10-18 May 2022
During a routine inspection
Cygnet Hospital Derby provides one male and one female low secure wards and a locked rehabilitation ward for male patients who no longer require secure care.
Our rating of this service stayed the same. We rated it as good because:
- The service provided safe care. The ward environments were safe and clean.
- The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
- Patients had an opportunity to manage their own medicines as part of their rehabilitation or recovery.
- Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
- The ward teams included or had access to the full range of specialists required to meet the needs of patients on the ward, which included substance misuse workers and social workers.
- Managers ensured that staff received training, supervision, and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
- Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and their families and carers in care decisions. This included carers' days and there was an allocated staff member on each ward to communicate with carers.
- Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
- The service was well led, and the governance processes ensured that ward procedures ran smoothly.
However:
- The wards looked tired and in need of redecoration particularly on Alvaston and Wyvern wards. There was a programme of planned refurbishment and we saw this had started in the corridors leading to the wards.
- There was a blind spot in the toilets of the seclusion rooms on Litchurch and Alvaston wards. Seclusion on Litchurch ward was not always in line with the Mental Health Act Code of Practice and one of the seclusion records was incomplete. Documentation was messy and handwritten and not always easy to understand.
- On Alvaston ward, staff had administered prescribed intramuscular injections to a patient but had not always documented what physical health observations had taken place. One patient did not have a T2 attached to their medicine record on Wyvern ward, but staff ensured this was done during our inspection.
- Although staff mostly managed medicines safely and where appropriate, patients had an opportunity to manage their own medicines as part of their rehabilitation or recovery, there were some gaps in the recording of monitoring the self-administration of medicines on Wyvern and Litchurch wards, so it was not always clear that patients were managing these safely.
- Staff did not always make reasonable adjustments in multidisciplinary team meetings to ensure patients could fully participate.