Cygnet Hospital Wyke

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

We have not awarded this service a score for Caring.

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

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

During our inspection we observed warm interactions between staff and patients. Patients and carers we spoke with told us that most staff were kind, helpful, inclusive and supportive.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. Throughout our inspection, staff told us how the care they provided reflected these needs on an individual basis for different patients.

Patients we spoke with could tell us about what care and support they expected to receive, and some directly related this to actions which were agreed in their care plans. Patients also told us that most staff took time to listen to them, understood their needs, and made them feel safe and comfortable on the ward.

Some patients told us that they could sometimes hear staff speaking in a language other than English on the ward. They told us that they had sometimes heard their name within these conversations and it made them feel uncomfortable as they did not know what the staff were saying about them. They told us that the staff they had experienced this with did not work regularly on the ward. When we raised this with the service, they told us that they had previously received this feedback from patients and it was unclear if this was referring to the same or a more recent incident. They assured us that they would remind staff of the impact this could have on patients and speak with the patients who raised the concern to support them.

Staff we spoke with on both wards described an "open-door" culture throughout the service. They told us how this supported staff to voice any concerns with management on the wards and at a hospital-wide level.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Both wards worked to ensure that patients were treated as individuals.

The service provided access to spiritual support for patients in line with their preferred faiths. Staff told us how the service received regular visits from a local Imam and how they were able to arrange chaplaincy input from other religions as required.

Patients were supported to choose food that met their individual preferences, even where this was not due to a religious or ethnic dietary requirement, or an allergy/intolerance. For example, we heard how one patient had been supported to order a food delivery to meet their individual preferences when these were not met by the menu provided by the service.

The service made adjustments for disabled patients where possible – for example, by ensuring access to premises for those with mobility needs and by meeting patients’ specific communication needs. Where these needs could not be met, the service supported work to ensure an appropriate alternative placement was secured for the patient if these needs emerged during their admission.

Staff ensured that patients could obtain important information about their care and treatment including on medications, their rights, and how to complain. Information displayed around the ward on these topics appeared to be in a format accessible to the patient group, and throughout our conversations with patients they demonstrated an understanding of these topics.

Staff on Bennu ward told us about a recent quality improvement project that involved improving awareness amongst patients and their carers about how they could speak to pharmacy staff to ask questions about medications.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients were supported to increase their level of independence throughout their admission. The service had strong occupational therapy input and occupational therapy staff described how a key focus of their work was supporting patients to develop independence.

Carers we spoke with felt that the service supported their relative to be independent and exercise choice. They told us that the service had supported their relative to develop independent living skills for after discharge, for example how to access banking.

Patients we spoke with told us how staff supported their choices in relation to involving family in their care, including not sharing information with family members where this was requested. Carers also shared that patient choice was considered when offering visits, this included some family members meeting outside the ward to accommodate patient preference.

Patients were also supported to personalise their rooms in a way that was meaningful to them whilst also ensuring the environment remained safe.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Care plans we looked at documented patients’ individual risks and the staff we spoke with demonstrated their awareness of these. The staff we spoke with could tell us how they used different de-escalation techniques to reduce the need for physical interventions.

A small number of patients voiced concerns that some agency staff seemed to have a limited understanding of their needs and risks, which they told us could mean they sometimes did not identify and respond to their needs. We did see evidence in handover notes that key information about patients risks and needs was shared with staff at the beginning of a shift, and agency staff usage within the service was low.

The permanent staff we spoke with were aware of the individual needs of patients and explained how they worked with a least restrictive and personalised approach towards responding to risk.

Both wards held daily meetings with ward staff to review patients risks and respond to any changes identified. These meetings ensured that actions were allocated to a nominated staff member and supported reviewing progress against any agreed actions. Regular meetings were also held with staff from the multidisciplinary team and hospital leadership to ensure changing risks were identified, communicated, and responded to.

Patients experienced care that was thoughtfully designed to understand and support their sensory needs. Patients on both wards had access to a dedicated sensory room, which supported them to regulate their sensory needs and reduce distress. The room was designed to offer a range of options to both decrease sensory stimulation and provide grounding sensory experiences where needed. For example, it included an egg chair, which created a darker, more enclosed, and noise-reducing space to promote calm. It also contained coloured lighting and a texture wall, which staff told us helped patients to feel more grounded.

Patients were supported to manage distress linked to sensory overwhelm through clearly identified low and high stimulation areas across both wards. During the inspection, we observed posters displaying a ‘heat map’ which highlighted areas with differing levels of sensory stimulation. For example, a smaller lounge area was identified as a low sensory environment, as it was quieter, darker, and away from busier ward areas. Staff told us these maps enabled them to identify and direct patients to appropriate spaces when they were becoming distressed, particularly where this was linked to sensory overload.

Seclusion facilities were also adapted and designed to consider patients sensory needs and reduce additional stress. The seclusion room allowed staff to adjust lighting and sound to support self-regulation. Staff we spoke with described how they also used these adaptations to support patients who required a more gradual reintegration to the ward following a period of seclusion. They explained that these design features were particularly helpful in facilitating this transition.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

Staff we spoke with were positive about their experiences of working for the service overall. Staff across the service described a team-based approach and told us they felt supported by colleagues. They also described feeling proud of their work.

Staff on both wards told us they felt supported by managers within the service. A small number of staff told us they sometimes did not feel they had been listened to when making suggestions for improvements. However, staff told us that overall, they felt valued, were treated equally, and the service was supportive of their professional development. For example, several staff had been supported through an apprenticeship pathway from working as a support worker to gaining professional registration such as becoming a registered mental health nurse. Staff working within the MDT also told us they felt their opinions were respected and valued.

Staff success was recognised by the service. The service had recently held a staff appreciation day and introduced an employee of the month award on Bennu ward. Positive feedback was also shared with staff via email and in team meetings.

The service had a range of support available to staff following an incident or injury at work. Staff had access to an employee assistance line and could be referred by their manager to receive additional Trauma Risk Management support should this be required. Referrals could also be made to an occupational health service. A small number of staff told us they felt staff could be offered better sick pay if they were off work due to a serious injury following an incident at work, however they still felt supported by the service. Managers also provided assurance that discretionary sick pay was approved "most times" and shared that this was dependent on individual circumstances. We also saw evidence of provisions for discretionary sick pay in the provider's policies.