Cygnet Hospital Godden Green

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

We reviewed all 6 quality statements in the effective key question. This means we looked for evidence that patients’ care, treatment and support achieved good outcomes and promoted a good quality of life, based on the best available evidence. At our last inspection we rated this key question as Good. At this assessment the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Qualified nurses or doctors completed a comprehensive mental health assessment of each patient either on admission or soon after. Assessment documentation was comprehensive and covered all relevant areas. This included an assessment of the patient’s capacity to consent to admission and treatment. Staff we spoke with were able to describe the assessment process. They were able to describe how they were informed of the outcomes of patient assessments and how care and risk management plans were then created and shared with them. Staff we spoke with described how updated information on each patient was shared at handovers between shifts. Staff described how patient observation levels were assessed and reviewed daily.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Physical health screening was completed within 24 hours of admission, either by the hospital physical health team or the nurse on duty. Physical health assessments included baseline bloods and an electrocardiogram. Staff developed a care plan for each patient, with their input, which met their mental health and physical health needs, including food and drink and for any specialist nutrition and hydration needs. However, Physical health checks following the use of rapid tranquilisation were not always being completed appropriately to ensure people were being kept safe.

Care plans were recovery orientated. Plans for treatment set out the patient’s goals, the support they needed as well as arrangements for occupational therapy, psychology and risk management. They included the views of patients and carers. However, there were not always personalised and there was no restraint care plans, as required in line with the provider’s own policy. There were some patients who had physical health needs which could have meant that usual restraint methods would not be appropriate. Restraint care plans should have been completed to inform staff what safe practice to use with those patients. We raised this with the hospital director as part of our inspection feedback, and shortly after the inspection we was assured that restraint care plans had been reinstated.

Multi-disciplinary discussions during the patients’ individual care reviews were supportive, there was appropriate discussion and challenge between team members and the focus was on improving care and outcomes.

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 (NICE). For example, in line with this guidance, the service ensured that people with a recurrence of psychosis or schizophrenia were offered oral antipsychotic medication along with psychological interventions. In addition to providing medicines and psychology therapy, the service provided therapeutic activities and support with daily life skills.

Provider policies were written in line with national guidance. There were governance structures at hospital and provider level to review and disseminate new guidance. Staff completed clinical audits to ensure compliance with relevant standards and guidance. Staff participated in clinical audit, benchmarking and quality improvement initiatives to make improvements to the service.

Staff held regular multidisciplinary meetings to discuss patients and improve their care and outcomes. Each patient was reviewed by the full multidisciplinary team at least every two weeks. The responsible clinician, ward doctor, nurse, psychologist and occupational therapist all attended the meetings. At these meetings, staff reviewed the patients’ progress and made changes to there care and treatment, where needed.

Staff made sure they shared clear information about patients and any changes in their care and treatment or risk indicators. Nurses and healthcare assistants held a handover meeting at the start of each shift. The multidisciplinary team met each day to review risks and incidents. A meeting for senior staff across the hospital was held each morning. At this meeting, staff shared information about incidents, safeguarding, staffing, maintenance, patients enhanced observation levels, patients’ physical health, discharges, admissions and referrals and plans for the day. We observed the meeting and found conversations between colleagues to be friendly, supportive and engaging with appropriate challenge.

Staff we spoke with described a supportive multi-disciplinary team within the ward and told us that they worked well together.Staff were able to describe the processes for sharing information within the multidisciplinary team and with external professionals and services. They were able to discuss examples where they had worked collaboratively with staff, teams and services to deliver care and treatment and support patient’s future care needs.

There were clear processes and systems in place to support admissions, discharges and transfers of care. There were bed management and patient flow services at provider level that helped manage and facilitate this. There were clear pathways and referral procedures into the service. Staff worked with bed commissioners and local services to support discharge. Staff had access to policies and procedures to support transitions and pathways into and out of the service.

Staff assessed patients’ physical health needs and recorded them in their care plans. Staff completed checks of each patient’s pulse, temperature, weight, height and blood pressure each week. Staff wrote up detailed progress notes for each shift covering patients’ compliance with medication, food and fluid intake, personal hygiene and sleep.

Staff made sure patients had access to physical health care, including specialists as required. Patients were seen promptly by a doctor when they felt unwell or taken to an Urgent Treatment Centre or AE, if required.

Patients we spoke with told us that their care and treatment was well coordinated and that felt well supported by staff and their needs and wishes were listened to. They told us that the care and support they received was helping them to improve their mental and physical health and their well-being.

Staff used recognised rating scales to assess and record severity and outcomes, these were used for both mental and physical health outcomes. Staff were able to show how patients were progressing through their treatment.

Staff took part in clinical and benchmarking audits. They were supported by audit, assurance and performance monitoring teams within the service and wider organisation. Results from audits and quality assurance processes were used to make improvements.

Staff used technology, for example accessing and storing medical results electronically where needed and the patients’ records were stored electronically which made information sharing easier and quicker.

Data on patient outcomes was reviewed and analysed within the hospital and provider wide governance structure and in external governance and performance meetings with commissioning bodies.

Staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions such as treatment and personal finances. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Family members were involved, where appropriate.

Staff completed mandatory training around the Mental Health Act and Mental Capacity Act. Staff we spoke with were able to describe the five principles of mental capacity and give examples of when capacity had been assessed and considered as part of care and treatment.The service regularly audited Mental Capacity Act compliance on the ward.