- Independent mental health service
Cygnet Hospital Maidstone
Report from 24 April 2025 assessment
Contents
Ratings - Forensic inpatient or secure wards
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 12 (safe care and treatment), regulation 10 (dignity and response), 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, Effective, Caring and Well-led were rated Requires Improvement, and Responsive was rated Good.
At this inspection we found that the service had made significant improvements and was 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. There was a robust ligature audit programme in place, and staff completing the ligature risk audit had the right training, skill and experience.
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
Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff had received training in the Mental Health Act and the ward was 100% compliant.
Staff had easy access to administrative support and legal advice on the implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
The provider had relevant policies and procedures that reflected the most recent guidance; which staff had easy access to.
Patients had easy access to information about independent mental health advocacy.
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.
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, such as, Section 17 leave forms, correctly so that they were available to all staff that needed access to them. We reviewed Section 17 leave forms and they were in good order. These were also regularly audited.
The service audited adherence to the Mental Health Act every six months.
Mental Capacity Act
Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles. Staff had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards and the ward was 100% compliant.
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 knew where to get advice 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.
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 best interest decisions recorded in patient records.
The service had arrangements to monitor adherence to the Mental Capacity Act and this was audited every three months.
People's experience of this service
We spoke with eight patients and two relatives. Patients reported feeling safe and supported on the ward, with staff described as caring, respectful, and readily available. Most patients commented on the variety of therapeutic and meaningful activities, including art, psychology groups, gym sessions, and gardening. Patients had access to advocacy services and had copies of their care plans. The ward environment was noted to be clean, and patients maintained contact with family and friends. Food was generally well-received, and staff interactions were viewed positively.
Carers reported feeling informed and supported, with confidence in the care provided. Observations of group activities, such as the Recovery College session and the coffee group, highlighted positive staff-patient engagement and a relaxed, inclusive atmosphere.
Some areas for improvement were identified, including occasional delays in facilitating patient leave and isolated concerns about medication. One patient expressed frustration with the responsiveness of staff, particularly when requesting leave.