Cygnet Hospital Sheffield

Updated 20 January 2022

Cygnet Hospital Sheffield is an independent mental health hospital providing child and adolescent mental health services (CAMHS) for male and female adolescents aged between 12 and 18 years old and low secure services for women aged over 18. Patients are admitted from across England and the hospital provides care and treatment for informal patients and patients who are detained under the Mental Health Act 1983.

The hospital had four wards:

• Pegasus, a 13-bed mixed sex acute mental health ward for children and adolescents;
• Unicorn, a 10-bed mixed sex psychiatric intensive care unit for children and adolescents;
• Griffin, a 12-bed mixed sex low secure ward for children and adolescents; and
• Spencer, a 15-bed low secure ward for women.

The hospital had a registered manager and a controlled drugs accountable officer in place at the time of the inspection. (A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have the legal responsibility for the service meeting the requirements of the Health and Social Care Act 2008 and associated regulations. An accountable officer is a senior person within the organisation with the responsibility of monitoring the management of controlled drugs to prevent mishandling or misuse as required by law.)

Cygnet Hospital Sheffield is registered with the Care Quality Commission to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Diagnostic and screening procedures
• Treatment of disease, disorder or injury

We last undertook a comprehensive inspection of Cygnet Hospital Sheffield in August 2017. The hospital did not meet three regulations of the Health and Social Care Act (Regulated Activities) 2014. We issued requirement notices in relation to the HSCA (RA) Regulations 2014; Regulation 9 (Person-centred care), Regulation 16 (Complaints) and Regulation 17 (Good governance). The hospital was rated as requires improvement in all five domains.

Between our last comprehensive inspection in 2017 and this inspection, we have completed five focussed inspections of Cygnet Hospital Sheffield. We found that the provider had made improvements and worked to rectify the breaches in Regulation identified during the comprehensive inspection.

The most recent focused inspection took place in May 2020, in response to a whistleblowing and concerns about patient safety on the CAMHS wards. We identified one breach in Regulation 17 (Good governance). We stated that the provider must maintain an accurate, complete and contemporaneous record of care and treatment provided; ensuring there is a clear care plan for as and when required medication. We reviewed this breach during this inspection. The provider had made improvements to their documentation and there was a clear care plan in place relating to patient’s medication and the use of as and when required medication.

What people who use the service say

We spoke with 17 patients and 13 family members or carers of people using the service. Feedback about staff approach was largely positive, with patients describing feeling well cared for. Many young people on the CAMHS wards informed us it was the best placement they had experienced. Patients particularly noted that the multidisciplinary team was skilled, consistent, and fair. Patients and carers described the progress that patients had made while in the service and steps that were being taken towards discharge.

Staff supported patients to maintain contact with their families and friends; and carers felt involved in the care of their loved ones and the use of technology enabled them to be involved in meetings. They felt their views were listened to and respected. Carers felt welcome and confident to raise concerns if they had any.

However, both young people and their carers told us that increased agency use in the evenings impacted upon the quality of care on the CAMHS wards. On the forensic ward, two patients and one family member raised concerns about the lift being broken.

Updated 20 January 2022

Our rating of this location improved. We rated it as good because:

• The service provided safe care. The ward environments were safe and well maintained. The wards had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely and followed good practice with respect to safeguarding. They minimised the use of restrictive practices and worked collaboratively with patients towards reducing restrictive practices.
• 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 audits 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 wards. Managers ensured that staff received continuing development of their skills, competence and knowledge; providing training, supervision and appraisal. All staff were committed to working collaboratively as a multidisciplinary team to provide consistent high-quality care, as well as liaising with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions. The young people, in particular, were truly respected and valued as individuals and empowered as partners in their care.
• Services were tailored to meet the needs of individuals, and the hospital had created a safe and inclusive environment for LGBT patients. Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. The service was well led and the governance processes ensured that ward procedures ran smoothly.
• There were examples of outstanding practice within the child and adolescent mental health service (CAMHS) wards.

However,

• The hospital did not always follow best practice with regards to medicines management and application of the Mental Health Act 1983. There was not always clear information management within patient records or incident recording for the adult wards; and although the hospital was working to reduce incidents across the hospital, there was a high number of self-harm incidents on the CAMHS wards. The service did not have consistent quality of staffing from day to night.
• The discharge care plans were not always reflective in the adult services and the patients reported that food was not of a good standard.
• The provider did not always resolve environmental concerns in a timely way and the hospital’s cleaning processes were not always robust.

Updated 20 January 2022

Our rating of this service improved. We rated it as good because:

• The ward environments were safe and well maintained. The wards had enough nurses and doctors. Staff assessed and managed risk well, had low use of medicines, and followed good practice with respect to safeguarding. The service had a comprehensive strategy focused on minimising the use of restrictive practices, they placed trust in the young people, who were actively involved in managing their own risks.
• Staff developed a truly holistic approach to assessing, planning and delivering care and treatment to all people who use services, 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 audits 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 wards. Managers ensured that staff received continuing development of their skills, competence and knowledge; providing training, supervision and appraisal. All staff were committed to working collaboratively as a multidisciplinary team to provide consistent high-quality care to the young people, most notably with the school staff; as well as liaising with those outside the ward who would have a role in providing aftercare.
• Staff understood their responsibilities under Mental Capacity Act 2005 and followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients, families and carers in care decisions.
• Services were tailored to meet the needs of individual people and delivered in a way to ensure flexibility, choice and continuity of care. They celebrated individuality and created a safe and inclusive environment for LGBT patients and those with protected characteristics. Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. The service was well led and the governance processes ensured that ward procedures ran smoothly.

However,

• There was a disparity in the quality of care provided during the day and night due to an increased reliance on agency staff in the evenings and there was a high number of self-harm incidents across the wards. Medicines management and stock processes were not always effective. Cleaning processes were not always thorough on the wards.
• Staff did not always follow best practice when discharging their roles and responsibilities under the Mental Health Act 1983.
• The information management systems in place made some patient documentation complex to track.

Updated 20 January 2022

Our rating of this core service improved. We rated it as good because:

• The service provided safe care. The ward environment was clean. The ward had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• 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 audits to evaluate the quality of care they provided.
• The ward team included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these 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, families and carers in care decisions.
• 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 provider had not taken timely action to reduce all environmental risks. Staff did not consistently document incidents, as debriefs were not always recorded.
• The discharge care plans were not always reflective of the work being undertaken or carer input. Patients reported that food was not of a good standard and did not meet their nutritional needs.