The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: Cypress

Overall: Requires improvement read more about inspection ratings

35 Totnes Road, Paignton, Devon, TQ4 5LA (01803) 551066

Provided and run by:
Step One Charity

Important: This service is now registered at a different address - see new profile

All Inspections

10/07/2017

During an inspection looking at part of the service

We carried out this unannounced inspection in response to a serious incident at the hospital. We focused on specific aspects of two key questions, ‘safe’ and ‘effective. This was to establish whether the provider had adequate safeguards in place to keep patients safe and to review the measures the provider had put in place to mitigate the potential risks.

  • The building was not purpose built and there were multiple ligature points. Risk of ligature was reduced through the assessment of patients. Patients who were a known suicide risk were not admitted. All patients were risk assessed, such as for risk of self harm and ligature history.
  • The service carried out regular ligature audits and staff mitigated ligature and other risks through observations and engagement. Staff followed the observation and engagement policies and followed procedures and recorded observations of all patients. Policies on risk and observation were embedded in the team.
  • The provider planned to move from the current premises to a purpose built unit that was designed to minimise ligature risk. Notice had been given on the lease of the current building and they were expecting to move in January 2018.
  • The provider had responded to the shortage of two trained nurses and had closed two beds to ensure safe staffing levels in the short term. The provider was actively recruiting for trained staff.
  • Staff were debriefed after incidents and learning was shared across the team. Staff knew how to report incidents and the culture was open and transparent in response to incidents, with evidence of improvement in practice.
  • Patients and staff were positive about the service and patients told us that they felt safe and staff told us that they felt supported.
  • The provider worked well with partners, such as the local mental health trust. Cypress staff attended regular meetings with the wards and crisis staff. The crisis team were on site at Cypress three days a week and worked in close partnership with the provider. Information was shared between the local trust and Cypress, with read only care plan information for senior staff. The provider was in the process of implementing a joint action plan with Devon Partnership NHS Trust to improve access to care records so that there was access for all staff.

However;

  • The regular ligature audits had not addressed all the environmental risks, we asked the provider to revisit this with Devon Partnership NHS Trust and carry out a joint ligature audit.
  • Although individual risk was discussed in handover meetings and regular meetings with the crisis team and ward, the provider admission documentation did not always specifically include a prompt to exclude any patients with a current or historical ligature risk.
  • Staff felt well supported and supervised, but the provider was not meeting its appraisal targets.

14 - 15 January 2016

During a routine inspection

We rated Cypress as requires improvement because:

  • There was a lounge on the ground floor which could be used for women if required, but it was not designated solely for women, and there was not always a quiet room for patients to meet visitors. The building had few adaptations for patients with physical disabilities.
  • Blood pressure monitoring equipment and scales had not been calibrated.
  • 45% of staff were overdue for one to one supervision and 36% were overdue for annual appraisal. One appraisal was overdue by was more than three months.
  • Staff did not have access to the electronic care notes system used by the local NHS provider. This led to duplication of records. There were ongoing discussions about providing the ward with access to the NHS provider’s records for patients referred to the ward.
  • Although there were a number of clear policies on the Mental Health Act on the organisation's website, all of these were overdue for review and none had been revised in the light of the new Mental Health Act Code of Practice, which came into force from 1 April 2015.

However:

  • Staffing levels were good. Activities were rarely cancelled due to lack of staff and patients told us there were always enough staff. Staff offered patients one to one time twice a day and patients said staff were always available if they needed them. The manager had authority to increase staffing levels temporarily if needed, and could provide an individual with constant one to one time for up to 72 hours if required.
  • There had not been any serious incidents reported on the ward in the last 12 months.
  • Staff knew what incidents should be reported and understood safeguarding procedures. When incidents occurred, staff were debriefed. There was a portable alarm system and this was tested every day. 
  • Medicines, including controlled drugs, were stored securely and staff checked the temperature of the fridges that were used to keep medication.
  • Care plans, which were referred to as work plans, were personalised, holistic and recovery focused. A physical health check form was completed when patients were admitted and patients could access specialist care when needed.
  • Communication was good within the team and with other professionals. A detailed handover was conducted daily between the early and late shifts and there were brief handovers at the beginning and end of the day. There were regular multi-disciplinary team meetings and clinical reviews and staff attended handover meetings at the local acute ward.
  • We observed friendly and informal interactions between staff and patients. The staff were respectful, positive and flexible. Patients were generally very positive about the ward.
  • Patients were able to personalise their bedrooms, had keys to their rooms and access to the kitchen to make their own drinks and snacks. Patients told us that they liked the homely atmosphere.
  • Patients were only moved if clinically appropriate. Discharge from the ward was carefully planned and beds could always be accessed on return from leave.
  • There were a range of activities that staff facilitated during the week. Staff encouraged patients to see friends and family. Patients were encouraged to get used to doing things on their own as part of their recovery and in preparation for moving on.
  • Most staff said they felt confident to raise concerns without fear of victimisation and spoke very positively about the team manager and clinical lead. Staff were motivated and enthusiastic and spoke favourably of working on the ward. 

3 May 2013

During a routine inspection

This was a planned inspection and a follow up on improvements made since our inspection in October 2012. On 30 October 2012 we had concerns because some radiators were very hot and had no surface protection. There were no risk assessments in place for the radiators. We had concerns because some windows had non safety glass in them.

At this inspection 03 May 2013 the home had made improvements. The home had identified environmental risks and had made changes to the environment to improve safety.

People told us "They have been really good and it's a really good atmosphere to get well in." and "It has been really helpful for me. I am less stressed now". A member of staff told us "We work with the clients, at a pace suited to their needs and in a way that they can best recover".

People received good support to become independent. We saw that people were following clear programmes to prepare them for life in the community. We saw that people had consented to their care and treatment. Staff were knowledgeable about the Mental Capacity Act 2005.

Care plans and records were comprehensive. People were supported to follow activities of their choice and engage with the local community. People were supported to make choices about their future and involved in decision making, within a risk managed framework.

Records were well organised, easily accessible and stored securely. Staff recruitment records were well maintained. Some files did not contain photographic ID of staff.

30 October 2012

During a routine inspection

Cypress is an independent mental health hospital, which means they can accept people detained under the Mental Health Act 1983. The service provides accommodation for both male and female clients, and there is a separate supported flat. Cypress is a recovery based home for people looking to progress to independent living.

People told us "It's not too bad here. Much better than where I was before." and " I like it. The staff are really good and help me with the things I want to do". A staff member we spoke with told us "I wouldn't hesitate to have a member of my family in here. The care people get is really excellent".

We found that the service was being well run and that people were receiving good support to progress into independence. We saw that people were following clear programmes to prepare them for life in the community and had individual time with support workers every day to plan their progress.

Care plans and records were comprehensive. People were supported to follow activities of their choice and engage with the local community. People were being supported to make choices about their future, and be involved at all levels of decision making, within a risk managed framework.

We found that some areas of the environment had not been fully assessed for risks or actions taken. Some carpets were due for replacement and a new kitchen was planned.

Staff were being well trained and supported, but some formal supervision systems had fallen behind schedule.

1 September 2011

During a routine inspection

This inspection included an unannounced joint visit with a Mental Health Act commissioner. The role of the Mental Health Act Commissioner was to ensure the powers of the Mental Health Act 1983 were being used appropriately at the service, with particular respect to detained patients and ensuring people's rights are being respected. The compliance inspector role was to look at areas of compliance with the Health and Social Care Act.

People using the service have regular and on request access to an Independent mental health advocate, who visits the service every fortnight, as well as to community mental health services. We saw that people were being given clear information about their rights, and access to support.

People we spoke to at the service told us:

"I'd trust them with my life. I feel safe here with them."

"The staff are really good. They know what I am trying to do and give me lots of help to achieve things I want."

"I am trying to get involved more and find my own ways of doing things to help me more when I am not here."

"It is a place where I am treated like an adult."

We also were able to speak with one person who had recently been discharged from the service but had come back to visit. They told us about the level of support they had received to help them live independently in the community and how much they had valued the service. They said "If it was so bad I wouldn't keep coming back to see them would I?".

One person told us they did not always feel safe or comfortable as there were mainly men in occupation at the time of our visit. Parts of the service are for single sex accommodation only, and this can be increased at times when people feel vulnerable. For example all the female bedrooms are on the ground floor in a female only area and a small lounge can be designated for females only if needed.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.