Cygnet Lodge Brighouse

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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 inspection we rated this key question good. At this inspection, the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this. Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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 scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff assessed the physical and mental health of all patients on admission and continued to assess this throughout their hospital stay. Individual care plans were developed in collaboration with patients and the wider multidisciplinary team. These were reviewed on a regular basis. Staff followed national guidance in the treatment of patients. There was a specialist doctor on site and the different disciplines worked well together to ensure the needs of patients were met.

The pathway for referrals to a dietician for patients, was complex, due to these needing to go through the GP. The speciality doctor was exploring this further, but following our inspection, we were informed staff will record all patients’ weights and SANSI (which is a specialised nutritional screening tool to assess dietary risk factors) forms would be completed. Following our inspection 3 consented to GP appointments, for weight monitoring and dietary needs, and patients who declined had follow ups at their next monthly check to review this.

We reviewed 6 care records and found staff developed plans that met the needs identified during assessment. Care plans were reviewed monthly or updated after any changes. They were also reviewed as part of the monthly ward round process. Discussing care plans was a standing agenda item in the hospital’s morning meeting and other topics discussed included physical health, mental health and presentation and use of section 17 leave. Any restraints carried out and matters relating to the Mental Health Act were also discussed.

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.

There were a range of care and treatment interventions suitable for the patients at Cygnet Lodge Brighouse, which included medication, psychological therapies and activities such as skills for living (for example, gardening and cooking). There were also volunteer opportunities, for patients who wanted to take part, at a local wildlife reserve. Care and treatment were delivered within National Institute for Health and Care Excellence (NICE) guidelines.

We saw evidence in the records we reviewed that other professionals had input into the patients care such as referrals to speech and language therapist (SALT) where required. Positive Behaviour Support (PBS) plans were in place for patients as well as hospital passports, where appropriate.

Staff were qualified, experienced and had a good skill mix with knowledge to meet the needs of the patient group. The staff team comprised of a hospital manager, head of care, consultant psychiatrist, psychologist and assistant psychologist, occupational therapist, occupational therapy assistant, speciality doctor, nurses and health care support workers.

The hospital staff were working towards the Triangle of Care, which is a quality improvement scheme for health and social care providers that promotes safety, recovery and wellbeing by including and supporting unpaid carers. Cygnet Lodge Brighouse have since been awarded this accreditation following our inspection.

Managers provided new staff with appropriate induction and mandatory training. Staff we spoke with reported that they were provided with the necessary training to undertake their roles. Some staff had completed sensory integration training which was funded by Cygnet, which allowed a bigger focus on sensory groups and activities.

Managers provided staff with supervision, both clinical and managerial. These are meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development. All clinical departments were at 100%, with support workers at 94% compliance.

Appraisals were conducted, once yearly, to discuss performance in the role and goal setting of staff. Appraisal compliance at the time of inspection was 79%. Staff reported that supervision in Cygnet Lodge Brighouse was very effective and meaningful. They were encouraged to take the lead and prepare for their supervision sessions, which were clinically driven, with an emphasis on reflective practice.

Mental Health Act

Staff we spoke with had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. The compliance rate was 89%.

Staff knew who to go to for administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice.

The provider had relevant policies and procedures that reflected the most recent guidance which were accessible to staff on the providers intranet.

Patients had easy access to information about independent mental health advocacy and advocates visited the service.

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 able to take Section 17 leave (permission for patients to leave hospital) when this had been granted.

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 completed 6 monthly audits to ensure that the Mental Health Act was being applied correctly.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary team meetings, which included people and families involved in their care. Morning meetings also took place where information was discussed such as the patient’s presentation, any significant overnight events, any immediate actions that were required, section 17 leave arrangements and upcoming appointments. The service invited relevant external partners to these meetings and stakeholders confirmed they attended.

The in-house social worker contacted families and kept them updated on any changes. Relatives we spoke with confirmed this.

There were effective relationships with teams outside the organisation, including the adult safeguarding team and commissioners. We received feedback from external partners who told us that they were kept informed and information was provided to them prior to meetings. They also confirmed that they were invited to monthly ward rounds for patients.

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.

Care records evidenced that patients were supported to manage their physical and mental health. Food and fluid monitoring was documented. Reviews and management of medicines were also documented. There were smoking cessation initiatives in place.

The hospital made sure that patients had choice with food, offering variety and healthy options. Patients reported that the food was good, and it met their dietary and cultural needs.

The activities on offer at Cygnet Lodge Brighouse encouraged healthy lifestyles, such as walking groups and cooking groups, help with budgeting and healthy meal planning.

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 rating scales to monitor progress such as NEWS, used to monitor physical health, clozaril bowel monitoring and LUNSERS was carried out to monitor the effectiveness of management of medication.

We observed that hospital staff could recognise changes in behaviour and screenings were carried out if neurotypical signs were altered. Patients had positive behaviour support plans in place.

We observed how occupational therapy goals had improved outcomes and enabled patients to build on life skills, such as using public transport, cooking sessions and budgeting to prepare them for eventual discharge.

Patients were given a choice regarding their use of medication. Examples were given of patients who requested changes in medication, and these were implemented after clinical discussion with the consultant.

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 undertook training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

We reviewed care records to ensure that there was consideration made for a patient’s capacity to consent. It was clear from the documentation we reviewed that capacity assessments were carried out appropriately and were both decision and time specific. Where appropriate, best practice decisions were undertaken and involved an advocate or the patient’s family and noted in the records. The hospital used a tracker system to ensure that they were reading people’s rights who were detained under the Mental Health Act.

The service conducted regular reviews for people and regularly reviewed the restrictions it imposed on people. Audits were in place to monitor consent and Mental Capacity Act practices to ensure they were only in place when this was necessary.

Patients had access to advocacy services and advocates were seen on site during our inspection.