A HEALTH watchdog has taken urgent action against a psychiatric hospital after investigating complaints of an increase in abuse between patients.

The Care Quality Commission identified risks to patient safely when it carried inspection at Cygnet Appletree in Durham in April. There were also concerns received about a number of internal staff moves which affected the management of the service.

It found high levels of restraint and the use of "rapid tranquillisation", as well as ligature risks which had not been identified. The CQC imposed a series of urgent conditions upon Cygnet Appletree.

This included restricting new admissions into the service, without prior written approval of CQC. Since the inspection, 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 tranquillisation.

“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.

He added: “Cygnet Appletree have now made the necessary changes and can admit people to the service.

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

A spokesperson for Cygnet Hospital Appletree said: “In the months since this inspection, all the necessary changes required by the CQC have been completed and the progress we have made has led to the CQC lifting its earlier restrictions so that we are able to accept new admissions.

We move forward with strengthened local leadership, including a new Hospital Director and Safeguarding and Quality Improvement leads. Among extensive changes, we have carried out additional staff training with a focus on creating a safe environment that embodies our principles of treating patients with dignity and respect. Following internal audits, we have also put in place robust governance and compliance procedures to ensure we are able to quickly identify and manage any risks.

“We continue to work closely and collaboratively with the CQC and look forward to being able to demonstrate our continued progress at agreed monthly engagement meetings and at future inspections with a clear focus on sustaining a quality service.”

 

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