The Care Quality Commission (CQC) has told leaders at Cygnet Wast Hills that they must make further improvements to the quality of services.
CQC carried out the inspection in November to follow up on concerns from a previous inspection where the service was first rated as inadequate and placed into special measures.
Cygnet Wast Hills is an independent hospital in Birmingham providing assessment, treatment and care to people with a complex learning disability and autistic people.
Following the latest inspection, the service has been rated inadequate overall. The rating for effective went down from requires improvement to inadequate and the rating for caring went down from good to requires improvement. Safe and well-led remained as inadequate and responsive remained as good.
Debbie Ivanova, CQC deputy chief inspector for people with a learning disability and autistic people, said:
“During our latest inspection of Cygnet Wast Hills, whilst some improvements had been made by the new director and leadership team, these were new and had not been fully embedded. We remain concerned by what we found and there are several areas where the provider needs to make urgent improvements.
“Leaders had a poor oversight of the hospital environment and we found risks that had not been identified until we raised concerns. For example, a communal bathroom had a broken bath panel, visible mould and the kitchen in the annexe was very dirty. The hospital had plans for significant environmental changes so that they could better meet the needs of people. The hospital needs to put plans in place to mitigate these risks whilst they wait to carry out the environmental work.
“The setting and design of the service did not fully reflect the CQC guidance ‘Right support, Right Care, Right Culture’ and improvements were needed to ensure care was delivered in line with best practice and national guidance.
“People’s needs were not always being met. A new occupational therapist as well as additional staff had been appointed to assist with peoples’ activity. However further work was needed to ensure these appointments were having a positive impact on the day-to-day experience of people using the service, as several people continued to be inactive and not always meaningfully occupied. Many people using the service were sleeping excessively during the day, which led to poor sleep patterns and wellbeing issues. In addition, staff did not consistently support and monitor physical health or always encourage people to live healthier lives.
“We were pleased, however, to see the use of restraint and restrictive interventions on people had reduced with staff using effective de-escalation techniques. Moderate incidents of self-harm had also reduced which was an area of concern at our last inspection.
“We will continue to monitor this service and if insufficient improvement is made, we will use our enforcement powers further to ensure people receive appropriate and safe care.”
Inspectors found:
- Physical health records and observations were not always up to date or complete. Several families had concerns about their family member’s weight and records indicated that weight was not always well managed by staff
- There were ineffective governance processes and leaders did not have oversight of all areas and local audits were not always effective
- Not all areas of the hospital provided a well-maintained environment which met peoples’ sensory and physical needs, although the provider had commenced a programme of environmental improvements
- Staff did not always keep care records up to date and accurate, and information was not always easy to locate in the system used.
However, inspectors also found:
- The hospital had appointed a new occupational therapist since the previous inspection, and there were improvements in relation to people’s activity. There was a new activity timetable and further actions planned to develop activity. For example, two people had been on holiday and there were more group activities and work opportunities for people. However, at inspection people still were not engaged in enough activity, and we continued to see people inactive, sleeping excessively or demonstrating irregular sleep patterns, so there needs to be more work in this area
- People had clear discharge plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support after they went home
- All staff spoke highly of leaders and said the culture was open and supportive
- Risk management and incident reporting had improved, and staff completed high level observations in line with policy
- The provider had increased staff on shift to meet peoples’ needs and although the service relied on agency support workers, they ensured that these staff were familiar with the service.
Full details of the inspection are given in the report published on our website.
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