- Independent mental health service
Cygnet Churchill
Important:
The provider of this service changed. See old profile
All Inspections
During an assessment of the hospital overall
11 October 2022
During a routine inspection
Our rating of this location stayed the same. We rated it as good because:
- We rated acute wards for adults of working age as good overall with requires improvement for the safe domain. We rated long stay or rehabilitation mental health wards for working age adults as good for well-led. The hospital remained good overall.
- The ward environment was clean, well equipped and well furnished. The ward 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.
- Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Staff assessed the physical and mental health of all patients on admission. 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.
- Staff supported patients with activities outside the service, such as work, education and family relationships.
- The ward teams had access to a range of specialists to meet the needs of patients on the ward. Managers ensured that these staff received training. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
- The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each patient’s mental and physical health.
- 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.
- The service was well led, and the governance processes ensured that ward procedures ran smoothly. The service informed CQC of all statutory notifications.
- Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the service they managed and were visible in the service and approachable for patients and staff. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Staff could raise any concerns without fear.
However,
- Whilst the ward had a ligature risk assessment, the risks were not as well mitigated as they could have been. Staff did not always know where ligature risks were on the ward.
- Some staff did not ensure that they varied when they checked patients. When patients were checked 4 times per hour for their safety, the checks were not always carried out at 4 random times throughout the hour.
- The ward had introduced fans onto the ward following a risk assessment. However, routine oversight of the fans’ use had not yet been incorporated into ward systems, such as the daily environmental checklist.
- Handover documentation and daily allocation sheets were completed each day; however, they were not always completed in full to include staff members’ allocated roles.
- Controlled drugs were not always checked by 2 registered nurses as per hospital policy. The ward was not able to provide assurances that their blood glucose monitor was fit for use.
- Restraint documentation within incident reports did not always show which staff were involved or the role they played in the restraint.
- Patient awareness of the advocacy service and the complaints procedure was patchy.
- Staff had regular appraisal and managerial supervision, but staff were not having regular monthly clinical supervision and monthly reflective practice sessions for staff were poorly attended.
- The team meeting did not routinely cover matters such as incidents, safeguarding and the learning from these.
29 to 30 October 2019
During a routine inspection
We rated Cygnet Churchill as good because:
- The service provided safe care. The ward environments were safe and clean. Juniper ward (an acute admissions ward) had recently been refurnished and was a suitable environment for its patient group. The wards had enough nurses and doctors to meet the needs of patients. 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 cared for in a mental health high dependency rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
- All 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 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.
- Staff planned and managed discharge well and liaised well with services that would provide aftercare. There were some instances of delayed discharges due to challenges in finding suitable placements in the community, but staff worked well with external organisations in the patients’ local area to solve this.
- The service worked to a recognised model of mental health rehabilitation. It was well led and the governance processes ensured that ward procedures ran smoothly and that patients were discharged to local community services or their home, within a reasonable timeframe.
However:
- At the time of the inspection, the provider did not stock emergency Naloxone medicine despite admitting patients who presented with risks for illicit opiate and substance misuse. The provider had since sourced and stocked emergency Naloxone medicine.
- Staff on Maple Court did not always meet their responsibilities under the Mental Health Act 1983 Code of Practice. For example, ensuring a manager’s review hearing took place before the expiry of a patient’s section and having clear records of whether a patients’ nearest relative was informed of their detention under the Mental Health Act.
- Staff did not make notifications to external bodies as needed. For example, between 01 January 2019 and 29 October 2019 we found 17 incidents of allegations of abuse in relation to service users that were not reported to the Care Quality Commission.
16 -17 May 2017
During a routine inspection
We rated Cambian - Churchill Hospital as good because:
- Following our last inspection of the service, in December 2015, we told the provider they must make improvements to ensure the safety of patients. At this inspection, we found that the management team had effectively implemented changes and all health and social care regulations were met.
- Mirrors had been installed to enable staff to better monitor patients and ensure their safety. Managers met each morning to ensure that there was a safe staffing level on each ward and any safeguarding issues were promptly followed up.
- Staff skills in managing actual or potential violence had improved. There was a reduction in the incidence of staff restraint of patients. When staff did use restraint, or administer rapid tranquilisation, they kept full and accurate records. There were notices in place to advise informal patients of their rights.
- Lessons had been learnt from adverse incidents. The management team had introduced a new way of training staff to respond to medical emergencies using simulations. Staff told us this had increased their skills and given them more confidence to deal with such situations.
- The experienced and well-staffed multidisciplinary team on each ward provided recovery-focused treatment and care. Staff supported patients to improve their mental health and move on from the service to a community setting.
- Patients told us staff treated them with dignity and respect. They said staff involved them in planning their treatment and care. They had opportunities for work experience and to follow their interests.
- Patients said staff took the time to talk to them about their medicines. They told us they received helpful support from an advocate who assisted them in discussions about their care and treatment.
- Staff morale at the service was positive. Staff said they had received training which had enhanced their skills in relation to meeting the complex needs of patients.
However:
- Some patients were at risk of an opiate overdose. The service did not stock Naloxone for use in an emergency. Naloxone is a medicine that can temporarily reverse the effects of an opiate overdose, providing more time for an ambulance to arrive.
- Staff may not have all the equipment needed to respond effectively to a medical emergency. The provider did not have a pulse oximeter in the emergency response bags, which meant staff may not have been able to easily check a patient’s pulse. Staff did not routinely check the contents of first aid kits to ensure that all of the appropriate items are in the kit and can be used when required.
3-5 November 2015
During a routine inspection
We rated cambian Churchill Hospital as good because:
- Staff treated patients with dignity and respect.
- A wide range of facilities and activities were available for patients to support their rehabilitation.
- Staff supported patients to devise their own activities and scheduled regular time for these activities to take place. This empowered patients to be involved in the planning of their recovery. Activities had a strong rehabilitation focus including staff supporting patients to apply for paid therapeutic employment in the hospital.
- The service supported patients to raise ideas and concerns directly with senior hospital managers via a monthly patients’ forum. This took place before the hospital’s clinical governance meeting allowing issues to be put immediately to managers.
- The service was very responsive to patients’ complaints, acting promptly whenever they were raised and taking appropriate steps where necessary. Staff ensured that they met with patients to discuss their complaints and the outcome of any investigation
- The hospital was well-led with systems and procedures in place to ensure that staff were well managed. Staff morale was improving as a result of good leadership from senior hospital managers.
- The service worked well with external agencies including a local GP practice to ensure effective monitoring of patients’ physical health.
- The service was very supportive of independent advocacy ensuring that patients could always raise issues concerning their care and treatment.
However:
- The provider had not taken appropriate steps to address the risks to patient safety it had identified on the wards where the layout did not give staff direct lines of sight.
- There were not always sufficient numbers of staff on the wards to keep patients safe at all times.
- The provider had not taken all appropriate steps to ensure that important lessons from serious incidents were fully incorporated into practice.
- The hospital’s safeguarding procedures did not ensure that all safeguarding concerns were dealt with promptly. When managers responsible for dealing with safeguarding matters were absent there was a delay in responding to concerns creating a risk to patient safety.
- The records of incidents of when staff had restrained patients or administered rapid tranquilization were sometimes missing important details. This meant it was not always possible to know whether staff had acted safely and according to procedures.
- The provider had given information to informal patients about their legal rights that was inaccurate.
12 August 2014
During an inspection looking at part of the service
We checked the records of people who used the service and found that most people had up to date risk assessments and care plans. Staff had a good understanding of safeguarding and most staff had completed training related to safeguarding adults. We spoke with catering staff, checked menus and spoke with people who used the service. They told us that the menu was varied and people had access to a variety of food.
We checked the staffing levels and found that while the establishment figures were usually met, there were some occasions when the full complement of staff had not been achieved for some shifts. Staff and people who used the service told us that sometimes there were not enough staff. We saw that analysis had been completed regarding the skill mix on site. The provider had access to bank and agency staff to cover shifts. Most staff had access to training, supervision and annual appraisals.
28 August 2013
During a routine inspection
People's capacity to agree to treatment was regularly assessed. There were opportunities for people using the service to make suggestions about the service.
We observed staff responding to queries from people using the service and providing them with information. One of the people we spoke with said they had received a lot of support and good advice from their key nurse and key support worker. There were risk assessments and care plans in place, and these were regularly reviewed by the multi-disciplinary team. People had access to educational and other services in the community in addition to a variety of facilities at the hospital. People we spoke with said there were a lot of activities to choose from.
We found the service had reviewed staffing levels and had access to bank and agency staff when additional or cover staff were needed. The service was making improvements to the induction programme for new staff. However, we found that not all staff were receiving regular supervision.
There had been improvements to the monitoring of the requirements of the Mental Health Act 1983. There were regular meetings to discuss the results of audits and reviews of incidents. When there were incidents, appropriate action was taken to reduce the likelihood of these recurring.
4 February 2013
During a routine inspection
People told us the staff were kind, and that most of them would make time to talk to them. We observed staff interacting respectfully with patients and listening to their concerns. We found that people's mental health needs were well understood, and other needs, such as alcohol misuse, were addressed.
However, we found there had been delays in giving a patient information about his rights and his treatment because an interpreter had not been accessed.
We found the service adjusted staffing levels when the number or needs of patients changed. However, there were no arrangements to access staff to fill in when there were unexpected staff shortages because of leave or sickness. We found there were some restrictions in the access people had to therapeutic activities.
Appropriate arrangements were in place in relation to the administration and recording of medicines. We found some examples of delays in accessing the second opinion appointed doctor (SOAD), when additional medication was prescribed.
There was evidence of systems to assess the quality of the service and to take action to make improvements. When there were incidents, appropriate action was taken to reduce the likelihood of these recurring.