Cygnet Hospital Wyke

Updated 3 May 2024

Cygnet Hospital Wyke is an independent mental health hospital provided by Cygnet Health Care Limited, situated in West Yorkshire. It has been registered with CQC since November 2010. The hospital is registered to provide care and treatment to up to 46 patients and the following regulated activities:

• Treatment of disease, disorder or injury

• Assessment or medical treatment of persons detained under the Mental Health Act 1983.

The hospital had three inpatient mental health wards. These were:

• Bennu - a 12-bed psychiatric intensive care unit for male adults of working age.

• Phoenix - a 19-bed acute mental health ward for male adults of working age.

• Adarna - a 15-bed high dependency rehabilitation ward for male adults with autism and/or a learning disability.

The hospital had a registered manager and an accountable controlled drugs officer.

We have inspected this location 13 times previously. We last carried out a comprehensive inspection of the hospital in September 2022. We rated the hospital as requires improvement overall with requires improvement ratings for all key questions except safe, which was rated inadequate.

At this inspection, we inspected all five key questions across all three wards.

What people who use the Acute wards for adults of working age and psychiatric intensive care units say

Patients told us that they were happy about the environments on the wards and that staff were available when they needed them. They said they felt safe, and that staff treated them with compassion and kindness.

Patients said that they were able to make use of section 17 leave when they wanted to, and that staff were supporting them to make changes in their lives. Those that wanted to be involved in the development of their care plans were and some had copies of them in their rooms.

Carers and families told us that they were involved in the planning of care and treatment of patients where it was appropriate. They said that when they visited that staff were polite and supported them to understand the patient’s treatment. They said they knew how to contact the hospital and give feedback. Not all carers and families said it was easy to contact someone at the hospital if they wanted to enquire about a patient.

What people who use the Long stay or rehabilitation mental health wards for working age adults say

Patients told us that staff were not always sensitive to their needs, and that they often made noise on the ward such as shouting people for meals or talking loudly to each other on the corridors. Patients told us the ward was noisy and chaotic, they told us they spent a lot of time in their bedrooms because of this and some patients wore ear defenders. However, patients told us that staff treated them with compassion and kindness most of the time and respected their privacy and dignity.

Patients told us they were able to make use of section 17 leave, and described going out to the gym and the shop. All patients except 1 told us they had a copy of their care plans and had been involved in the development of those to some extent.

We spoke to 7 carers of people on Adarna ward. All but 1 carer told us they felt their loved one felt safe on the ward. However, 6 out of 7 told us they felt communication from the ward could be improved whilst 4 out of 7 told us the ward and toilets and bathrooms used by people were not clean when they visited.  

Out of the 7 carers we spoke to, 5 of them told us the service did not keep them as informed as they would like about their loved one . For example, carers told us that they were informed about a change after it had already been made, such as changes in care, medications, care plans and discharge plans. However, 2 carers felt that they had been involved and were kept up to date with relevant information.  

Updated 3 May 2024

Our rating of this location ​went down​. We rated it as ​inadequate​ because: 

• We have taken enforcement action against the provider to make sure they improved their governance systems. This normally limits the rating for that key question to inadequate.

• The service was not always well led and the governance processes did not always ensure that ward procedures were effective. There were gaps in governance processes that failed to identify areas of concerns.

• The service did not provide safe care. It did not manage medicines, medicine fridges and medical supplies safely and risk assessments were not always complete. Medicine records were found to have been filled in retrospectively by staff when gaps were identified at our inspection. Prescribed medicines were not always in stock and available and that accurate records of medicines were not always made. Medicines were not always lawfully prescribed prior to administration.

• The service was using both a paper and electronic records system, we found that paper records did not contain the most up to date risk assessments for people in 4 out of 4 records we reviewed on Adarna ward.

• Staff on Adarna ward were not all bare below the elbow in accordance with the provider’s own policy.

• The environment was not always clean, we found food on the floor, staining on furniture, cigarette ends in the lounge and some of the furniture was ripped.

• Staff on Adarna ward did not always understand the individual needs of people. They did not always actively involve families and carers in care decisions. Care plans on Adarna ward did were not always of sufficient quality and detail to meet the needs of people

• Physical health was not always managed safely on Adarna ward in respect of bowel monitoring, particularly for people taking medication that caused a risk of bowel obstruction.

• The ward environment on Adarna ward was still too noisy and steps taken to reduce the level of noise for people since our last inspection had not been fully effective.

• On Adarna ward Staff restricted people’s access to items on the ward and this was not always based on individual needs.

However:

• There was enough staff working on the wards to keep people safe with low levels of vacancies. The wards had enough nurses and doctors. Staff followed good practice with respect to safeguarding and complaints. Use of restrictive practices was minimised.

• Mandatory training compliance rates were high and managers had oversight of when training was due to be renewed.

• Staff 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 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.

•  Therapeutic activities took place and people described things they enjoyed doing both on and off the ward.

• Staff worked well with external stakeholders and professionals to support people’s discharge plans.

Letter from the Chief Inspector of Healthcare, Dr Sean O’Kelly:

"I am placing the service into special measures. This is because the service has had two inadequate ratings against any key question on two consecutive inspections. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration."

Updated 3 May 2024

Although this ward falls within the long stay/ rehabilitation core service for CQC inspection purposes, we also used our guidance on inspecting services for people with a learning disability and autistic people to inform the inspection because the ward provides specialist rehabilitation services for autistic people. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Our rating of this location ​went down​. We rated it as ​inadequate​ because: 

• We have taken enforcement action against the provider to make sure they improved their governance systems. This normally limits the rating for that key question to inadequate.

• The service did not provide safe care. It did not manage medicines, medicine fridges and medical supplies safely and risk assessments were not always complete.

• The ward was using both a paper and electronic records system, we found that paper records did not contain the most up to date risk assessments for people in 4 out of 4 records we reviewed.

• Medicine records were found to have been filled in retrospectively by staff when gaps were identified at our inspection.

• Staff were not all bare below the elbow in accordance with the provider’s own policy.

• The environment was not always clean, we found food on the floor, staining on furniture, cigarette ends in the lounge and some of the furniture was ripped.

• People did not always feel safe on the ward and some people told us they did not feel they could approach staff when they needed to talk, despite being on the ward for some time.

• Staff restricted people’s access to items (hot drinks, cups and spoons) on the ward and this was not always based on individually risk assessed needs.

• Staff did not always understand the individual needs of people. They did not always actively involve families and carers in care decisions.

• Physical health was not always managed safely in respect of bowel monitoring, particularly for people taking medication that caused a risk of bowel obstruction.

• The ward environment was still too noisy and steps taken to reduce the level of noise for people since our last inspection had not been fully effective.

• There were gaps in governance processes that failed to identify areas of concerns.

However: 

• There was enough staff working on the ward to keep people safe with low levels of vacancies.

• Mandatory training compliance rates were high and managers had oversight of when training was due to be renewed.

• Use of restrictive practices was minimised and ward staff followed good practice with respect to safeguarding and complaints.

• They provided a range of treatments suitable to the needs of the people and in line with national guidance about best practice.

• Allied health professionals worked with people on a regular basis and had completed specialist training associated with autism.

• We saw some good examples of care plans, positive behavioural support plans and “grab and go” sheets for staff to understand the needs of people using the service..

•  Therapeutic activities took place and people described things they enjoyed doing both on and off the ward.

• Staff worked well with external stakeholders and professionals to support people’s discharge plans.

Updated 3 May 2024

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service was not always well led and the governance processes did not always ensure that ward procedures were effective.
• Prescribed medicines were not always in stock and available and that accurate records of medicines were not always made.
• Medicines were not always lawfully prescribed prior to administration.
• The ward areas were not always clean and tidy.

However:

• The service provided safe care. The ward environments were safe. The wards had enough nurses and doctors. Staff assessed and managed risk well 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 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 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 and families and carers in care decisions.