The Care Quality Commission
  • Mental Health
  • Independent mental health service

Cygnet Fountains

Overall: Outstanding read more about inspection ratings

Pleasington Close, Blackburn, Lancashire, BB2 1TU (01254) 269530

Provided and run by:
Cygnet Behavioural Health Limited

All Inspections

3,4 September 2019

During a routine inspection

We rated Cygnet Fountains as Outstanding because;

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a longer-term high dependency mental health rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • There was an effective and creative approach to understanding the needs of different groups of people and to deliver care in a way that meets these needs and promoted equality. This included patients with complex needs.
  • There was a mix of highly skilled staff who used a wide variety of recognised tools and rating scales to support patients in their recovery. Staff were involved in clinical audits and in quality improvement initiatives to improve their practice and outcomes for patients.
  • Managers ensured that staff received training, supervision and appraisal. The continuing development of the staff’s skills, competence and knowledge is recognised as being integral to ensuring high quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills and share best practice.
  • Staff were committed to working collaboratively and had found innovative and efficient ways to deliver more joined up care. Staff worked well with external agencies and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions. Patients who used the service were active partners in their own care and the staff team were fully committed to working in partnership with patients. Staff empowered patients to have a voice and to realise their potential in their rehabilitation and recovery pathway.
  • The Fountains had employed a peer support worker to work alongside patients to enable patients to share and discuss their issues with someone who has had lived experience. They had developed a people’s council where patients were encouraged and supported by advocates to make decisions about the service and where patients could give feedback about the Fountains. This was then developed into an action plan to make improvements for the patients.
  • Patients emotional and social needs were highly valued by the staff team and imbedded in their care and treatment.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service worked to a recognised model of mental health rehabilitation. It was well led, and the governance processes ensured that ward procedures ran smoothly.
  • There was a systematic and integrated approach to monitoring, reviewing and providing evidence of progress against the strategy and plans. Plans were consistently implemented and had a positive impact on quality and sustainability of services.
  • There was a demonstrated commitment to best practice performance and risk management systems and processes. The organisation reviewed how they functioned and ensured that staff at all levels had the skills and knowledge to use those systems and processes effectively. Problems were identified and addressed quickly and openly.

However;

  • There were limited rooms available for patients to access that were quiet and provided a therapeutic space. This also included the lack of suitable space to see visitors in.
  • Patients we spoke with told us they would prefer more male staff.

4,5 September 2017

During a routine inspection

We rated the Fountains as good, however:

  • The patient bedrooms we checked were not all clean and tidy. Eleven of the 32 bedrooms had a combination of issues including dirty bedding, missing bed linen, dirty mattresses, old pillows and one bedroom had a significant leak from the bathroom area into the bedroom.
  • There was a blanket restriction in place that had not been individually risk assessed.
  • We found that although the National Institute for Health and Care Excellence guidance was being implemented in monitoring of physical health care needs, monitoring the use of antipsychotic medication and Clozapine monitoring there were no audits in place to check the implementation of this with individual patients.

We found;

  • Systems were in place to monitor and manage patient risks. Assessments were carried out in a timely manner, regularly reviewed and reflected in care plans.
  • Staff delivered person-centred therapeutic interventions to patients to support them to achieve improved independence and wellbeing. Staff interactions with patients demonstrated personalised, collaborative, recovery oriented care planning and involvement.
  • Staff ensured patients were engaged with assessments, care plans and discharge arrangements.
  • The service was proactive in promoting equality and diversity and meeting the specific needs’ of vulnerable groups of patients.
  • Staff had an understanding of the Mental Capacity Act 2005 and the Mental Health Act 1983. They assessed mental capacity and supported patients to make decisions where possible. Staff routinely referred patients for advocacy support if they lacked the capacity to do so themselves.
  • Staff received mandatory training, specialised training, supervision and appraisals.
  • Patients were protected and safeguarded from avoidable harm and incidents were appropriately reported to the local authority. Staff received specialised training, supervision and appraisals.
  • Patients were positive about the care and treatment they received and staff behaviours were responsive, respectful and caring. Staff involved patients in the care and treatment they received.
  • The service had physical health checks in place.
  • There was a programme of ligature risk assessment in place along with policies to support the management of this risk.
  • There was an open and transparent culture within the hospital. Staff were aware of the provider’s incident reporting and complaints processes.
  • Staff received debrief sessions after incidents and feedback when things had gone wrong and there was a multi-disciplinary approach to care and treatment.
  • Patients were able to access a range of psychological therapies and activities.
  • Patients were positive about the care they received. We observed staff treating patients in a respectful manner. Patients were involved in their own care, and attendance at multi-disciplinary ward rounds was facilitated.
  • Outcome measures were in place to assess the effectiveness of treatment.

14th September 2015

During a routine inspection

We rated Cambian Fountains Hospital as good because:

  • Systems were in place to monitor and manage patient risks. Assessments were carried out in a timely manner, regularly reviewed and reflected in care plans.
  • There was a programme of ligature risk assessment in place along with policies to support the management of this risk
  • Staff displayed a good understanding of their roles and responsibilities in relation to safeguarding. Safeguarding was embedded within practice
  • Staff accessed mandatory and specialist training. Staff were appraised and supervised regularly
  • There was an open and transparent culture within the hospital. Staff were aware of the provider’s incident report and complaints processes.
  • Staff received debrief sessions after incidents and feedback when things had gone wrong
  • Ward shift establishment were developed using a staffing analysis tool. Actual staffing levels matched the identified need. There was access to a regular cohort of bank staff
  • There was a multi-disciplinary approach to care and treatment. Patients were able to access a range of psychological therapies and activities. Patients had released a charity CD and won awards for art projects
  • Feedback from patients was positive. We observed staff treating patients in a respectful manner
  • Patients were involved in their own care and attendance at multi-disciplinary ward rounds was facilitated
  • Outcome measures were in place to assess the effectiveness of treatment.
  • Senior management were a visible presence. Staff felt supported in their role and there was good staff morale. A whistleblowing policy was in place. Staff told us they were confident in raising concerns
  • There were good governance structures in place to support the delivery of care. Key performance indicators were used to monitor performance

However

  • We found two instances where physical health checks had not been carried out on patients receiving high doses of medication.

20 January 2014

During an inspection looking at part of the service

At our last inspection in May 2013 we had concerns there were not enough staff to meet people's needs. This meant people were not able to take their planned leave at the agreed times. Following the inspection visit the provider sent us an action plan informing us of the changes they intended to make.

We revisited the service to ensure the necessary actions had been taken.

We spoke with three people who used the service. They told us there were sufficient staff on duty to meet their needs and they had not had any difficulties in accessing their leave at the agreed time. Comments included, 'I always get my leave and there are enough staff to supervise it' and 'I think there's enough staff on. I get escorted leave to the shop and it always takes place'.

We spoke with three staff. They told us they felt staffing levels had improved over recent months. One person commented, 'I think we are well staffed now. I can't think of anyone not having their leave facilitated since the last inspection'.

We found improvements had been made to staffing levels in the service. This meant there were enough qualified, skilled and experienced staff to meet people's needs.

13 May 2013

During a routine inspection

We found peoples' care plans were personalised and addressed their mental health, physical health and social care needs. People told us they had opportunities to discuss their care and treatment with their responsible clinician (RC).

People spoken with told us their views were not always listened to and they felt disempowered. They said, 'I feel my wishes and feelings are undervalued' and 'The psychiatrist never listens'. Also 'My section is up in July and nobody has told me what will happen next'.

We found some patients had been detained at the hospital for several years and were unlikely to progress to more independent living. This meant there was a risk that the ethos of the service might be compromised.

We saw there was guidance in place to support staff to deal with difficult behaviours which would help to keep themselves and others safe.

Patients and staff told us that staff shortages in the hospital meant that patients were not always able to take their planned leave at the agreed times.

Whilst we found staff received a range of appropriate training to look after the patients' properly formal supervision was infrequent, this may make it difficult to identify any shortfalls in staff practice.

17 December 2012

During an inspection looking at part of the service

We spoke with six patients about their medicines and the care they received.

Comments from patients included:

'I take my medicines in private but I'm not bothered about it'

'I can ask for painkillers when I need them'

'I was given the wrong medicines once, they were over worked and understaffed but things are okay now'

'I know what medicines I am taking'

'I get my inhaler for breathing problems when I need it'

'I am aware of my medicines'

'I can discuss my medicines with staff '

Overall we found improvements had been made in the way medicines were managed.

10 August 2012

During a routine inspection

"We were supported on this inspection by an Expert by Experience. This is a person who has personal experience of using or caring for someone who uses this type of care service". People told us they were happy with the care and support they received and were treated well by staff. They were able to express their views and opinions and could influence the way the service was run. They said they could raise any concerns with their key worker or with the management team and were confident they would be listened to. Staff spoken with told us they were given the training, development and support they needed to do their jobs properly. People told us they were able to share their views and opinions about the service by taking part in service satisfaction surveys.

22 June 2011

During a routine inspection

We spoke with five patients at The Fountains about the care and support they receive and they told us:

'Staff here help me in every way they can'.

'There is always somewhere safe to talk to staff if we want'.

'Staff treat me with dignity and respect'.

'I have only got good comments about this hospital'.

'I get to see a dentist and my GP whenever I need'.

'Yes I feel safe here'.

'Abuse, no not here'.

'I've not seen any abuse here'.

'There's no staff bullying here, staff are ok'.

They told us that they can express their views and are involved in making decisions about their care treatment and support at anytime of the day or night. They spoke positively about the hospital staff and felt they treated them properly and gave them support in a way that respected their privacy, dignity and independence.

They told us they felt their views were listened to and that they knew who to speak to if they were not happy with something.

When asked about their knowledge of the hospital complaints procedure the patients confirmed they knew how to complain and that they had been given a copy of the complaints procedure as part of the patients guide.

A patient told us, 'No I've no complaints, its ok here and so are the staff'.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.