The Care Quality Commission (CQC) has taken urgent action after it identified risks to patient safety at Cygnet Appletree in Durham.
CQC carried out a focused responsive inspection in April following concerns regarding an increase in abuse between patients. There were also concerns received about a number of internal staff moves which affected the management of the service.
Following this inspection, CQC imposed urgent conditions upon Cygnet Appletree to ensure the safety and wellbeing of people. This included restricting new admissions into the service, without prior written approval of CQC. Since this inspection in April, Cygnet Appletree have made the necessary changes and are again allowed to admit people to the service.
Cygnet Appletree, run by Cygnet Behavioural Health Limited is an independent hospital providing acute and psychiatric intensive care service for patients who are detained under the Mental Health Act 1983 and those who are admitted as informal patients. The hospital is split over two floors and has two wards: Bramley and Pippin.
Inspectors looked at whether the Pippin ward was safe and well led. It was not re-rated following this inspection as the service type had changed since the previous comprehensive inspection in August 2019, and this was only a focused inspection.
The Bramley ward was not inspected as it was not open at the time of the inspection.
Brian Cranna, CQC head of hospital inspection for mental health, said:
“When we inspected Cygnet Appletree in April we were deeply concerned about the safety and quality of care being delivered to people. There were high levels of restrictive practices being used, including restraint and the use of rapid tranquilisation.
“Staff did not always attempt to use less restrictive options first which is unacceptable. We found that not all risks had been identified or action taken to mitigate these and there were ineffective systems in place to monitor these interventions. There were ligature risks which had not been identified and no action had been taken to minimise these risks to patients.
“We also found that the leadership team had been unable to implement and sustain actions to make improvements following our previous inspection of the service in August 2020.
“Following this inspection, we immediately took urgent action to stop new admissions to the service. Commissioners then worked with Cygnet to transfer all patients to other services to ensure they receive the appropriate care they require. This allowed Cygnet to carry out the work they urgently needed to complete.
“Cygnet Appletree have now made the necessary changes and can admit people to the service. “We continue to work closely with Cygnet and local stakeholders and will return shortly to check on progress.”
Following the inspection, CQC told the service it must make the following improvements:
- Ensure that restraint and rapid tranquilisation are used as a last resort and in line with the Mental Health Act Code of Practice
- Ensure that patients’ privacy and dignity are upheld during incidents of restraint and rapid tranquilisation
- Ensure that episodes of seclusion are appropriate and used only when necessary, as detailed in the Mental Health Act Code of Practice
- Ensure that observation sheets for patients on enhanced observations provide a clear and accurate account of the level of observation required and where privacy is permitted
- Ensure that records of incidents give a true reflection of what happened and include actions taken, debriefs and outcomes
- Ensure that systems in place to review incidents are robust
- Ensure that an environmental risk assessment is in place which identifies all ligature risks and any actions to mitigate these risks
- Ensure that staff consistently follow infection control principles.
Full details of the inspection are given in the report published on our website.
For enquiries about this press release please email regional.engagement@cqc.org.uk.
Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here (Please note: the duty press officer is unable to advise members of the public on health or social care matters).
For general enquiries, please call 03000 61 61 61.