People were referred to the hospital from a number of different health trusts and organisations throughout England. We found people’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Staff told us they often do not get enough information in the initial referral and would have to send a follow up email to get more information before a decision could be made. They said dates and times of admittance were agreed in advance.

The hospital manager told us at the time of the last inspection they were piloting a new care plan form titled ‘my shared pathway’ which allowed for more information to be documented.

The hospital manager told us that all staff including temporary staff received a comprehensive induction. We were told an induction form was completed for all staff which they signed and kept a copy for their records. Staff we spoke to confirmed this.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. One person we spoke to told us they had made numerous complaints and were not always happy with the response or outcome but that did not stop them making other complaints.

Patients had mixed reviews about the service. One patient said, “the place is ok, sometimes staff just hear, but don't really listen." Another patient said, “I like it here, Its just one person who makes too much noise and is always picking on everyone." whilst another person said, "on the whole care is ok."

Patients were assessed before they were treated. Care plans were reviewed as people's conditions changed. There was evidence of involvement of patients in planning care. There were advocacy services available and these were accessed by patients regularly. We found that records that related to patient care were not always accurate as they did not reflect the input we observed and the input described by staff. Other records for the management of the service were up to date.

Patients were cared for by staff that were trained and had been recruited appropriately. There was evidence that staff renewed their professional registration and that staff had been asked to do a criminal records bureau check before they were employed.

We found that medicines were stored and administered safely and patients knew when they took their medication. Staff had been trained and were able to administer medication safely.

Equipment was clean and staff were able to use them. There was equipment available to promote the comfort of the patients. One patient said, "this my home for now. I don't mind it as staff are ok. My room is very nice and I brought in my personal items."

Overall people we spoke to told us that they were happy with the arrangements that were in place to meet their needs and that the hospital compared favourably to other hospitals they had experienced. We received comments about the hospital that included: “The staff explained things to me when I arrived here”. “The staff are nice and it makes such a difference”. “The hospital is run properly and the staff do a great job”.

We visited Cygnet Hospital Beckton was a planned routine inspection which was intended as a follow up to the previous inspection where concerns had been identified. We found that improvements had been made in all areas that we followed up.

Please note: Asterisks **** are used throughout this report so that patients cannot be identified from what they told us.

We found that patients had mixed opinions about the hospital and their experiences of the treatment and care that they had received from Cygnet Hospital Beckton. All patients are detained under a section of the Mental Health Act and comments are considered in the context that treatment and care is of a compulsory nature.

On commenting about care planning processes patients said:

‘Yes, I am aware of what my aims and goals are. These are worked with by staff and I am moving on soon.’

‘I have things to work on but I am struggling with things. I’m not happy with the move on place’ (‘step down’ accommodation).

‘I have clear objectives, my CPA is on *** and I will be moving to the other side of (the ward).’

Another patient felt that she knows what she is to work on as she works towards her discharge. ‘I don’t find it easy to contribute to my care plan. I have ***** issues and feel ashamed, but I’m not given space to say what I think about this. I feel I have become institutionalised.’

‘I don’t agree with all the areas in my care plan and I signed it to state that’.

On staff attitude and helpfulness patients said:

‘Staff are okay. If they’re busy they ignore you. They spend a lot of time doing paperwork. Should have 1 more nurse – 4 instead of 3’. ‘Some staff are helpful, some can be a bit rude and abrupt’

‘The staff are professional and there are no concerns at all’.

On therapeutic activity patients said:

‘I have to wait until my therapist is here so sometimes I don’t see him for 2 weeks because he can be busy on the ward. It’s a strict regime once we do it.’

‘They are going to start groups at the weekend but there haven’t been any yet’.

‘I found the psychology sessions very helpful’, another stated; ‘The rehabilitation and recovery group really enabled me to sit by and think carefully – given my behaviour before’.

One patient told us that she had been to the cinema recently. Another patient told us; ‘I enjoy the mental health awareness group, as we discuss medication and the next steps in moving on’.

On the use of restraint patients told us:

‘Some staff are rougher than others’, the patient went on to name the two ward staff who she said are known for being rough. ‘I have never had a meeting after restraint to talk about it.’

Another patient said ‘The atmosphere is not good on the ward, it’s hostile because of different patients. I don’t feel safe anymore. There’s violence on the ward, nurses get attacked and one had her head bashed on the wall’.

‘They bend my wrists back and my wrists hurt for hours or the day afterwards’. ‘It’s better here than in other places’ she added.

‘Once I had calmed down the staff spoke to me about the incident. I think their actions made me safe’.

On the management of physical conditions patients told us:

‘The other week I ***** and was so weak that staff had to stop me from ******. The doctor was called but they didn’t come to see me. I had to wait until the next day- the ward doctor took ages to come. I suffer from *****, it isn’t worked with here.’

‘I need a dentist check up. I mentioned it to a doctor, (ward doctor) who said to mention it in the ward round. I spoke to a ward doctor about seeing an optician who said the same as before’.

Another patient said they had **** ***** ‘a while ago’. ‘Sometimes it plays up, I could hardly move and was taken to hospital. The doctor said she couldn’t give me painkillers because she didn’t know enough about my antipsychotics. The doctor here didn’t give me painkillers because she said it was out of her area of expertise’. ‘I am still on my own with this.’

We rated this service as good because:

• During this most recent inspection, we found that the services had addressed the issues that had caused us to rate safe and effective as requires improvement following the July 2015 inspection.

• Following the last inspection in July 2015, we also made a number of recommendations for the service to consider improving. At this inspection we found that these improvements had been made.
• The hospital provided good care in challenging and complex circumstances. Staff sought to minimise incidents of self-harm, aggression, violence and other challenging behaviour in a caring and supportive way.
• Staff consistently responded to patients with care and compassion. They said that morale within their teams was good and that they felt supported by their managers.
• Staff knew which patient safety incidents to report and how to report them. Senior managers monitored incidents through the clinical governance process. Through this monitoring, managers looked for trends and ways to reduce the number of incidents.
• The service had introduced a programme to reduce restrictive practices. As a result, patients had unrestricted access to dining rooms, activity areas and quiet rooms. Patients were also now able to make hot drinks whenever they wished.
• Senior managers demonstrated a strong culture of seeking improvements to the service.
• Staff assessed risks to patients using standard risk assessment tools. Staff updated risk assessments during patients’ admission, either at regular multidisciplinary team meetings or after incidents.
• The services used evidence-based therapies to work with patients across the wards.
• Cygnet Health Care had appointed an Expert by Experience Lead. At this hospital, they had established meetings to promote the views of patients across and facilitating further service user involvement.
• The hospital had achieved national quality accreditation for the psychiatric intensive care unit, the forensic ward and the ward for people with learning disabilities.