Cygnet Bury Forestwood

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• 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.

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 maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 13 care records during the assessment. Staff completed a comprehensive mental health assessment of each patient in a timely manner at, or soon after, admission.

Staff assessed patients’ physical health needs on admission. Each patient was assessed by the on-call doctor who completed an initial physical healthcare check including a body map and diet and weight monitoring was carried out.

Staff developed care plans that met the needs identified during assessment. We saw that care plans were personalised, holistic and recovery oriented. Staff routinely updated care plans when patients’ needs changed. Each patient had a positive behaviour support plan (PBS) in place. All 13 of the PBS plans reviewed were comprehensive and detailed and contained information on the patients’ triggers and how best to respond to them.

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.

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. The service had occupational therapists, psychologists and psychology assistants on each ward. The psychology service provided group and one to one sessions with patients. There was also access to art therapy, family therapy and pet therapy. In some cases, the young people were able to have their pets on the ward and they took responsibility for caring for them.

Staff ensured that patients had good access to physical healthcare. Each patient had a physical health care plan. A GP service attended the wards weekly for general health, routine blood tests and electrocardiogram tests (ECG) and referrals were made to specialists if this was required. In some cases, the young people were able to access the GP in the local community. A chiropodist visited the service and young people were able to access the opticians and the dentist off site.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. We saw evidence in care records that patients were weighed and staff used food and fluid charts when required. There was a dietician available to advise on diet and nutrition.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. This included auditing medication, patient records, observations records, cleaning records and clinic rooms.

The team included a full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, there were occupational therapists, psychologists, assistant psychologists, social workers, a pharmacist, speech and language therapists (SALT) and a dietician.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. All staff had completed specialist training to best meet the needs of the patients. This included mandatory completion of the Oliver McGowan training on learning disability and autism.

Managers provided new staff with an appropriate induction. There was a training, learning and induction policy and all staff had to complete mandatory face to face and e learning training. All new staff completed an orientation to their ward and were assigned a buddy. Staff completed an observation competency and there were opportunities to shadow other team members on the ward. The induction check list was signed off by managers when complete. All bank and agency staff were required to complete an induction before they were allowed to work on the wards.

Managers provided staff with reflective practice and clinical supervision to discuss case management, to reflect on and learn from practice, and for personal support and professional development and appraisal of their work.

Managers ensured that staff had access to regular team meetings. We reviewed the last three months of team meeting minutes and saw that there was a standing agenda and all staff had access to the minutes.

Almost all staff had received an appraisal in the last 12 months and compliance was at 96% at the time of the assessment. Staff received regular supervision in accordance with the provider’s supervision policy. At the time of the assessment supervision compliance was at 99%.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff we spoke with said that they had been supported to complete their nurse training and that there had been flexibility with shifts to assist with studying. There was also an occupational therapy apprenticeship available.

Managers ensured that staff received the necessary specialist training for their roles. All support workers had completed the care certificate for support workers.

Managers dealt with poor staff performance promptly and effectively. We saw evidence of management support and consultation with HR in some cases.

We 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.

Staff held weekly multidisciplinary meetings which all disciplines attended. Staff shared information about patients at handover meetings within the team from shift to shift. There was a daily morning meeting at which all patients were discussed along with incidents, staffing requirements and any changes in risk.

The nursing teams had effective working relationships, including good handovers, with other relevant teams within the organisation. The multi-disciplinary team shared an office, and this had led to prompt sharing of information and effective communication. The headteacher of the onsite school attended the morning meetings.

The teams had effective working relationships with teams outside the organisation. This included care coordinators who were invited to attend patient meetings, commissioners and the local safeguarding team.

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.

Staff supported patients to live healthier lives. The service offered smoking cessation and healthy eating and nutrition advice with support from a dietician.

Ward activities helped promote a healthy lifestyle for patients and there was a range of activities that supported this, including walking groups, cooking groups, access to the gym with guidance from gym instructors and healthy meal options on the menu.

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.

Staff used recognised rating scales to assess and record the severity of children and young people's conditions and care and treatment outcomes. In this case the provider used Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA) and the Children's Global Assessment Scale (CGAS) which is a numeric scale used by mental health clinicians to rate the functioning of young people under the age of 18.

Staff used technology to support patients effectively. This included electronic patient records, iPads and the use of closed-circuit television for the review of incidents. Staff were able to access physical health tests and results promptly using online systems and accessed useful tools such as self-help guidance for young people.

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

Staff took all practical steps to enable patients to make their own decisions. There was evidence in patient records that consent was explored with the patient. Those informal patients had choice over their treatment options.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When we reviewed patient records, we saw that capacity was considered and in some cases capacity assessments had been completed and best interests meetings held. Capacity was assessed on a decision specific basis such as a patient being able to consent to physical health treatment.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.