Cygnet Hospital Wyke

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our last assessment in January 2024, we rated this key question inadequate. Following this latest assessment, the rating has changed to good.

All areas of the hospital were now clean and staff followed infection control procedures correctly.

Staff now assessed and managed risks to patients and themselves well. They knew how to report incidents; made safeguarding referrals when required and worked with external partners to keep people safe.

Staff received lessons learned from investigating of incidents, complaints and safeguarding concerns, both internal and external to the service. Staff met to discuss lessons learned.

Staff were debriefed and received support after a serious incident.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

The medicines management arrangements within the hospital were now safe and effective.

There were enough experienced staff to safely meet the needs patients. Staff received appropriate training for the patient group they cared for.

However, the form used for general observations did not stipulate the frequency required and had no column to record engagement with the patient. The form used for high-level observations only had a small column to record any engagement information.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 4 patients using the service. They told us they felt safe on the ward. They said staff managed incidences of restraint in a safe way that had not resulted in them being harmed.



Patients had regular meetings with their named nurse from whom they could seek advice, support and information to help them with their health, wellbeing and manage their own risks.

Staff were able to demonstrate their understanding of the types of incidents that needed to be reported. Staff felt able to raise concerns about care and treatment freely and told us managers dealt with these well.



Staff told us they received lessons learned from investigating incidents, complaints and safeguarding concerns via emails, during team meetings and during supervision. They also said they had access to reflective practice sessions and debriefs.



There was a freedom to speak up guardian within the organisation who supported staff to speak up if they felt uncomfortable doing so alone.



Staff gave examples of safety improvements on the wards. On Kingfisher ward, boards had been put up to quieten the ward and a light fitting had been replaced due to the old one being a possible ligature risk. On Phoenix ward, ligature anchor points had been removed.



Most of the staff we spoke with knew what their responsibilities were under the duty of candour. However, 3 staff healthcare support workers on Kingfisher ward did not know what the duty of candour was. The duty of candour is a legal and ethical obligation for health and social care providers to be open and honest with patients, their families and their carers when something goes wrong.

Staff used an electronic system to report incidents on the wards. Managers conducted investigations into incidents, complaints and safeguarding concerns and shared any areas of learning they identified with staff.



The hospital director sent a lessons learnt log out each month to staff, which also included lessons learned from other Cygnet hospitals.



There were daily meetings called sitreps in which managers on the wards shared any information in terms of incidents, restrictive practices, complaints, staffing issues, patient admissions and Mental Health Act tribunals with the hospital director. Minutes were taken and shared with any actions recorded to ensure they were followed up.



The lost property process had recently been revised as not all patients’ property was being logged previously, resulting in some disputes about belongings going missing.

The people we spoke with told us that services communicated well with each other to ensure they had continuity of care.

Staff told us there were effective working relationships with other relevant teams, both within and outside the organisation. Staff said that people’s risks were shared between teams at regular handovers between staff.

Feedback from commissioners was positive. They told us staff worked proactively to facilitate patient discharge when appropriate. Staff arranged regular meetings with commissioners and provided reports to provide clear and factual information about the progress of patients under the commissioning body’s remit.



The local authority told us that they were confident staff at the hospital shared information about patient risk.

The hospital had a safe and effective system to ensure the needs of patients being referred for admission could be safely met. Staff ensured they had information about risk, the section the patient was being detained under, what their current situation and presentation was, their usual accommodation, any information gathered over the past 48 hours, their physical and sensory needs, any information around learning disabilities or autism and the predominant reason for the referral.



We saw evidence in care records that staff supported patients in accessing care and treatment from other healthcare professionals such as GPs, dentists, dieticians and speech and language therapists.



We attended a multidisciplinary meeting between staff within the hospital and external partners such as commissioners, a ward manager from a mental health inpatient service within a local trust and staff from the trust’s community mental health team. Staff at the hospital shared details about a patient’s presentation and risk. They were clear that the patient could not be given Clozapine due to their non-compliance with the necessary physical health monitoring required when using this medicine. Due to the patient’s current health status, it was agreed to transition the patient to the alternative inpatient service at the trust to meet their needs.

Patients who spoke with us said they felt safe on the wards and had not experienced any abuse. They felt supported by staff to manage any risks.

Staff received training on how to recognise and report abuse, appropriate for their role. Staff kept up to date with their safeguarding training.



Staff knew how to recognise adults and children at risk of or suffering harm and worked with other agencies to protect them. Staff followed clear procedures to keep children visiting the service safe. These visits were pre-arranged and took place in a room away from the wards.

Staff knew how to make a safeguarding referral and who to inform if they had concerns.



We were made aware of a staff member who had been dismissed from the service following an inappropriate use of restraint. The hospital director assured us that the staff member concerned would be referred to the Disclosure and Barring Service and Nursing and Midwifery Council.

We observed positive interaction between patients and staff throughout our inspection.



When we first arrived, there had been an incident on the ward which resulted in damage to the environment. However, the hospital director and staff had notified the police and quickly arranged for the environment to be made safe for patients and staff.



We saw evidence that multiagency risk assessment conferences took place between staff at the hospital and external professionals such as the local authority, police and domestic violence advisors. These are meetings in which professionals discuss risks associated domestic abuse and find ways to safeguard the people concerned.



During out tour of wards, we saw posters on patient noticeboards relating to safeguarding, including reporting abuse.

There was a safeguarding lead within the hospital who provided advice and guidance to staff about potential safeguarding concerns.



The provider had safeguarding policies in place that staff could easily access.



Sexual safety was managed within the hospital. Staff were required to wear uniforms and follow the provider’s dress code. Sexual safety was also assured via the use of observations and engagement, lines of sight and closed-circuit television.

The local authority told us that the quality of safeguarding referrals received from the hospital were variable in quality.



Staff had made 121 safeguarding referrals to the local authority in the last 12 months.

The patients who spoke with us that had been restrained said they had not been hurt during the incident. They had been restrained due to non-compliance with their prescribed medication. They said staff spoke with them afterwards to ensure they understood why they had been restrained and that they were ok. They also said staff undertook physical observations after the restraint.

Staff completed personalised risk assessments for each patient on or soon after admission using a tool built into the provider’s care records system. We reviewed 11 care records and found that staff reviewed risk assessments regularly, including after any incident.



Staff knew about the risks associated with each patient and acted to prevent or reduce them. Risks included self-harm, suicidal ideation and violence and aggression. Staff identified and responded to any changes in risks to, or posed by, patients.



Staff made every attempt to avoid using restraint by using de-escalation techniques and restrained patients only when these proved unsuccessful, or it was necessary to keep the patient or others safe. De-escalation techniques included verbal de-escalation, redirection, distraction or arranging for a member of staff the patient was familiar with to talk with them.

Staff followed national guidance and good practice when using restrictive interventions.



There were 103 incidences of restraint within the service in the past 12 months, 11 of which were in the prone position. These related to 54 patients. The highest outlier was Bennu ward (71) which was the psychiatric intensive care unit.



There were 34 incidences of seclusion within the service in the last 12 months. These related to 27 patients. The highest outlier was Bennu ward (25).



There were 18 incidences of rapid tranquilisation within the service in the last 12 months. These related to 15 patients. The highest outlier was Phoenix ward (11).



No patients were placed in long-term segregation in the last 12 months.



Blanket restrictions were only used when needed. For example, on one ward, there had been instances of patients' clothes going missing, so staff had taken the decision to hold the key to the laundry room, so patients had to ask for access to it. This had been effective in preventing the loss of patients' clothing.



Banned and restricted items on the wards were appropriate for the risks associated with the patient group. These included access to alcohol, drugs, sharp items and lighters.



Staff followed good policies and procedures for use of observation. We looked at 30 observation charts relating to 8 patients within the service. Staff had carried out observations in-line with those prescribed by the patient's doctor. However, the form used for general observations (minimum of 1 per hour) did not stipulate the frequency required and had no column to record engagement with the patient. The form used for high-level observations (regularity dependent on risk identified) only had a small column to record any engagement information. We raised this with the hospital director and director of operations and they agreed to look into this as an area for improvement.

Patients told us that they felt safe on the ward and could speak with staff if they needed to.



Patients told us that they feel safe overall.

Staff told us that the ward managers undertook daily walk throughs, and all actions identified were recorded and there was a clear plan that was followed to follow up on identified areas. Work was undertaken by the hospital maintenance team.



Staff told us that no children were permitted to visit the ward but there was a multi-faith room available, to book, for visitors including children.



Staff told us that there is a sensory room available to be used by patients as and when required and there is a de-escalation room area attached to the seclusion room to give patients further time to feel able to return to the ward environment.



Staff told us that on occasions staff have the flexibility to move between wards, if required, to cover any shortfalls, due to sickness, because of current patient numbers.



Staff told us that there was always a qualified nurse on the ward at all times.



Staff told us that leave is encouraged, for walks in the grounds, for health and wellbeing and that is why visits are prebooked so staffing levels can accommodate such activities.



The social worker team told us they supported patients who are admitted and had pets at home. They arranged provision to ensure the safety of patients' pets.

We saw an environment that was well maintained both internally and externally.



Mirrors were also in place in corridor and communal areas to mitigate risk from blind spots.



We saw staff undertaking observation checks regularly and completing documentation accordingly.



We saw that lighting and external areas of the hospital were safe and accessible for all patients and visitors.



There was clear and effective signage should there be the need to evacuate in the instance of a fire.

Of the 5 health and safety folders that we reviewed, all were completed accordingly.



Fire evacuations were undertaken regularly and had been documented accordingly. Staff and patients knew the process to follow and the need to respond in a timely manner.



There were policies, procedures and risk assessments in place for health and safety. All certificates were available to view and were in date, such as, gas safety certificate, electrical wiring certificate and PAT testing certificate and accompanying stickers.



Seclusion room and de-escalation room was clean, tidy and had appropriate viewing panels. The outside area was calm and quiet and offered some outside space with a pleasant view.

Patients and carers who spoke with us said there were enough staff to meet their needs. Patients said they had regular meetings with their named nurse.

We asked the hospital manager how they were assured that there were always enough staff to safely meet the needs of patients on the wards.



They told us ward managers maintained oversight of staff rotas to ensure there was sufficient staff on the wards. Managers monitored staffing via daily situation reports meetings (known as sitrep meetings). The sitrep meetings ensured that not only were there enough staff numbers for each shift but also the right skill mix to safely meet patients' needs. Managers planned 3 days ahead so there was enough time to make any necessary staffing adjustments.



Duty nurses on night shifts were required to highlight any staffing issues such as sickness absence within their report to support with any cover requirements.



A daily email was also sent to senior managers within the service and wider organisations that gave them an ongoing oversight of staffing levels over the course of the month.



We spoke with staff within the service and the overwhelming majority felt there was enough staff on the wards to meet patients' needs and deliver safe care. They also told us that regular bank and agency staff were used so they were familiar to the patients.

Throughout our assessment, there were enough staff members on the wards to deliver safe care and treatment. Our discussions with staff clearly evidenced they had the skills and experience to meet the patients' needs.



On Phoenix ward, staff reacted quickly but calmly and appropriately when a patient's behaviours became heightened and began to cause disruption on the ward.



We looked at staff rotas on the wards and found the planned numbers of staff for a particular shift matched the actual numbers on the day.

There were enough staff to deliver safe care and treatment and meet the needs of patients using the service. There were some vacancies at the time of our inspection but because none of the 3 wards were full at the time of our inspection, this was not having a negative impact on the quality of care.



The service had an interim clinical manager but a permanent replacement had been recruited and was due to start in February 2025. The interim manager was in post until March 2025 so they could support their permanent replacement.

There was a 1.5 whole time equivalent shortage of nurses but 5 new nurses had been recruited and due to start working at the service. There were also 8 healthcare assistant vacancies but these had been recruited to.

Any unforeseen absences of nurses and healthcare assistants were covered via the use of overtime or bank and agency staff, most of whom were regular and familiar to the patients.

The average staff turnover in the last 12 months was 22%. This figure included staff who had been dismissed for poor performance or gross misconduct, had relocated to another service or had left to pursue a role with another employer.

New staff received both corporate and local inductions. The provider also had a specific induction program for agency staff.

Staff had completed and kept up to date with their mandatory and required training. At the time of our assessment, the overall compliance with mandatory training was 94%. The training modules were appropriate to meet the needs of the patient group and included basic life support and immediate life support.

Staff received regular managerial and clinical supervision. The compliance rates at the time of our assessment were 94% for managerial supervision and 96% for clinical supervision. Staff were appraised and at the time of our assessment, 90% of staff had received their annual appraisal.

Patients told us that they saw staff use personal protective equipment when needed. There were no concerns raised by patients or their family members about cleanliness on the wards.

Staff had access to personal protective equipment and hand washing facilities.



Staff conducted daily checks of the ward environment. Daily checks were also undertaken of the seclusion room on Bennu ward. Managers told us that maintenance staff undertook regular checks of the environment and made any repairs necessary.



Staff undertook ligature audits and mitigated any identified risks accordingly.

All ward areas were now clean, tidy, free from clutter and had a fresh smell about them.



Outside areas were also tidy, clean and the space provided was quiet, calm and therapeutic, offering a pleasant view by the means of safely attached scenic fence dressings.



Domestic staff were visible on all wards during our visit and all stock cupboards were stocked appropriately with in-date cleaning products.

All areas viewed during our visit were clean, hygienic and tidy. Cleaning records were displayed in toilet areas.

Personal protective equipment was available for staff and utilised accordingly.



Food hygiene was effective. For example, we saw kitchen areas displaying completed fridge checks on the wards.

Domestic staff worked regular hours over 7 days a week across the hospital to ensure the wards were clean and adhered to infection control measures.

People that were prescribed clozapine had appropriate documentation to evidence any side effects reported by patients, and relevant blood monitoring was in place to ensure this was administered safely.

Regular medicines audits were carried out throughout the service on all wards. These picked up any topics that may need to be addressed, and any medicines related themes were reported via incident forms. These were actioned appropriately, and staff knew the correct processes to follow if needed.

Drugs liable for misuse were treated like controlled drugs to ensure they were being stored safely, and administration was documented by two members of staff.

A pharmacist was available to help with medication queries and they reviewed people’s medicines charts cards to oversee that medicines were being prescribed and administered safely. The pharmacist also conducted weekly clinic room audits and monthly emergency bag audits to guarantee medicines would be safe and ready for use if needed.

Staff also filled out a short expiry date folder to identify any medicines that were due to expire that month.

All medicines were documented on the medicines administration records as administered or a code was used to explain why they had not been given, for example if a patient refused. There were no blank administration boxes.

Creams were kept in the medicines trolley, but did not have labels on them to show which patient they were for; however, they did have date opened labels on them.

Discretionary medicines that were prescribed for patients were not readily available on all wards. Staff stated they would have to borrow from another ward if needed, but these were not all available.

Clinic rooms were clean and tidy and well-equipped. However, some of the clinic rooms were small and would not have enough room in them for examinations to take place. Medicines, including controlled drugs, were stored safely and appropriately.

Rapid tranquilisation monitoring was completed every 15 minutes in line with the provider's policy, to ensure people did not experience any untoward side effects of medicines that can be used to manage challenging behaviour. This was documented on the National Early Warning Scores 2 (NEWS2) chart.

Relevant legal documents needed to comply with the Mental Health Act were in place and up to date to ensure patients were receiving their medicines in line with legislation.

Drug alerts issued by the National Patient Safety Alerts (NPSA) were actioned and filed accordingly in case patients were affected by any particular medicines.

Temperature monitoring was completed on all wards.