

The service ensured patients had care plans in place to support nursing staff around the use of their medicines and treatment. These were stored alongside their prescription charts. For example, we saw patients had ‘learning disability and autism support care plans’. These included the patients likes, dislikes, communication needs, how they like to participate during medicines administration, and any additional physical health monitoring required. Patients also had PRN protocols in place. These included how staff can help support patients at times of distress, and when PRN medicines would be appropriate to use.

Following an inspection in May 2023, 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. At this inspection, we found that the service had improved. Staff reviewed the effects of medicines on patients’ physical health regularly and in line with NICE guidance. For example, we saw evidence that when patients were prescribed medicines such as clozapine, staff carried out the required physical health checks.

Clinic rooms were clean, orderly and fully equipped. Cleaning records were available and completed. Staff recorded daily room and fridge temperatures to ensure the safe storage of medicines. However, the clinical rooms on the wards did not have enough space to support clinical procedures. Staff told us these take place in the patient’s bedrooms, or if the patient has Section 17 leave, in one of the additional hospital-based clinic rooms, on the grounds. This off-ward clinic room had a hospital bed in to support clinical procedures.

At an inspection in May 2023, the provider had the following breach: the provider must ensure equipment used to monitor patient’s physical health is properly maintained and calibrated. During this inspection, we found the ward had implemented sufficient improvements to comply with the requirement notice. Equipment to support physical health care was available, regularly cleaned, audited and calibrated in line with manufacturer guidance.

The service had emergency medicines and emergency equipment available. Its location was clearly marked in clinic rooms. There was an oxygen cylinder available in each clinic room which was in date and more than half full. Records showed staff carried out daily checks of the defibrillator and resuscitation equipment.