Cygnet Bury Forestwood

We rated it as requires improvement because:

• The service did not always provide safe care. The ward environments were not all well maintained and clean. The ligature risk assessments did not include the action that staff should take to mitigate the risks. The service did not manage medicines safely and staff were not following the provider’s dress code policy in relation to being bare below the elbow and staff having long, manicured nails Young people told us that they had been hurt when receiving care because staff had long nails.
• On Buttercup ward we saw that staff did not always maintain appropriate professional boundaries and were talking about their personal lives and ignoring the young person.
• The governance processes did not always ensure that staff were following policies and procedures in relation to dress code and professional boundaries. Learning from organisational whistle blowing’s had not been implemented fully. For example, the policy relating to resuscitation had not been updated to include paediatric resuscitation. The recommendations from pharmacy audits has not been sustained and medicines were still not being labelled appropriately which meant that staff may administer medicines incorrectly to young people.

However:

• Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Managers ensured staff received induction, training, supervision and appraisal. The ward staff worked well together as a team and with those outside the ward who would have a role in providing aftercare.
• The service provided a range of treatments suitable to the needs of the young people and in line with national guidance and best practice.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
• Staff treated young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs of young people. They actively involved young people and families and carers in care decisions.
• Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.