The Care Quality Commission (CQC), has rated Cygnet Hospital Harrow, run by Cygnet Health Care Limited inadequate following an inspection that took place in May and June.
CQC looked at the below four services and how well-led the organisation was overall as part of this inspection, which took place as part of CQC’s regular monitoring of services:
- long stay rehabilitation ward for autistic people (Springs Wing)
- acute wards for adults of working age and psychiatric intensive care units (Byron Ward)
- wards for people with autism (Springs Centre)
- forensic inpatient wards for autistic people (Springs Unit).
The long stay ward has been rated as requires improvement, whilst the other three have all been rated as inadequate. As well Cygnet Hospital Harrow being rated as inadequate overall, as has how well-led they are overall. Individual domain ratings can be found below, which are also included in the report.
Long stay or rehabilitation mental health wards for working age adults
- Safe: requires improvement
- Effective: inadequate
- Caring: requires improvement
- Responsive: requires improvement
- Well-led: requires improvement
- Overall: requires improvement.
Forensic inpatient or secure wards
- Safe: inadequate
- Effective: inadequate
- Caring: inadequate
- Responsive: inadequate
- Well-led: inadequate
- Overall: inadequate.
Acute wards for adults of working age and psychiatric intensive care units
- Safe: inadequate
- Effective: requires improvement
- Caring: requires improvement
- Responsive: requires improvement
- Well-led: inadequate
- Overall: inadequate.
Wards for people with learning disabilities or autism
- Safe: inadequate
- Effective: inadequate
- Caring: inadequate
- Responsive: requires improvement
- Well-led: inadequate
- Overall: inadequate.
Overall
- Safe: inadequate
- Effective: inadequate
- Caring: inadequate
- Responsive: requires improvement
- Well-led: inadequate
- Overall: inadequate.
CQC has told Cygnet Hospital Harrow where it must improve and expects to see rapid and widespread improvements. CQC will continue to monitor them during this time to keep people safe and return to check these improvements have been made.
Rob Assall, CQC’s director of operations in London said:
“When we inspected Cygnet Hospital Harrow, we saw a service that wasn’t being well-led. Our experience tells us that if services aren’t well-led, it makes it difficult for them to provide a good quality service, which is what we found here. This is particularly true in organisations providing specialist services for autistic people, whose very individual needs should be considered at the heart of their care and treatment.
“Three of the services we visited were specialist services for autistic people, who often have very individualised communication needs. Staff weren’t adequately trained to communicate effectively with people using the service, which had a negative impact on how they interacted with them. People using the service told us that as a result, they didn’t always feel like staff treated them with compassion and kindness.
“On two of the wards, leaders hadn’t created ward environments that were suitable for autistic people on a really basic level. They were institutional, and noisy with alarms frequently going off, and the lighting was very harsh. This is important as autistic people often have additional sensory needs and can find this sort of stimulus distressing. Leaders weren’t able to show they had a clear plan in place to address this. It’s also concerning as the fire alarm routinely going off had become normalised, meaning people may ignore it in a real emergency.
“We found that autistic people who were staying at the hospital for longer periods of time, weren’t having their physical needs met with all routine appointments such as optician, dentist and annual GP health checks. Autistic people have a shorter life expectancy as their physical health needs aren’t always met so it’s important that these are taking place regularly.
“On Byron Ward and the Springs Unit we didn’t always see evidence that people who were given rapid tranquilisation medicines had their physical health monitored afterwards. This treatment can result in serious side effects so people need to be monitored closely.
“It was however reassuring to see that in general across all of the services we saw, that staff used physical restraint as a last resort, using verbal de-escalation techniques first, and that discharges were well planned and tailored to people’s individual needs.
“Cygnet Hospital Harrow still haven’t fully addressed some issues which we found at our previous inspection despite being told where we needed to see improvements. We expect leaders to use our report to make rapid and widespread improvements, and will continue to monitor the service closely during this time to make sure people are safe.”
Across all of the services inspectors found:
- Staff didn’t always treat people with compassion or respect their dignity
- The hospital’s governance systems and processes weren’t robust. The processes in place hadn’t identified many of the issues found at this inspection
- People eating on their own in their rooms rather than socially had also become normalised across some of the services
- Autistic people’s carers and families told inspectors that their loved ones physical health had deteriorated whilst staying at the hospital, in particular that they were putting on weight and weren’t having routine health checks. People using the service told inspectors that the food wasn’t good quality or a big enough portion so they needed to eat snacks
- Leaders had not addressed all breaches from the previous inspection report. Inspectors found ongoing issues, with clinical equipment not being routinely checked it was in working order on three wards. This meant in the event of an emergency the equipment might not work.
Across the services for autistic people, inspectors found:
- The care record systems on Springs Unit, Springs Centre and Springs Wing were poorly organised, and staff struggled at times to find important information
- Although staff had some basic mandatory autism training, this didn’t include specialist communication training. As a result, on Springs Unit, inspectors saw staff who didn’t appear to know how to interact appropriately with the people they were supporting, and didn’t understand how their behaviours could be perceived by an autistic person
- Also on Springs Unit and in the Springs Centre, inspectors saw staff standing for long periods observing people but not interacting with them. Inspectors observed that this approach of the nursing and care staff was at times custodial and threatening rather than supportive. One member of staff said they were guarding people using the service
- On Springs Unit, inspectors saw an incident when someone had smeared faeces on the wall of a seclusion room and staff left them in there for over 17 hours without cleaning it up. This wasn’t upholding people’s basic human rights
- At two of the service, the lack of specialist communications training for autistic people meant that while people felt safe, they didn’t feel treated with compassion and kindness. Some people said they didn’t a positive rapport with the staff. At the Springs Centre, some people raised concerns with inspectors about how staff treated them, telling CQC they felt staff mimicked and laughed at them
- At Springs Centre, the ward wasn’t clean, and was visibly dirty.
On Byron Ward inspectors found:
- Despite the ward having blind spots, there was no clear plan in place to mitigate the risk and staff did not observe people in all parts of the ward in order to keep them safe
- Some people using the service had complained but their concerns hadn’t been acknowledged or addressed by staff. Carers also told inspectors they didn’t know how to complain, but leaders had started to take steps to address this by offering face to face meetings with them
- People didn’t always receive visits from their families and carers because staff were unclear about the ward rules on visitors.
However:
- Staff followed best practice in de-escalating and managing challenging behaviour. As a result, they used restraint and seclusion only after attempts at de-escalation had failed
- Inspectors saw discharges were planned in advance, in partnership with care managers and co-ordinators. Staff met weekly with partners from the two commissioning trusts to discuss each person and the wards also held weekly multi-disciplinary meetings which they used to plan people’s discharges. Staff considered people’s individual needs upon discharge thinking about referrals to community mental health teams and ensuring people had a place to live
- Staff did not move or discharge people late night or very early in the morning which can be distressing
- When inspectors pointed out some areas where blanket restrictions were in place, leaders reviewed these and also increased the frequency of their reviews from six months to monthly.