Cygnet Bostall House

Updated 4 September 2023

We undertook this short notice announced, comprehensive inspection of Cygnet Bostall House because of a serious incident that took place at the beginning of 2023. The incident involved inappropriate restrictions on a patient by staff. The manager had investigated and found that the staff had not reported the incident appropriately.

Bostall House is a six-bed independent hospital located in Abbey Wood, London. The service provides a high dependency complex care rehabilitation service for men living with a learning disability and associated complex needs.

The service has a registered manager in place and is registered for the following regulated activities: Assessment or medical treatment for persons detained under the Mental Health Act 1983 Treatment of disease, disorder or injury.

We have inspected this service three times since 2015. The last inspection was in January 2020 when we rated the key question of caring as outstanding and the service as good overall.

What people who use the service say

We spoke with 4 people using the service. Patients said staff treated them well and behaved kindly. Patients said they had choices in their care and activities and that staff were caring and supportive.

Patients said staff listened to them and knew them well. One patient said that staff ‘listen to any concerns we have, and we can approach them if we are feeling unsafe.’

Another patient described staff positively, that when he is distressed, they support him with one-to-one and talk to him. He said they help him a lot and they support him to his room to listen to his music.

Three of the patients we spoke to mentioned staff by name that helped them specifically the ward manager and the occupational therapist assistant. Patients said that staff arrange group activities on a Friday, and they have barbecues and pool competitions.

One patient said they have ward round every Monday and ‘we can present our concerns to doctors and nurses. If there’s anything we want that needs approval, we can raise it then too’.

Patients said that staff go through their care plan with them monthly and give them easy read versions if they needed it.

Updated 4 September 2023

Cygnet Bostall House provides a high dependency complex care rehabilitation service for 6 men living with a learning disability and associated complex needs.

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.

We carried out a short notice announced, comprehensive inspection of Cygnet Bostall House after a serious incident took place earlier in the year.

Our rating of this location stayed the same. We rated it as good because:

• Staff provided safe care to patients with a learning disability. The service had enough nursing and medical staff, who knew the patients and received essential training to keep people safe from avoidable harm. The service provided staff with emergency scenario training to help staff prepare for a medical emergency.
• Staff received training to give them the knowledge and skills to meet the needs of people with a learning disability.
• The service ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. Staff understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both).
• The service had a full range of specialists to meet the needs of the patients with a learning disability. The team included a consultant psychiatrist, nurses, a clinical psychologist, a speech and language therapist and an assistant occupational therapist.
• Patients had care and support plans that were personalised, holistic, strengths-based and reflected their needs and aspirations, including physical and mental health needs. Patients, those important to them and staff reviewed plans regularly together.
• People were empowered to make decisions about the service when appropriate and felt confident to feed back on their care and support. The service held a monthly empowerment meeting for patients. This enabled patients to make suggestions and voice ideas. These ideas had led to changes in the menu, physical health, group outings and activities. Patients could put questions to members of the multi-disciplinary team which they then responded to.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
• Patients were listened to, given time, and supported by staff to express their views using their preferred method of communication. Staff devised a communication grab sheet for each patient, which had their photo how they like to be communicated with. Staff could use this to support patients out in the community.
• The service was well led. The leadership of the service worked hard to create a learning culture. Since a recent serious incident staff felt valued and empowered to suggest improvements and question poor practice. The service had Freedom to Speak Up Champions on the ward.

However:

• Whilst staff planned patient discharge well, the length of stay for most patients was longer than the provider’s aimed length of stay. As a result, patients may have stayed in hospital when they were well enough to leave.
• The hospital site was not smoke-free as patients could still smoke in the garden area. This was not in line with best practice.
• The service could do more to meet patients’ sensory needs. For example, noise-reducing furnishings and calm diffused lighting, which support people with sensory sensitivities.
• Further works were needed to ensure bedroom doors were anti barricade and all communal doors had anti-ligature fixtures.
• The staff survey results were mixed. It was not clear what actions senior managers had taken to address the results and make improvements.

Updated 4 September 2023