Cygnet Victoria House

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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 assessment we rated effective as good. At this assessment the rating has remained good.

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.

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 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 completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Multidisciplinary team (MDT) ward rounds occurred routinely, where risk assessments and care plans were reviewed with the patient present. Patients were offered copies of their care plans and asked to sign to confirm agreement or note any concerns. Family members, carers, and advocates were involved where appropriate, with options to join online or by telephone. Independent advocacy was automatically offered in line with legal requirements, and an on-site advocate supported with benefits and rights.

Staff used individualised approaches to communication, including visual aids and hand signals for patients with sensory or speech difficulties, ensuring care was led by patient preferences. Capacity assessments were requested when needed for specific decisions, and best interest meetings were held where required. Daily morning meetings reviewed risks and observation levels, supported by structured handovers and documentation tools. Staff developed care plans that met the needs identified during assessment.

Care plans were personalised, holistic and recovery oriented. Staff updated care plans when necessary. Staff assessed patients’ physical health needs in a timely manner after admission. For example, 100% of respondents to a Patient Satisfaction Survey stated they felt enough care is taken of any physical health problems such as diabetes, asthma and heart disease.

Patients were actively involved in planning activities and escorted leave. Before leave, staff discussed risks and requirements during handover and morning meetings, ensuring safety and engagement. Activities such as football competitions, cinema trips, and community outings were offered, alongside themed events like World Mental Health Day. Staff adapted plans based on patient choice, for example, adjusting leave duration if a patient wished to return early.

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. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medication and psychological therapies and activities intended to help patients acquire living skills.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration where needed. Patients had access to facilities to make themselves drinks, and where, necessary, access to these had been risk assessed.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, there were occupational therapists embedded in the MDT and a review process to support patients with their treatment. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff with appropriate induction to the service and the ward they worked on. Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. The percentage of staff that had had an appraisal in the last 12 months was 92%.The percentage of staff that received regular supervision was 92% for clinical supervision and 93% for management supervision. Managers dealt with poor staff performance promptly and effectively.

Managers ensured that staff received the necessary specialist training for their roles. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff told us, they felt supported and the level of training they received helped them to do their job well. Managers ensured that staff had access to regular team meetings.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. 97.3% 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 were. The provider had relevant policies and procedures that reflected the most recent guidance.

Patients had easy access to information about independent mental health advocacy. 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 has been granted. Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Staff requested an opinion from a second opinion appointed doctor (SOAD) 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. The service displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to Section 3 or equivalent Part 3 powers authorising admission to hospital for treatment (if applicable).

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 meetings.

The teams had effective working relationships, Staff shared information about patients at effective handover meetings within the team (for example, shift to shift) and with other relevant teams within the organisation, for example, care co-ordinators, community mental health teams, and the crisis team.

The teams had effective working relationships with teams outside the organisation (for example, local authority social services and GPs). We attended MDT meetings and reviews where we observed good communication with teams, particularly for people who were placed out of area.

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.

Staff supported patients to live healthier lives. For example, advice relating to smoking cessation schemes, healthy eating advice and dealing with issues relating to substance misuse were available to patients. Staff had received training in physical health care.

Ward activities helped promote a healthy lifestyle for patients – for example sports activities and cooking healthy meals. There was Occupational Therapy support to help people with the skills to do this where needed.

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 recognised rating scales to assess and record severity and outcomes. These included the Global Assessment of Functioning scale and the provider’s ‘PARA’ risk assessment tool which was in-line with recognised tools used in the mental health sector. Outcomes were also measured through 1-to-1 time with the patient’s named nurse and community meetings on the wards.

Staff used technology to support patients. Patients had access to phones and could use video links to maintain contact with family members and friends.

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 took all practical steps to enable patients to make their own decisions. We observed discussions on a 1:1 basis and in MDTs where people were supported to do this and we saw evidence of it in the care records we reviewed.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.