- Independent mental health service
Cygnet Hospital Maidstone
Report from 24 April 2025 assessment
Contents
Ratings - Acute wards for adults of working age and psychiatric intensive care units
Our view of the service
We carried out a comprehensive on-site assessment on 4 and 5 June 2025 to determine if the service had made improvements since the last inspection. Following the last inspection in June 2023, the provider was issued a Warning Notice under Section 29 of the Health and Social Care Act 2008 due to our concerns regarding the management of ligature risks, and therefore patients were not receiving safe care and treatment under regulation 12 of the Health and Social Care Act 2008 (regulated activities). The provider was also in breach of regulation 10 (dignity and respect), regulation 9 (person-centred care), regulation 17 (good governance) and regulation 18 (staffing) of the Health and Social Care Act 2008 (regulated activities).
At this inspection, we assessed all 33 quality statements across the Safe, Effective, Caring, Responsive and Well-led key questions. During our last inspection in June 2023, Safe, Caring and Well-led were rated Requires Improvement. Effective and Responsive were rated Good.
On this inspection we found the service had made significant improvements and it is no longer in breach of regulations. The service now ensured that all ligature risks were managed well across the wards and that there were clear plans in place to remove or mitigate against such risks. The service had a robust ligature audit programme in place, and staff completing the ligature risk audit had the right training, skills and knowledge to complete the audits. The provider now ensured that patients had access to enough therapeutic activities during weekends. The provider ensured that patients had access to quality food and had a variety of food to choose from. The provider ensured the kitchen provided food to meet the dietary needs of patients.
The overall rating for this service is Good. We rated all five key questions as Good.
Mental Health Act and Mental Capacity Act Compliance.
Mental Health Act
The service admitted patients under the Mental Health Act 1983.
Staff had received face to face training on the Mental Health Act and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
Staff had easy access to administrative support and advice on implementing the Mental Health Act and its Code of Practice.
Staff knew who their Mental Health Act administrators based at the hospital were.
The provider had relevant policies and procedures that reflected the most recent guidance and staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
Patients had easy access to information about independent mental health advocacy. Patients could access independent mental health act advocates if needed.
Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. Records we reviewed demonstrated this.
Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.
Staff requested an opinion from a Second Opinion Appointed Doctor when necessary.
Staff stored copies of patients' detention papers and associated records correctly so that they were available to all staff that needed access to them.
Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. The provider regularly completed audits on the Mental Health Act paperwork to ensure the correct and relevant paperwork was easily accessible and stored correctly.
Mental Capacity Act
The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.
Staff received and kept up to date with training on the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act was mandatory, and the compliance rate was 100% for all staff.
Staff knew where to get advice from the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.
Staff took all practical steps to enable patients to make their own decisions.
For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. We saw evidence of this in patient records.
When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. We saw evidence of this in patient records.
Staff made deprivation of liberty safeguards applications when required and monitored the progress of applications to supervisory bodies.
The service had arrangements to monitor adherence to the Mental Capacity Act.
Staff audited the application of the Mental Capacity Act and took action on any learning identified.
People's experience of this service
We spoke with 8 patients in total across Roseacre and Bearstead wards. All patients said they felt safe, well supported and cared for. Patients said staff were kind, caring and compassionate and that they took an interest in their wellbeing and supported them to recover. Patients said staff worked with them to maintain contact with families and carers, and that access to an advocate was straightforward. Patients were happy with the environment, staff interactions, and the level of involvement in their care and recovery.
Patients told us that access to activities during the day was good, but evening activities could be better. Patients said the quality of food was good, the choice of food was okay, and their specific dietary requirements were met.