• CQC also issued two requirement notices on Cygnet Hospital, Godden Green
  • Hospital was heavily criticised in previous report
  • Latest inspection found “good progress” but more to be done

A private mental health hospital has been downgraded to “requires improvement” and told it must do more to ensure safe care.

Alongside its report earlier this month, the Care Quality Commission also imposed two requirement notices – relating to safe medicines management and having a permanent registered manager in place – on Cygnet Hospital, at Godden Green near Sevenoaks. The hospital had previously been rated “good”. 

The hospital, which treats NHS-funded patients, was heavily criticised in a CQC report earlier this year, after staff whistleblowers raised concerns about a poor culture, lack of supervision and the number of safety-related incidents. However, as that report related to a focussed inspection, it did not change the hospital’s rating. 

The new CQC report said there had been “good progress” but more needed to be done. Issues raised included the hospital not having a permanent registered manager and hospital director, which the CQC said was necessary to “deliver consistently high-quality care that could be sustained”. The report noted a permanent manager has since been appointed.

Safety concerns highlighted included:

  • Uncertainty over which young people could enter rooms when medication was being administered;
  • A lack of clarity among staff about which items needed to be removed from young people to avoid repeated self-harm;
  • Areas where medicines management needed to improve, such as medication in a resuscitation bag not being listed in an audit; 
  • Some nursing staff not having completed medication competency assessments;
  • Issues with medication charts, such as one patient having two charts with the same medication but different doses recorded; and
  • No process in place to make sure staff tested personal alarms and no records of alarms being signed out.

In one instance, a patient gained access to a clinic room and took medication and sharp items. When a staff member tried to raise the alarm, their personal alarm failed to sound.

The hospital was rated “requires improvement” in the safe and well-led domains. It was rated “good” for effective, caring and responsive. 

However, the inspectors found improvements requested at the focussed inspection in January had been made. There were enough nursing and medical staff, and staff knew how to protect young people from abuse and reported incidents, which were then investigated and learning from these was shared.

At the time of the latest inspection in April, the hospital only had five patients and a limit on admissions to six – out of 23 places – was in place. This has since been lifted.

However, uncertainty continues about whether the hospital will open additional beds for adolescents with eating disorders. NHS England had commissioned these but this has been “paused” while it reconsiders what is needed in the south east and south west.

In a statement, Cygnet said: “Following the CQC’s previous report… we have been working closely with the CQC and NHS England to develop a comprehensive action plan in response to the concerns raised. The hospital now has a full, permanent senior leadership team in place which includes the hospital manager, medical director and clinical manager. All employees at the hospital are permanent members of staff.

“We will continue to work with NHS England and key stakeholders to ensure that our new, improved systems are fully embedded and any outstanding issues are addressed. We are confident that the CQC will see these additional improvements at the next inspection.”

The HSJ Transforming Mental Health Summit, taking place at the Hilton Leeds from 28-29 November, unites 120+ senior figures from across the NHS, local authority and wider mental health service delivery landscape to discuss how to realise the visions of the NHS long-term plan and ensure successful local implementation of national priorities. Held under the Chatham House Rule, attendees will quiz Paul Farmer and other national figures on general policy direction and co-develop solutions to their local challenges with NHS and local government colleagues from across the country. The Summit is free to attend for senior NHS and public sector figures – register your interest here for this free to attend forum on our website: https://mentalhealth.hsj.co.uk/register-2019