A third young people’s mental health service run by Cygnet Health Care has been heavily criticised by the Care Quality Commission – which ordered admissions to be suspended unless it specifically approved them.

Knole Ward at the Cygnet Hospital at Godden Green, near Sevenoaks, Kent, is an acute admissions ward, with beds commissioned by NHS England. The CQC inspected in July and August after it was informed of concerns about the safe care and treatment of young people. Its report was published today.

After the August visit the CQC imposed restrictions on the provider’s registration, saying it could not admit any young person to the ward without prior agreement with the CQC. This remained in place for a month.

In the last two weeks, HSJ has reported on critical reports on inpatient child and adolescent mental health services run by Cygnet in Woking and Sheffield. The fourth site listed on its website as having CAMHS services is in Bury and was rated good by the CQC earlier this year.

Natasha Sloman, head of hospital inspection for mental health described the latest report as “disappointing.” She said the CQC reinspected in September and found the provider had put systems in place to reduce the risks to young people.

“We did however, take further enforcement action and issued a warning notice in relation to seclusion and segregation, which we were concerned was used to control and contain young people in the absence of other approaches”, she said. “We will follow this outstanding issue up at a future inspection.

“While leadership have provided assurances to us that it now has oversight of the issues and [is] making the improvements necessary, we will continue to monitor and inspect the hospital to ensure the changes put in place are further embedded.”

The initial inspections found

  • Rapid tranquillisation was used on young people to deal with agitation or aggressive behaviour. This is potentially high risk but the CQC found limited evidence that monitoring of their physical health was carried out afterwards. It says it was “significantly concerned” about this.
  • Medicines were not always stored correctly or available when needed – for example, there was only a single adrenaline injector which was out of date and with a dose designed for younger children available. Medicines were changed without individual assessments being made.
  • A high level of prone restraint was being used by staff on patients, without any records on why it was required.
  • There were unwarranted blanket restrictions and restrictive practices on the ward. The approach to seclusion and segregation was “punitive” – for example, the care plan for one young person included five days of segregation if they attempted to self-harm even though the providers’ policy was not to use segregation in this way.
  • There was no evidence that the local safeguarding team was being informed if a young person was placed in long-term segregation.
  • Although serious incidents were reported to the commissioners, it was not clear what action was taken in response to ensure learning and reduce future incidents.
  • Mixed sex accommodation did not comply with Department of Health guidance in that male and female patients did not have separate bedroom corridors.

Some of these concerns were addressed before the reinspection in September. Because of the nature of the inspection, the CQC did not give an overall rating.