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A hospital in Sevenoaks has shut down its mental health services for children and adolescents following a damning inspection.
All young patients have now been moved from the Cygnet Hospital Godden Green after an unannounced inspection by the Care Quality Commission (CQC), which found repeated incidents where young people suffered harm and injury.
The CQC has now told the hospital it must make improvements to its Psychiatric Intensive Care Unit (PICU), which is still running, after identifying risks to the safety and wellbeing of patients.
The hospital is run by Cygnet Health Care, which provides mental health services for the NHS and local authorities.
An unannounced focussed inspection of the Child and Adolescent Mental Services (CAMHS) wards took place late September and a further inspection of the PICU took place in early October, after concerns were raised by members of the public, relatives and other professionals.
There are 21 en-suite bedrooms for males and females aged from 12 to 18, spread between two CAMHS wards.
The PICU, on Castle Ward, is for female patients only and comprises of 12 en-suite bedrooms.
During the visits concerns were raised by inspectors about the high number of incidents resulting in harm, the cleanliness of wards, staff training, complaints handling and leadership.
On Castle ward, restrictive practice was routinely used without any attempt at de-escalation. Most Castle ward patients said they had limited access to fresh air and would like to go outside more, the report said.
Male staff did not always knock on bedroom doors and entered bathrooms without permission on Castle ward.
"We found that there wasn’t enough staff with the skills, knowledge and experience to keep young people safe..."
"This did not promote people's dignity or sexual safety, and patients told us they were afraid to shower as a result of this," the report reads. However, patients, families and carers said most staff on Castle ward were kind, respectful and doing their best.
The inspection also found Castle ward staff received appropriate training and effective ongoing supervision.
The CQC decided that the CAMHS service should be temporarily closed, and following this, Cygnet Health Care shut the service down completely. Patients have been moved to another placement or discharged home.
Cygnet Health Care have been ordered to make a raft of improvements at the hospital, including staff using appropriate de-escalation techniques before moving to physical restraint and making sure there is an appropriate ratio of male to female staff on the PICU ward.
Karen Bennet-Wilson, CQC’s head of hospital inspection for mental health said: “People using services at Cygnet Hospital Godden Green are entitled to safe, high-quality care.
"However, when we inspected, we found that there wasn’t enough staff with the skills, knowledge and experience to keep young people safe resulting in a high number of incidents in which young people were harmed.
“In addition, staff did not always treat young people with kindness and compassion. None of the wards were clean.
"On the PICU a culture of negativity towards patients had developed among some staff. We saw records where patients were referred to as ‘difficult’ and ‘trouble-makers’.
"We are heartened that the CQC recognised that most patients and carers on the adult PICU ward said staff were kind, respectful and caring..."
“We will continue to monitor the PICU service closely, including at the time of this inspection, through weekly meetings with the provider, and will use our enforcement powers further if satisfactory improvements are not made and sustained.”
A spokesperson for Cygnet Godden Green said: “Since the inspection two months ago, we have worked with the CQC to address their requirements through a detailed and robust action plan.
"The CQC has told us they are satisfied with the steps we have taken and can see the progress that has been made. The CQC did not take any enforcement action to restrict admissions to Castle Ward, they have supported the opening of an acute ward and have also now reduced their weekly reviews to monthly, which is a reflection on the positive progress made.
"We are heartened that the CQC recognised that most patients and carers on the adult PICU ward said staff were kind, respectful and caring, and that staff from different disciplines worked together as a team, and had good working relationships with other teams in the hospital and with external services.
"Staff also reported they felt respected, supported and valued, and felt able to raise concerns. As previously reported, Cygnet took the decision to no longer deliver a child and adolescent mental health service at this location.
"The challenge of recruiting specialist CAMHS staff in rural locations is a well-documented national issue. Instead, we are focusing on providing adult mental health services from Godden Green and we are working in partnership with key stakeholders, including the CQC, to do so.
"As a responsible provider we are committed to safely supporting those in our care. Whilst we are obviously disappointed by the report, and disheartened that it does not reflect the positive steps that have been taken and embedded into practice, which would give a more accurate picture of the service as it is today, we acknowledge the concerns raised by the CQC.
"Throughout this process, Cygnet Godden Green has worked collaboratively with the CQC and we welcome the open and transparent dialogue that has occurred between our operational team and CQC inspectors.”
