Archived: Cygnet Yew Trees

Updated 23 September 2020

Cygnet Yew Trees is a 10-bed hospital for women aged 18 years and above who have a learning disability. The provider, Cygnet (OE) Limited, took over this hospital in May 2019. This location was registered with the Care Quality Commission on 27 November 2012 for the following regulated activities:

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

The hospital does not have a registered manager. In June 2020 the previous registered manager applied to de-register. The hospital had a manager in place who was processing an application (submitted on 17 June 2020) which was interrupted by human resource processes.

On 30 April 2019 we completed a comprehensive inspection and identified a breach of regulation 12 (safe care and treatment) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In October 2019 we issued a section 29 warning notice, following a focused inspection. We completed this inspection after receiving information of concern. We identified continued breaches of regulation 12 (safe care and treatment) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also issued a requirement notice for this regulation. We placed the service in special measures in December 2019.

In January 2020, during a comprehensive inspection, we identified breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for regulation 12 (safe care and treatment), 16 (receiving and acting on complaints) and 17 (good governance). We imposed conditions on the provider’s registration at this location, under Section 28 of the Health and Social Care Act 2008.

At this focused inspection we identified serious concerns relating to breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for regulation 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment), 17 (good governance) and 18 (staffing).

On 15 September 2020 the provider submitted an application to vary a condition of registration by removing the location Cygnet Yew Trees. The application was invalid because the Care Quality Commission had served a Notice of Proposal on 21 August 2020 to vary conditions by removing this location of Cygnet Yew Trees.

On 8 October 2020 the Care Quality Commission issued a Notice of Decision under section 28(3) of the Health and Social Care Act 2008, to remove the location of Cygnet Yew Trees from the providers registration.

Updated 23 September 2020

Cygnet Yew Trees is a 10-bed hospital, which provides care and treatment for women aged 18 years and above who have a learning disability.

We rated Cygnet Yew Trees as inadequate because:

• The provider did not ensure that there was adequate leadership and oversight of the safety and quality of the service. It had not made the required improvements that we told them were needed at previous inspections in relation to a section 29 warning notice.
• The provider did not address concerns related to staff ensuring the safe observation of patients and completion of accurate records.
• The provider did not ensure adequate governance structures, processes and systems of accountability for the performance of the service. We identified risks with the provider’s systems for assessing and monitoring of staff appraisal and supervision, response to complaints, the workforce race equality standards, and the accessible information standards.
• Despite being a hospital for women, from November 2019 to January 2020, only 40% of staff were female. This meant that there were often insufficient female staff to support patients with personal care needs.

At this inspection we also found:

• The provider did not have systems in place to ensure the effective sharing and implementation of policies such as physical health policy, epilepsy care pathway and their ‘engagement and observation policy’ to ensure all staff knew how to respond should a patient experience a seizure. Staff were not ensuring relevant patients’ care plans detailed how to keep patients who might experience a seizure safe in line with The National Institute for Health and Care Excellence ‘Epilepsy in adults Quality standard [QS26]’.
• We identified further risks as staff did not fully follow the provider’s systems for responding to complaints.
• The provider did not ensure that staff had easy access to essential information. We received conflicting information from staff about where the up to date care plans and risks assessments were for patients, therefore not all staff on duty knew where to locate information.
• The hospital had insufficient space for the number of complex patients with challenging behaviour. The staffing levels required to undertake patient observations made the environment crowded. There was limited quiet space for patients or staff to use for de-escalation. There were a number of incidents where patients were violent and aggressive towards staff or other patients, affected by the lack of space.
• The provider could not demonstrate that (where relevant) staff had supported, informed and involved families or carers in patients’ care and treatment. Carers told us that staff did not always effectively communicate with them and they were not involved as much as they would like in patients' care.
• The provider currently had eight of 10 patients with delayed discharges. Staff spoke with us about the challenges of working with commissioners to find and fund suitable placements outside of the hospital. The average length of stay at the hospital was three years. This is an increase since our April 2019 inspection (782 days) and above the national average (554 days source: Learning Disability Census Further Analysis: England 2015).

However:

• The provider was bringing the hospital and other local hospitals in the Cygnet group under one-line management ‘healthcare’ structure and one operations director) to help improve line management structure and oversight.
• Managers had made some improvements to their governance system for their oversight of restraints and safeguarding adults’ procedures. Staff had improved their recording of incidents. The provider had made some improvements to ensure staff received feedback from investigation of incidents.
• Staff regularly reviewed the effects of medications on each patient’s physical health. They knew about and worked towards achieving the aims of stopping over-medication of people with a learning disability, autism or both (STOMP).
• Staff completed assessments of patients either on admission or soon after. Care plans were personalised. Positive behaviour support plans were present and supported by a comprehensive assessment.
• Staff were discreet, respectful, and responsive when caring for patients. Staff used appropriate communication methods to support patients to understand and manage their own care treatment or condition.
• Most staff felt respected, supported and valued. They were positive about the management changes since our April 2019 inspection.

Updated 14 April 2020

Cygnet Yew Trees is a 10-bed hospital for women aged 18 years and above who have a learning disability.