Cygnet Joyce Parker Hospital

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

Risks were not overlooked or ignored. They were dealt with willingly as an opportunity to put things right, learn and improve. Safety and continuity of care was a priority throughout people’s care journey. This happened through a collaborative, joined-up approach to safety that involved patients along with staff and other partners in their care. This included referrals, admissions and discharge. Individual patient risks were assessed, and patients and staff understood them. There was a commitment to taking immediate action to keep people safe from abuse and neglect. This included working with partners in a collaborative way. However, staff did not always report incidents appropriately and one patient did not always feel supported when they felt unsafe.

This service scored 9 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders shared examples of learning from incidents and actions taken. These included additional training for staff; strengthening processes for staff to access support during evenings, nights and weekends; discussions with system partners and sharing across other Cygnet services. Leaders advised they talked to staff following incidents and the completion of 72 hour reports to get an in depth look at what happened and what could be done differently. Ward managers completed 24 hour reports identifying immediate actions following incidents. This learning was entered into a lessons learnt log which leaders shared monthly with staff. Leaders were in the process of rolling out the ‘Patient Safety Incident Response Framework’ (PSIRF) approach to learning from incidents. This approach aims to encourage greater learning for staff and people using the service. As part of the roll out leaders provided training to ward managers to complete ‘After Action Reviews’ following incidents. An After Action Review (AAR) is a method of evaluation that is used when outcomes of an activity or event, have been particularly successful or unsuccessful. It aims to capture learning from these tasks to avoid failure and promote success for the future. We observed a morning multi-disciplinary meeting. These meetings were held each weekday and included a review of any incidents that occurred across all wards. We saw the team discussing an incident that occurred the previous day between 2 patients. The team agreed actions to reduce the likelihood of repeat incidents. Following this, we cross checked the patients’ care records which referenced the agreed actions. The team discussed an environmental hazard identified by staff and action was agreed to resolve this.

Leaders told us they ensured all required information was received before admitting a new patient. They told us there was no pressure to admit if they were not confident about supporting a patient, an example included a referral that read like the person was withdrawing from alcohol so after follow up questions they were able to refuse the referral. Leaders implemented a new on call system for overnight admissions for staff to access support. We were told that following a new admission, the service multi-disciplinary team met with the patient’s community team within 24 hours. Nursing staff told us they received training to assess referrals. Training included inclusion and exclusion criteria, record keeping, reasons for declining and information needed before accepting a referral. Managers described the safe discharge process, which included thorough handovers to include current and previous risks; doctors discharge summary; 3 days medication supplied as a minimum; transport arrangements, including who is responsible and what level of security is required; current care plans and therapy input. All staff spoken with told us they received training to support the transition from changing the service type from CAMHS to adult acute and PICU. This training included completing physical health observations, identification of a deteriorating patient, safeguarding and personality disorders. In addition, staff were sent to other Cygnet hospitals providing adult acute and PICU services to shadow and gain experience.

We observed a morning multi-disciplinary meeting where the team discussed a patient due to be admitted to the PICU later that day. The team made sure that the right processes were followed, and Mental Health Act paperwork was in place before the patient was admitted.

We spoke with a carer who told us their relative did not always feel safe at the service as other patients would enter their bedroom. They also expressed concerns that their relative was allowed to go out on their own after expressing suicidal thoughts. They told us their relative had to ask staff to come with them as they did not feel safe. The carer also said staff had tried to explain their relative’s rights under the Mental Health Act when they were first admitted, however they struggled to understand, and staff had not tried again. However, another patient told us they felt safe at the service.

Leaders told us they were meeting with local partners in the health and social care system to establish relationships and share learning. Ward managers would be taking on the role of safeguarding leads and were due to attend safeguarding lead training in the week following the assessment. This was internal training based on intercollegiate guidance.

We reviewed care records for all patients and found evidence that staff were explaining patients’ rights under the Mental Health Act. In 1 record reviewed we found staff had recorded 2 incidents of racial abuse in the patient’s notes but had not reported them on the incident reporting system. This meant that patients were at risk of not being sufficiently safeguarded from abuse. We raised this with leaders at the service who told us they were aware of these incidents and had taken action to ensure staff reported them correctly.

We spoke with 1 carer who told us staff involved their relative in discussions about risks and how to manage these. This included ensuring a member of staff accompanied their relative when they went out. However, the carer expressed concerns that their relative had taken risky items in with them and still had access to these.

There was a balanced and proportionate approach to risk that supported people. Leaders told us staff had used physical restraint once since the service opened for adults. Staff had not used seclusion or rapid tranquillisation to manage patient risks and had been able to de-escalate verbally. Leaders said they introduced a new process for any restraint incident to be reviewed by the senior leadership team. If the use of restraint increased, ward managers would take the lead in overseeing these reviews. Staff told us they reflected on the previous incidents of poor restraint and stressed the importance of stopping things in the moment. Managers described how staff supported patients to manage risks by identifying triggers, for example, for one patient a particular type of music was a trigger. Named nurses would explore any triggers further and create a care plan with the patient.

We observed a multi-disciplinary meeting on Brook ward. Staff involved the patient in discussions about risks. This included an open discussion with the patient about a recent incident, with staff and the patient reflecting on what happened. We also observed a positive risk taking approach to granting patient leave. We reviewed care records for all 4 patients in the service at the time of the inspection. Staff identified risks and completed care plans to support patients to manage these risks. We saw evidence of regular updates, including after incidents. However, we identified one discrepancy between a risk assessment and a care plan where a specific risk was rated differently.

A senior staff member described environmental changes made as part of the transition from CAMHS to an adults acute/PICU service. Changes included being able to leave internal doors unlocked and the creation of a vaping area in the courtyard.

We observed Brook and Blythe wards to be clean and well maintained. On Brook ward leaders removed the door from the seclusion room and advised it was now a de-escalation area. At the time of our visit patients had not used this area. On Blythe ward the seclusion area met the requirements in the Mental Health Act Code of Practice. We found appropriate patient access and restrictions in place on both wards. We reviewed a patient record which referred to leaders introducing zonal areas on the ward to keep patients safe from sexual harm.

Leaders told us there were more staff than needed for the number of patients in the service when we inspected. Leaders advised the number of staff was enough for when the wards were fully occupied. However, some support staff raised concerns that these numbers would not be sufficient once the service was full. Leaders said they had not used agency staff and had no plans to use them. Managers were not using bank staff at the time of the inspection but advised they had staff on the bank to use when required. We spoke with members of the multi-disciplinary team who told us about Cygnet’s large acute/PICU directorate and how other practitioners have reached out to support. They told us about shadowing colleagues in other Cygnet acute/PICU locations and the constant communication and advice available from these colleagues. Leaders recruited an adult consultant psychiatrist for one ward who was supporting consultants on the other wards. Consultants accessed shadowing and training opportunities at other Cygnet adult services. Leaders told us there were directorate wide weekly acute/PICU meetings and a peer group for all medics to meet. There was also monthly Continuing Professional Development for doctors and a weekly medical directors meeting. Support staff told us about the training received to support the transition to an adult acute/PICU service, this included different Mental Health Act (MHA) sections; conditions; diagnosis; MHA paperwork; observations; lessons learnt; physical health training, including National Early Warning Score (NEWS), which is a tool to identify a deteriorating patient. Support staff advised the training gave them more skills and confidence.

We observed a morning multi-disciplinary meeting where hospital leaders checked the staffing levels on site for the day were sufficient to meet patient need.

We did not look at Infection prevention and control during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

We did not look at Medicines optimisation during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.