Cygnet Nield House

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

We reviewed all 8 quality statements in the safe key question. This means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question as Requires Improvement. At this assessment the rating has changed to Good.

There were effective systems and processes to protect people from abuse and neglect. Staff understood how to protect patients from abuse. Staff completed risk assessments for patients.

Environments were clean, well-maintained and fit for purpose. Ligature risk assessments were up to date and staff managed environmental risks effectively.

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.

Patients we spoke with felt safe on the wards and supported to understand and manage their risks. Some patients we spoke with told us that staff would spend time with patients following incidents, ensuring that they felt safe on the ward. Carers we spoke with said they were aware of how to raise concerns and would do so without fear of repercussions.

Staff understood what type of incidents to report and were able to describe the process for reporting, reviewing and responding to incidents. Staff were able to give examples of identified learning and improvements that had been made following incident investigations. Staff understood the processes for managing and investigating complaints and supported patients, relatives and carers to raise concerns.

Appropriate systems and governance processes were in place to support the effective management of incidents and complaints and to promote learning and improvement.

Staff had access to a range of policies and procedures for additional guidance. There was a clear structure around whistle blowing and access to a Freedom to Speak Up Guardian.

Patients we spoke with understood their care and treatment and reason for admission. Many patients had started discussing discharge plans early on in their admission.

Staff worked collaboratively with each other and external stakeholders to promote joined-up care and ensure transitions between services were manged well. Staff had a good understanding of the processes and policies relating to referral, admission, transfer and discharge. Staff felt able to support patients along these pathways and were able to give examples of when they had done so. Staff were aware of the risks to people across their care journey and worked to ensure sufficient and appropriate information was shared during referral, admission and discharge processes.

The local host commissioners requested feedback from commissioners for each patient on the ward, in order to any identify any themes and trends, or areas of positive or concerning practice. The hospital managers and local host commissioners met every 3 months, and reviewed information submitted by the managers. No issues were raised about this quality statement.

Appropriate systems and governance processes were in place to support safe admissions, discharges and transfers of care. We observed ward rounds that included representatives from the patient’s NHScare team, an independent mental health advocate (IMHA) and the social worker. Staff worked together towards the best outcome for the patient.

People we spoke with felt safe and supported to understand and manage any risks.

Staff and managers had a clear understanding of safeguarding, the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff we spoke with confidently described what constituted a safeguarding and how they would protect patients from abuse. The service had safeguarding leads that were able to provide advice and support to staff along with a dedicated social worker. Staff knew where to seek further support or advice when required.

Information about safeguarding and how to raise concerns was on display in staff and patient areas.

We observed a daily morning meeting, where managers and staff discussed potential safeguarding concerns, and actions that needed to be taken to keep people safe.

There was a family visiting room outside the main ward area, where patients could meet with their visitors including children.

Appropriate systems and policies were in place to ensure people were safeguarded. Staff received appropriate training in safeguarding, with training levels at 71% for classroom training and 94% for eLearning. Staff training figures for MHA awareness was at 94% with MCA/DOLS training at 97%.

All patients we spoke with felt safe and supported to manage their risks. Patients felt confident to raise any concerns they had with staff and were involved in their care and treatment.

Staff were aware of the individual risks of each patient, and any changes in risk were discussed at handovers. Staff told us that they would work closely with patients to manage their risks and would prioritise de-escalation techniques over restrictive interventions. Staff received 'Safety Intervention' training to manage potential violence or aggression. 94% of staff had completed Safety Intervention training.

Appropriate systems and governance processes were in place to promote and ensure good risk management.

We reviewed 6 patient records and all of them had an up-to-date risk assessment in place. Risk assessments covered key areas and captured relevant information to support the ongoing management of risk.

The service had a reducing restrictive practice policy. Managers monitored and reviewed the use of restrictive interventions through the daily morning meeting, and through the governance process.

Patients we spoke with did not raise any concerns regarding the environment and that the facilities on the ward were clean and well maintained. One patient raised that the visiting room, which is located off the ward, was small and did not allow them to have their wider family visit them.

Staff we spoke with displayed a good understanding of environmental risks. They were aware of ligature risk assessment that had been completed and were able to describe how they used individual risk assessments, care planning and observations to manage environmental risk.

Staff were aware of fire evacuation procedures and reported regular drills and alarm tests.

Managers and staff we spoke with did not raise any concerns regarding the environments.

The way the ward was laid out did not allow staff to observe all parts of the ward. This was mitigated by the use of mirrors and CCTV. The ward environment was clean, well-maintained, and appropriate for use.

The service were aware of the environmental risks and had mitigate these. Ligature risk assessments for the service were accurate and up to date.

We received mixed feedback from patients around staffing levels, some patients believed there were enough or even too many staff on the ward while others stated that leave could be cancelled due to staffing levels.

We received mixed feedback from staff regarding staffing levels, there had been long term sickness for the ward manager for Compton.

Senior leaders informed us that they were currently no vacancies at the service.

We observed sufficient numbers of staff on the wards to facilitate the delivery of safe care and treatment. Staff were a visible presence in communal areas.

We observed staff engaging with patients and encouraging them to join in activities. Staff were familiar with patients and were able to describe individual patients’ background, interests and dislikes. We observed therapeutic engagement between staff and patients. There was sufficient staffing levels to meet the required level of observations and to respond to individual need.

We observed a daily morning meeting where managers and staff discussed staffing across the hospital. They discussed the immediate staffing levels for today, and the next few days, and made adjustments and changes where necessary. They identified factors that impacted on staffing levels such as how busy the wards were, enhanced observations, patients having leave off the ward, and other activities. They took account of the number of staff, but also whether staff were permanent or temporary, new or experienced, and male or female. Vacancies and recruitment of nurses and support workers, as well as medical staff and allied health professions was also discussed

Services had safe levels of staff for the number and acuity of patients. Staff were qualified, skilled, and experienced.

Staff completed mandatory training. At the time of our assessment compliance across the service was 86%.

Staff received regular supervision. There was a policy and guidance documents to support the supervision process and promote development. At the time of our assessment supervision compliance for qualified nurses was 58%. Supervision compliance for health care support workers was 72%.

Patients did not raise any concerns in relation to infection prevention and control (IPC).

Staff we spoke did not raise any concerns in relation to infection prevention and control. Staff were able to access personal protective equipment and further information and guidance on infection prevention and control.

Wards were clean and well-maintained. Staff had access to infection prevention and control resources including personal protective equipment, hand gel and cleaning materials. We observed staff following infection control principles including using handwash. Cleaning records were up-to-date, and clinical equipment was appropriately cleaned and maintained.

The service completed infection prevention and control checks and audits to ensure required standards were met. Staff had access to an infection prevention and control policy and support at provider level.

95% of staff in the hospital were up to date with the mandatory infection prevention and control training.

The hospital had procedures for preventing and managing outbreaks of infection.

Patients we spoke with felt they were supported and kept up to date with their care and treatment. Patients informed us that their medicines were explained clearly to them and they were actively involved in their care and treatment.

Staff reviewed the effects of each patient’s medicines on their physical health according to the National Institute for Health and Care Excellence (NICE) guidance. All patients had physical health observations take at admission, and as necessary afterwards. Staff used the National Early Warning System to record patients’ observations. Staff were trained in phlebotomy and taking electrocardiograms, so regular monitoring was carried out onsite.

Medicines and related paperwork were stored securely. Staff recorded temperature of areas where medicines were stored. Controlled drugs were stored according to legislation and policy. People’s medicines’ records contained information staff needed to administer medicines safely such as allergies.

Medicines prescribed to be given when required (PRN) had clear indications and maximum doses recorded. Staff recorded the times that these medicines were given to ensure that the safe gap between doses was maintained. Medicines were administered safely.

An external pharmacy supplied medicines to the service, provided advice, and carried out routine audits.

Medicines and equipment used in an emergency were stored and checked daily by staff.