Cygnet Hospital Woking

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last assessment we rated this key question good. We looked for evidence that the service met people’s needs.

At this assessment, the rating has remained good. This meant we found that staff included the multidisciplinary team to manage patients ‘risks. Care plans for the patients were holistic, individualised, recovery oriented, and showed patients strengths. However, people’s needs were not always being met through good organisation and delivery. Staff did not always involve patients and those close to them in planning and making shared decisions about their care and treatment. We did not find evidence on Greenacre ward that patients were always involved in their care plans.

We found the provider to be in breach of Regulation 9, Person centred care.

We have not awarded this service a score for Responsive.

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

The provider did not always ensure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Staff did not regularly involve patients and those close to them in planning and making shared decisions about their care and treatment. We reviewed care records for 14 patients. There was minimal evidence of staff involving patients and carers or other people close to the person in planning their care and treatment. For example, only 2 of the 14 records we reviewed on Greenacre ward demonstrated patient involvement in their care plans. When we spoke with patients, 3 patients said they were not involved in their care plan and 1 patient said they were not sure if they had a care plan. The care plans we reviewed showed care plans were completed by staff without the patient’s input. Two patients told us they were not aware of what was recorded in their care plan.

Five patients out of 12 on both wards had signed their care plans, and we found some evidence of patients’ awareness of their care plans. Two patients told us even though they did not want to get involved with their care plan, they engaged with staff when staff completed their care plan. However, five patients said they were not involved in their care plans. Staff updated care plans when necessary.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

When appropriate, staff ensured patients had access to education and work opportunities. For example, 1 patient was engaging in a course to be able to work in kitchens. Another patient who did not have access to section 17 leave worked in the hospital shop to gain life skills. Patients were encouraged to engage in gardening and received incentives when the garden proceeds were sold. One patient on Greenacre ward was waiting to go to college and another had started an online course. Another patient on Oaktree ward was enrolled in a shop and worked as a volunteer in a charity shop.

One carer told us they were happy staff engaged their relative in volunteering work at a local library, Staff engaged patients in the kitchen, in gardening and patients received an incentive for their contribution.

Staff supported patients to maintain contact with their families and carers with the support of the carers lead.

Staff supported patients to access their chosen place of worship within the community. Patients who also had section 17 leave could access the local community church.

The service provided appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service complied with the Accessible Information Standard. Staff provided information to patients in a form accessible to the patient group. For example, in easy-read form on wards for people with a learning disability. Staff made information leaflets available in languages spoken by patients.

Staff ensured carers, families and commissioners were regularly updated about the patient’s progress. Staff ensured they sought consent from patients before they involved their families in their care. Families of patients were invited to attend ward round every fortnight. Some attended ward round in person or others virtually. Relatives also attended Care Programme Approach (CPA) meetings. For example, one family member told us they were happy that staff invited them to attend ward rounds and CPA meetings. The relative said staff spoke about goals that were set for the patient to achieve and said they felt engaged and listened to during such meetings. The managers also encouraged families of patients to give feedback about their care through the carers lead and this made carers feel involved in their relatives’ care.

The service made it easy for patients to share feedback and ideas or raise complaints about their care, treatment and support. Staff involved patients in decisions about their care and told them what had changed as a result. There was space for improvement to let carers know how to complain or give feedback about the service.

Staff understood the policy on complaints and knew how to handle them. Staff informed us they first attempt to resolve patients’ concerns with them at ward level and if this could not be resolved informally, staff supported patients to make a formal complaint.

Patients, relatives and carers knew how to complain or raise concerns. The service clearly displayed information about how to raise a concern in patient areas. There were posters on the nursing office windows of how patients could make a complaint.

Managers investigated complaints and identified themes. Patients received feedback from managers after the investigation into their complaint. Managers shared feedback from complaints with staff and learning was used to improve the service.

When patients and carers complained or raised concerns, they received feedback.

For example, one carer told us they had complained to the manager about the noise on Greenacre ward and they were happy with how quickly the ward manager resolved the complaint and received feedback after the complaint was investigated.

Staff protected patients who raised concerns or complaints from discrimination and harassment. The service used compliments to learn, celebrate success and improve the quality of care.

The service made sure that everyone could access the care, support and treatment they need when they need it.

Staff ensured the needs of patients with mobility issues were met. For example, wheelchair users were placed in bedrooms at ground level or had access to lifts. However, during the inspection, we found that the basement lift had not been operating for about one month which made it difficult for patients with mobility difficulties to access various parts of the hospital. Staff informed us the damage to the lift had already been escalated to the estates department to get the lift repaired and it was logged on the service’s risk register.

Staff made reasonable adjustments for patients. For example, people with mobility needs were provided with walking aids, shower chairs etc. A carer gave us positive feedback about the support given to their relative who had mobility needs to access the ward. Another carer informed us that even though the lift on Greenacre ward was not functioning for a period of about one month, the provider had a specialist chair (Rollator) which was used to transport the patient in and out of the ward. This was useful for patients who wanted to access the downstairs garden.

There was adequate medical cover for both wards day and night, a doctor could attend the ward quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.

Staff ensured patients had access to post-discharge care. For example, one patient had Section 117 aftercare, community mental health services and crisis services.

On both Greenacre and Oaktree wards, we found evidence that staff planned well for patients’ discharge, including good liaison with care managers/co-ordinators. However, not all patients had discharge plans in place. For example, 2 out of the 8 records we reviewed on Greenacre ward and 2 out of 6 records on Oaktree ward did not have robust discharge plans. One patient on Greenacre ward had been in the service for about 10 years but did not have a specific discharge plan or pathway in place. The manager informed us the team were working towards ensuring all patients have discharge plans in place.

On Oaktree ward, the manager informed us there had been 3 discharges in the last 3 months and 3 patients discharged in the last 3 years on Greenacre ward. Patients were usually discharged within 1 year of being admitted to the ward and the longest length of stay for patients on the Oaktree ward was 5 years.

The service listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

The manager of Greenacre ward informed us the staff worked well with patients with protected characteristics. The provider had an inclusivity policy which encouraged staff to respect patients’ wishes.

Staff were trained in equality, diversity, inclusion and human rights.

The service supported patients to plan for important life changes, so they can have enough time to make informed decisions about their future.

Staff supported patients to make informed choices about their care and plan their future. We found evidence of discharge planning in care records reviewed. We saw the multidisciplinary team and community care co-ordinator were involved in the discharge process.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs.