Cygnet Hospital Bierley

Updated 9 February 2024

Cygnet Hospital Bierley is an independent mental health hospital provided by Cygnet Health Care Ltd situated in West Yorkshire. The hospital is registered to provide care for up to 62 male and female patients across 4 different inpatient wards.

• Blossom ward is a 15-bed female acute ward
• Lister ward is a 16-bed male acute ward
• Bronte ward is a 15-bed forensic low secure service for females
• Shelley ward is a 16-bed forensic low secure service for males

The 2 acute wards for adults of working age, Blossom and Lister, were opened by the hospital in February 2023 and May 2023 respectively. The hospital had previously provided a personality disorder service for women and a psychiatric intensive care unit for women which had both been voluntarily closed by the provider following CQC’s inspection of the hospital in January and February 2022.

The hospital had a registered manager at the time of our inspection and an identified controlled drugs accountable officer.

The hospital has been registered with CQC since October 2010 to carry out the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Treatment of disease, disorder or injury

CQC last carried out a full comprehensive inspection of this hospital in February 2022 where all 3 core services delivered by the hospital were inspected. As a result of that inspection, we rated the hospital as inadequate overall and placed the service in special measures. The 3 core services were all rated inadequate overall with the safe and well led domains rated inadequate and effective and caring domains requiring improvement. The responsive domain was not rated at that inspection.

The hospital was in breach of 6 regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at the February 2022 inspection:

• Regulation 9 Person centred care

• Regulation 10 Dignity and respect

• Regulation 12 Safe care and treatment

• Regulation 13 Safeguarding service users from abuse and improper treatment

• Regulation 17 Good governance

• Regulation 18 Staffing

CQC carried out an inspection of the forensic core service in November 2022. This was a focused inspection on the 2 low secure wards as these were the only 2 wards open at the time of that inspection. The rating of the forensic core service improved to requires improvement overall and in all key questions. The overall rating of the hospital remained inadequate due to the previous rating of the acute wards for adults of working age and psychiatric intensive care units core service from February 2022 which was not able to be re-rated due to these wards being closed at the time of this inspection.

A MHA monitoring visit had taken place to Blossom ward on the 22nd August 2023. Lister ward had not yet had a MHA monitoring visit at the time of this inspection.

This inspection was a focused inspection to visit the 2 new acute wards for adults of working age and assess whether the provider had made improvements to meet the requirement notices we issued in relation to the February 2022 inspection. At this inspection we inspected all five key questions on both wards, Blossom and Lister.

What people who use the service say

We spoke with 12 patients who were being cared for on Blossom and Lister wards.

Patients gave positive feedback about the staff and their experiences of care and treatment in the hospital. Patients described that staff were respectful, kind and would always try to respond to their requests as quickly as they could. Patients generally felt safe on the wards and were positive about the activities and groups that were on offer to them.

Patients stated some frustrations regarding delays with staff supporting and facilitating their section 17 leave and smoking breaks, although patients did not state their leave was ever cancelled. Patients noted that there could be quite lengthy delays in staff facilitating these requests due to pressures on staff and competing demands. Patients did recognise that staff were trying their best in these circumstances.

Patients on Blossom ward raised a complaint in respect to a nurse call alarm that was sounding frequently throughout the 2 days that the inspection team were on-site. The nurse call alarm was being pressed by a patient on Lister ward but could be heard throughout the hospital. The patients on Blossom ward were frustrated by this as they were aware that the alarm was not in respect to a patient on their ward.

Updated 9 February 2024

Our overall rating of this location improved. We rated it as requires improvement. This inspection covered the acute wards for adults of working age and psychiatric intensive care units core service only as the forensic inpatient or secure wards core service had been inspected in November 2022 prior to the 2 acute wards being opened.

Cygnet Hospital Bierley had been placed into special measures based on our inspection findings in January and February 2022. The report from that inspection was published in May 2022. Based on the findings of our inspection of the forensic inpatient or secure wards core service in November 2022, alongside this inspection of the acute wards for adults of working age in September 2023, Cygnet Hospital Bierley will be removed from special measures.

Updated 10 January 2023

Our rating of this core service improved. We rated it as requires improvement because:

• Since our last inspection there had been several incidents on one ward where staff may have deliberately abused patients, this was under investigation at the time of our inspection and the provider had suspended all staff involved.
• Patients did not always receive adequate support following incidents of self-harm to prevent a similar incident recurring.
• Staff had not always received timely emergency life support training updates at a level appropriate to their role.
• We identified some instances where patients were subject to restrictions which were not justified on the basis of risk or the hospital had taken insufficient action to review risks leading to the imposition of restrictions.
• We identified some isolated areas of the ward environment which were not clean or safe and staff were not always up to date with training to support them in caring for people safely.
• Some patients had a named nurse who was on long term leave from the hospital and so did not have regular access to one to one support from a member of ward based staff.
• People’s views about their care had not always been sought and/or documented in their care records.
• Agency staff working at the hospital had not always received an induction specific to the ward they were working on.
• Some staff raised concerns about experiencing racial discrimination at work and we did not see evidence that the provider had taken sufficient action to promote equality, diversity and inclusion at the hospital.

However:

• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• The service was well managed and the governance processes usually ensured that ward procedures ran smoothly.

Updated 9 February 2024

Our rating of this core service improved. We rated it as requires improvement because:

• There were issues identified with the storage and management of medications. This included issues such as out-of-date medication not being identified and disposed of, medication still being stored from patients who had been discharged and topical creams being stored without labels of which patient they were for.
• The service had not ensured that all agency staff had an appropriate induction to the service and the ward they were working on prior to starting their shift. We undertook a review of some of the agency induction checklists with a sample from one day where multiple agency staff were on duty on Blossom ward that day. Of that sample day, 4 staff were working on Blossom ward who had not had an induction specific to that ward. We had concerns about how this may impact on staff awareness of important information they need to know for that specific ward, such as the location of the ligature cutters or copies of patient personal emergency evacuation plans, which were different on each ward. The issue of ward specific inductions for agency staff had also been identified as an issue at the forensic core service inspection in November 2022.
• Staff had not always completed and regularly updated risk assessments and environmental reviews of all ward areas. We identified gaps in ward level recording of some of the documentation and checks that staff were required to undertake to ensure the environment was safe and appropriate for patients.
• We had a concern about the use of section 17 leave being used for smoking rather than therapeutic leave on the wards, in particular on Lister ward. On day one in the afternoon, some patients were becoming significantly agitated with having to wait to go out to smoke. It was identified that the ward was one staff member down at that time, so there were some contributory circumstances. It was also recognised that staff remained calm and tried to deescalate the patients by speaking with them and explaining the reasons for the delays.
• There were inconsistencies and gaps with governance processes identified at ward level in some of the audits, checklists and monitoring of areas such as environment and daily security checks. During our review of staff files, we also identified that the registration of a nurse had lapsed and this had not been identified by the service or staff member.

However:

• Patients gave positive feedback about staff and the wards. They recognised the efforts that staff made to respond to their requests and said that most staff were polite and respectful. Patients also gave positive feedback about the quality of the food and meals provided by the hospital.
• The wards had a range of activities and groups on offer to patients which patients gave positive feedback about. Care records contained evidence of staff offering activities and sessions to patients and recorded when these were declined. The hospital had a range of facilities that the patients could access on-site including a sensory room and gym.
• Care records were individualised to the patients and issues identified through risk assessments had relevant management plans. The records also contained evidence of conversations and considerations being given to discharge and of ongoing monitoring of physical health.
• Staff gave positive feedback about management support and interactions. They were happy in their roles and generally spoke positively about the hospital. Ward and hospital managers were passionate about improving the quality of the wards and the care and treatment being delivered. Staff gave feedback that the management across the service was more linked and were working together on the improvement of the hospital.