Cygnet Aspen Clinic

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

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 as good. At this assessment the rating has remained good. This meant people's outcomes were consistently good, and people's feedback confirmed this.

Patients had an ongoing assessment of their mental and physical health. Care and treatment was delivered in line with national guidance and best practice. Patients had care plans and positive behaviour support plans that were reviewed regularly.

The staff teams included or had access to the full range of specialists required to meet the needs of patients. Staff worked well together as a multidisciplinary team. Managers ensured staff received training, supervision and appraisal. Staff worked collaboratively with stakeholders to deliver joined-up care to patients.

Staff assessed patients' capacity to consent to their care and treatment. The service had processes for the effective implementation of the Mental Health Act.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. They gathered information about the patient as part of the pre-admission assessment, and carried out a fuller assessment with the patient when they were admitted to the service. This included their mental, physical and social care needs.

Staff developed care plans that met the needs identified during assessment. On admission, the manager created an initial 8-week care plan for the patient, which was reviewed and developed by the patient’s key nurse. The provider had ‘set’ care plans depending on the type of service. This covered key areas (such as physical health, medicines, and self-harm) but the plans themselves were individualised, and could be added to. Overall, the care plans were personalised, holistic and recovery-oriented.

Staff updated care plans when necessary. Care plans were routinely reviewed as part of the 4-weekly multidisciplinary team meeting. Patients had a positive behavioural support (PBS) plan that was developed with them. Staff told us that patients were usually but not always involved in developing their care plans, but their views were still included. Each patient’s care was discussed in the multidisciplinary team meeting each morning, and any required changes to the patient’s care plan identified there.

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. This included those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE) and the Royal College of Psychiatrists. The service had a psychology team that provided therapy to patients, which included dialectical behaviour therapy (DBT). Some of the nursing staff were also DBT trained.

`Enabling environments' is a network established by the Royal College of Psychiatrists (RCP) to support services to create positive psycho-social environments, with a focus on co-production with patients. The service was in the initial process of information gathering and auditing, with a view to ultimately meeting all ten standards following the submission of evidence and independent assessment through the network.

Managers and staff were working to reduce restrictive practices as much as possible. The consultant psychiatrist was the reducing restrictive practice champion. Information is displayed for patients to raise awareness of blanket restrictions and restrictive practices.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. The service had 2 registered general nurses who led on physical healthcare within the service. There was a dedicated physical health room suite that was large enough to carry out procedures, but did not have an examination couch. All patients have a mental and physical health check on admission, and an annual health check. There is ongoing monitoring of patients and access to physical healthcare dependent on their needs.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. In addition to doctors, nurses and support workers, the team included occupational therapy and psychology.

All patients were registered with a dentist and local GP. Community and specialist healthcare was accessed through their GP or local hospital. For example, patients may access support from the district nursing team, dietitians, tissue viability nurses, and speech and languages therapists.

Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Managers ensured that staff received the necessary specialist training for their roles. 96% of staff had completed mandatory personality disorder e-learning. This incorporated an online module, and a workbook for staff to go through. 98% of staff had completed training on maintaining therapeutic boundaries with patients.

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 shared information about patients at effective handover meetings within the team. A daily handover occurred between shifts. This was led by the nurse in charge to the incoming nurses and healthcare assistants.

A multidisciplinary team meeting took place every weekday morning. This was attended by managers and staff from all the professions in the service, including medical, nursing, psychology and occupational therapy. Any significant events were discussed and risk and their immediate care needs were reviewed. Actions from previous days were followed up at this meeting.

Each patient had a multidisciplinary team meeting every 4-weeks where their care was discussed in detail, and their relatives and all professionals involved in their care were invited. People could attend virtually if they could not attend in person.

The teams had effective working relationships with teams outside the organisation. All patients were registered with a GP, and had access to community healthcare through this. Staff worked with teams from each patient’s local area, to meet the needs of patients and plan for future care and support.

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.

All patients had an initial physical health assessment on admission to the hospital, and an annual physical health check. All patients were registered with a local GP, and there were two physical health nurses in the service who led on physical health care and screening.

Staff supported patients to live healthier lives. Food was cooked onsite, and patients were involved in menu planning, and offered a choice of food at each meal. Meals were colour coded so that patients could easily differentiate the healthier options (coloured green) from the less healthy options (red). There was information on display advising on healthy eating choices.

The service could access dietitians for patients when required. Patients had their own kitchen in the service, where they could make their own meals, and access staff support with planning and cooking.

Ward activities helped promote a healthy lifestyle for patients. This included walking groups, and sports activities at the local leisure centre which included swimming, badminton and the gym, and promoting healthy eating.

Managers told us that patients could smoke in a designated area outside. However, they were planning to make the service smoke-free, and were developing the smoking cessation support they offered to patients.

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 severity and outcomes. Staff used at variety of recognised tools to monitor patients depending on their needs. These were recorded in the patient’s care records, and used to review and direct their care. For example, patients had their physical health observations monitored and recorded on NEWS2, which highlights if further action may be required. Staff used tools to monitor the effect of medicines such as the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) which is used to assess the side effects of antipsychotic medicines; and ‘Stopping over medication of people with a learning disability and autistic people’ (often called STOMP) which is an NHS England initiative.

The psychology team used various rating scales with patients to monitor their mental health and progress over time.

Patients had access to the NHS app, where they could access their information online, such as their own blood test results.

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 as much as possible. When this was not possible, followed the provisions of the Mental Health Act and the Mental Capacity Act.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. 91% of staff had received training in the Mental Health Act. Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators (MHAA) were. There was a regional MHAA, and a MHAA based in the service.

Patients were usually detained under the Mental Health Act, particularly on admission to the service. Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated this as required and recorded that they had done this. Records showed that the frequency of these explanations was tailored to the needs of the patient, such as weekly or monthly. Where necessary, written information about the patient’s rights under the Mental Health Act was provided in an easy read format.

Patients had easy access to information about independent mental health advocacy (IMHA). The advocacy service regularly visited patients on the ward, which included providing support in meetings or signposting them to advice. Information was clearly displayed about the role of the advocacy service and how to contact them.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted. Patients had a specific and individualised Section 17 leave care plan. Patients and staff told us that Section 17 leave was rarely cancelled, other than for clinical reasons.

Care plans did not always refer specifically to Section 117 aftercare (which must be provided for all patients who have been detained under Section 3 of the Mental Health Act). However, all patients had discharge care plans, which were more detailed as they progressed through their care pathways.

Staff stored copies of patients' detention papers and associated records correctly and ensured they were available to all staff that needed access to them. Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. A 6-monthly audit of Mental Health Act implementation and documentation was carried out. The last 2 audits showed that this had all been completed correctly. An external pharmacy carried out routine audits of medicines, which included in relation to the application of the Mental Health Act. Managers told us that there had been some occasions when the Mental Health Act paperwork was not always with a patient’s prescription chart, so they improved access so that the Mental Health Act administrator could check this. Staff requested an opinion from a second opinion appointed doctor when necessary.

The provider had policies for the use of Section 63 of the Mental Health Act. Section 63 had been used to provide medical treatment on 7 occasions over the last year, involving a small number of patients. These were in relation to the provision of physical healthcare, often by another service, following or related to self-harm. The provider monitored the use of Section 63 to ensure that it was used appropriately. Staff clearly documented the rationale for the use of Section 63, and their attempts to obtain the consent of the patient before its use. All uses were recorded as an incident, and reported to the local safeguarding team, and to CQC. They were reviewed locally by the multidisciplinary team, and by the provider’s central risk department though the incident system.

For patients who might have impaired mental capacity, staff assessed and recorded their capacity to consent appropriately. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. They did this on a decision-specific basis with regard to significant decisions. Staff provided examples of when capacity assessments had been carried out, such as regarding financial decision making, or physical healthcare.

The service monitored adherence to the Mental Health Act and the Mental Capacity Act through its daily multidisciplinary team meetings and local and regional clinical governance processes.