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Cygnet Storthfield House Good

Inspection Summary


Overall summary & rating

Good

Updated 18 January 2019

We rated

Cygnet Storthfield House as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national best practice guidance. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured staff received training, supervision and appraisal in line with the providers policy. The ward staff worked well together as a multi-disciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service worked to a recognised model of mental health rehabilitation. It was well led, and the governance processes ensured ward procedures ran smoothly.

However:

  • Staff had not completed intermittent observations of patients as per the Mental Health Act Code of Practice and the Cygnet policy and procedure.
Inspection areas

Safe

Good

Updated 18 January 2019

we rated safe as good because

:

  • All wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose.

  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep people safe from avoidable harm.

  • Staff assessed and managed risks to patients and themselves well and achieved the right balance between maintaining safety and providing the least restrictive environment possible to facilitate patients’ recovery. Staff followed best practice in anticipating, de-escalating and managing challenging behaviour. As a result, they used restraint only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme.

  • Staff understood how to protect patients from abuse and/or exploitation and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and/or exploitation and they knew how to apply it.

  • Staff had easy access to clinical information and it was easy for them to maintain high quality clinical records – whether paper-based or electronic.

  • Staff followed best practice when storing, dispensing, and recording the use of medicines. Staff regularly reviewed the effects of medications on each patient’s physical health.

  • The wards had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However

  • Staff had not completed intermittent observations of patients as per the Cygnet policy and procedure.

Effective

Good

Updated 18 January 2019

We rated effective good because:

  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which staff and patients reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the assessed needs, were personalised, holistic and recovery-oriented.

  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. This included access to psychological therapies, to support for self-care and the development of everyday living skills, and to meaningful occupation. Staff ensured patients had good access to physical healthcare and supported patients to live healthier lives.

  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives.

  • The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. The managers made sure they had staff with a range of skills need to provide high quality care. They supported staff with appraisals, supervision, reflective practice sessions and opportunities to update and further develop their skills. The manager provided an induction programme for new staff.

  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The ward team had effective working relationships with staff from services that would provide aftercare following the patient’s discharge and engaged with them early in the patient’s admission to plan discharge.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. The manager and the Mental Health Act administrator made sure staff could explain patients’ rights to them.

  • Staff supported patients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

However:

  • The hospital had introduced a physical health screening tool National Early Warning Scores to support staff to monitor patients’ physical health and on two patient records staff had not completed the tool correctly.

Caring

Good

Updated 18 January 2019

We rated caring as good because:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.

  • Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. Service users’ views were incorporated, even when they differed from the clinical team’s. Staff ensured patients had easy access to independent advocates.

  • Staff informed and involved families and carers appropriately.

Responsive

Good

Updated 18 January 2019

We rated responsive as good because:

  • Staff planned and managed discharge well. They liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway. As a result, most patients did not have excessive lengths of stay and staff had not delayed a discharge other than for a clinical reason.

  • The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an ensuite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.

  • The food was of a good quality and patients could make hot drinks and snacks at any time. When clinically appropriate, staff supported patients to self-cater.

  • The wards met the needs of all people who use the service – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

Well-led

Good

Updated 18 January 2019

We rated well-led as good because:

  • Leaders had a good understanding of the service they managed, and it adhered to a recognised model of rehabilitation care. Leaders had the skills, knowledge and experience to perform their roles, were visible in the service and approachable for patients and staff.

  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

  • Staff felt respected, supported and valued. They reported the provider promoted equality and diversity in its day to day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

  • Our findings from the other key questions demonstrated governance processes operated effectively at ward level and performance and risk were managed well.

  • Ward teams had access to the information they needed to provide safe and effective care and used that information to good effect.

  • Staff engaged actively in local and national quality improvement activities.

Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 18 January 2019