Cygnet Bury Hudson

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We do not always maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 11 care records during the assessment.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission.

Staff assessed patients’ physical health needs in a timely manner after admission. Staff developed care plans for specific health needs, including epilepsy and COPD. However, we saw in 1 care record that staff were not consistently completing NEWS 2 monitoring and that records did not reflect the current observation levels for the patient.

Staff developed care plans that met the needs identified during assessment. Care plans focused on the areas of: ‘My mental health’, ‘My safety planning’, ‘Moving on plans’, ‘My life skills’, ‘My relationships’ and ‘Staying healthy’. However, in 1 care record staff were being creative to support a patient with personal hygiene needs but the interventions were not always recorded in their care plan.

Care plans were personalised, holistic and recovery-oriented. There was evidence of patient involvement in the care plans.

Staff updated care plans when necessary. All care plans we reviewed has been recently updated. However, in 1 record, named nurse sessions were not regularly taking place.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medicines, psychological therapies and occupational therapy (OT) interventions. The OT team were facilitating healthy habits groups and vocational skills groups. The psychology team were delivering mindfulness and relaxation groups, dialectal behavioural therapy graduate groups and mental health awareness groups. Patients and staff had co presented a presentation on the use of enabling environments in the service to the Royal College of Psychiatrists.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Records evidenced referrals made to external services for health needs.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Referrals were made to dieticians and guidance provided by the dieticians.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. They included care record audits and basic life support simulations, where there were areas for improvement identified from the audits, additional support and training was provided, resulting in improved scores.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. Including doctors, nurses, occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists and dieticians.

Staff were experienced, qualified, and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff with appropriate induction. We reviewed the induction process for bank and agency staff and found staff had had an induction to the ward they were working on and an observations competency assessment completed prior to conducting observations. The induction records were stored in a central folder and were in place for the staff we reviewed. Permanent staff attended an intensive 3 week induction covering an overview of the organisation, mental health awareness, safety intervention (physical intervention) training, ward orientation and carried out a range of e Learning.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. Supervision and appraisal compliance rate was over 90% for each ward.

Managers ensured that staff had access to regular team meetings. Minutes showed these took place monthly.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Minutes showed training needs were identified.

Managers ensured that staff received the necessary specialist training for their roles. Courses relevant to the service were personality disorder awareness, relational security, trauma informed care, learning disability and autism tier 1 and tier 2 training.

Managers dealt with poor staff performance promptly and effectively. Records showed appropriate action was taken in relation to staff misconduct.

Mental Health Act

99% of staff had received training in the 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 we spoke with, understood their role in relation to the Mental Health Act.

Staff had easy access to administrative support and legal advice on 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.

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. Posters were displayed on the wards and patients could tell us who the advocates were.

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 mostly able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Patients told us generally there was enough staff however there had been times when staffing challenges impacted on leave, being able to access the social hub and the outside spaces. Care records showed that patients were accessing their section 17 leave.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and 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. This was included in the policy for the administration of the Mental Health Act 1983.

We do not always work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings. Patient reviews took place fortnightly. We observed a CPA meeting and found that it was person centred and external people had been invited to the meeting. The advocate attended the meeting.

Staff did not always share information about patients at handover meetings within the team (for example, shift to shift). Risks were not routinely shared to staff during handover. We observed two handovers and reviewed handover documentation, and risk of patients was not discussed as part of this, only if there had been an incident. We reviewed the handover documentation and there was a risk score, but the RAG rating was green, the risk scores did not always reflect what was discussed at the daily risk meeting. The risk scores did not explain to staff what the risks were. There was a patient on one to one observation for physical health reasons and the handover record did not say what the health reasons were. A patient had epilepsy and this was not included in the handover record. There had been a ward shut down for searching due to potential contraband and this was not included in the handover, night staff were not aware of this when asked. This meant staff were not provided with the information to meet the needs of the patients they were supporting and were not fully aware of the risks they needed to mitigate.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. Daily morning meetings took place for each ward, attended by the multidisciplinary team.

The teams had mostly effective working relationships with teams outside the organisation We received feedback from 4 stakeholders. Stakeholders told us that the service was responsive, if they raised any concerns or queries, the service acted on these promptly and provided an update and outcome. Areas for improvement raised by stakeholders, included making statutory advocacy referrals more promptly, improving consistency of communication regarding patients’ leave, and adhering more reliably to scheduled meeting times. Communication was an area for improvement identified by stakeholders, including communicating when there were changes in ward managers. Also, staff absence and who to contact during the absence.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives – for example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse. Mental health awareness, mindfulness and relaxation, health habits groups took place. The service were developing a substance misuse group at the time of the inspection.

Ward activities helped promote a healthy lifestyle for patients – for example walking groups, sports activities and cooking healthy meals. The gym had been updated with redecoration and additional equipment including exercise bikes, treadmills, weights, free weights, exercise matts, table tennis and football facilities. Yoga took place weekly and records showed that the gym was very well used with several patients accessing the gym daily, the gym instructor provided one to one, group gym session, circuit training, table tennis and football opportunities for patients.

Cooking assessments took place by the occupational therapy team and we saw one to one cooking sessions taking place.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes, these included model of human occupation screening tool (MOHOST).

Progress was discussed within patient reviews and feedback was sought from the patient and the multidisciplinary team.

Staff used technology to support patients effectively (for example, for prompt access to blood test results and online access to self-help tools). The hospital had its own blood screening device for Clozapine blood test results.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. Advocates were involved in supporting patients to express their preferences and wishes. One page profiles were in place and neuro inclusive passports were starting to be completed for patients with additional needs, about how best to support them including in relation to communication.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Records evidenced that capacity assessments took place in relation to decisions relating to hospital attendance for physical health reasons and managing finances.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Records showed best interest decisions relating to managing finances and food intake.