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

Cygnet Bostall House

Overall: Good read more about inspection ratings

Bostall Heath, Knee Hill, London, SE2 0AT (020) 8319 7954

Provided and run by:
Cygnet (OE) Limited

All Inspections

21 and 22 June 2023

During a routine inspection

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.

13 January 2020

During a routine inspection

We rated Cygnet Bostall House as Good because:

  • Patients attended monthly ‘empowerment meetings’ when they could make suggestions and voice ideas. These ideas had led to changes in the menu, activities and new furniture. They also concerned environmental changes and where to go for day trips.
  • Staff arranged birthday parties and ‘leaving parties’ when patients were being discharged from the service. Patients families and carers were invited to attend.
  • When a patient did not wish to have psychology sessions, the psychologist still spent time with the patient. They gradually developed an informal relationship. After some time this led to the patient engaging in psychological therapy.
  • Staff provided care and treatment to patients in a collaborative manner. Staff supported patients to understand their needs. They involved patients in decisions and sought patients’ views on a wide range of topics. All of the staff were clear that patients’ needs were the priority over everything else.
  • Staff had a strong focus on relationships with patients, on meeting patients’ social and emotional needs, and ensuring patients felt safe.
  • Families and carers were invited to visit the service before a patient was admitted. In some cases they had two visits before the patient was admitted. This enabled families and carers to see the environment and to meet staff and patients.
  • Patients and families and carers feedback were consistently positive. Patients said staff were nice and that their privacy and dignity were respected. Families and carers felt welcomed, comfortable and involved in patients care.
  • Staff had a strong focus on relationships with patients, on meeting patients’ social and emotional needs, and ensuring patients felt safe.
  • Patients received care and treatment which followed best practice. This included psychological therapies and a range of activities.
  • Patients and families and carers gave consistently positive feedback. Patients said staff were nice and that their privacy and dignity was respected. Families and carers felt welcomed, comfortable and involved in patients’ care.
  • Staff knew how to identify any form of abuse and how to safeguard patients. They knew that if they raised concerns about a patient that it would be taken seriously, and action would be taken.
  • There was a positive incident reporting culture and there were well developed systems to embed learning from incidents. The governance system for the service was well developed. The manager had sufficient information to identify potential risks to the safety and quality of care provided to patients. Action was then taken to minimise those risks.
  • The leadership team was knowledgeable and experienced. They set clear standards of care and had developed a supportive and positive staff culture. There were very low rates of sickness and low rates of staff turnover. There were no vacant posts in the service.

However:

  • The introduction of the new electronic care records system meant that information on patients’ care and treatment was in a variety of places at the time of the inspection. This meant staff may not be able to locate all of the information they needed.
  • Patients did not have access to an alarm to alert staff to their needs.

9 -10 May 2017

During a routine inspection

We rated Bostall House as good because:

  • Patients and families were involved in their care and gave positive feedback about the service. Patients could give feedback to staff about their care in regular meetings and via their patient representative.

  • Patients said that the food was of good quality.

  • The service provided a wide range of activities that staff developed based on patients’ skills and interests. Staff supported patients to engage in activities in the community, such as part time jobs and using public transport.

  • Staff carried out detailed assessments of patients on admission, including assessment of risks and physical health needs. Staff reviewed risks and patient needs regularly and had clear risk management plans in place.

  • The service managed medicines appropriately and staff carried out clinical audits regularly to monitor and improve clinical practice.

  • Staff ensured patients received six month reviews in accordance with the Transforming Care Programme, which is a national programme that aims to enable more people with a learning disability to live in the community.

  • Staff morale was high and staff said that they felt supported. There were effective governance structures in place for senior staff to monitor the running of the service.

However:

  • Staff did not always complete incident forms in full when staff used physical restraint.

  • Staff had not included en-suite bathroom taps as a potential ligature risk in their ligature risk assessment and management plan.

17-18 November 2015

During a routine inspection

We rated Bostall House as good because:

  • We saw staff delivering care with kindness and respect. Patients told us that staff helped them to make decisions about their care and that they felt safe. The service regularly collected feedback from patients and this feedback was positive. Staff supported patients to meet their religious and cultural needs.

  • Staff completed comprehensive assessments when patients were admitted to the service and developed a number of care plans for each patient’s different needs.

  • Staff used verbal de-escalation and low-level guided restraint techniques on the ward. The ward did not use high numbers of bank and agency staff.

  • Several staff described positive changes that the new manager had brought to the service since they started in March 2015 and described morale as high. This was reflected in staff satisfaction surveys. The new ward manager had identified training needs of staff and was in the process of arranging this. Training rates were over 75% for all mandatory training.

  • The ward and clinic room was clean and tidy and medicines management was safe and appropriate.

However:

  • Not all risks identified in patients’ risk assessments had plans in place to reduce them.

  • Staff had not made sure that all records of patients’ ongoing physical health checks were in place.

  • The service had not told the Care Quality Commission (CQC) about three reportable incidents in 2015.

  • Patients did not have access to an advocate or independent mental health advocate (IMHA).

  • The garden posed some environmental risks that the service had not identified.

12, 19 February 2014

During an inspection looking at part of the service

Four people we spoke with who used the service told us that there had been an improvement in their involvement in planning their care, including planning for working towards being discharged from the hospital. They said activities had improved, especially outside activities such as attending college, seeing family and shopping trips. One person told us that they were supported regularly to see their family where as previously this had not been happening. Two people told us that cooking activities could be improved if more staff were able to be involved.

A clinical psychologist was now in post and told us how they had become involved in improving people's care, such as running a group to support people with their mental health needs, and an anger management group. Two people we spoke with who used the service said they found this helpful for their development.

There had been a significant improvement in the physical environment at the hospital and many areas had been redecorated and new furniture had been purchased with involvement from people who lived there. Four people told us they were very happy with the improvements made, including being able to freely make their own hot and cold drinks when they wished.

The provider's system for ensuring the quality of service provision had improved, and the provider was carrying out regular audits to ensure that people's care was being planned and reviewed appropriately. The provider also confirmed plans to improve management presence at the hospital at weekends.

9, 16 September 2013

During a routine inspection

We spoke with four people who told us that staff were helpful and treated them with respect. One person said 'the staff treat me well and the night staff treat me the same way'. There were activities for people to do and people were encouraged and supported to leave the hospital on outings. However, some people said that the activities could do with improvement.

People were supported to understand their rights and to consent to care and treatment through the involvement of an independent advocacy service. Care planning and reviews took place regularly with involvement from people who used the service, and care plans were agreed by them. The staff understood people's care needs and how to protect them from risk of harm; however plans for people to move on had not been included in their care plans. Medication was well managed.

The accommodation provided was poorly decorated for example the paint on many of the walls and doors were old and faded, and some furniture was in a shabby condition. There were limited communal spaces within the hospital. Staff were supported to understand their jobs through regular training and supervision. Quality assurance checks did not adequately check people's care plans and quality of the premises, and there was no formal system for checking the quality of care provided during the night and at weekends.