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Cygnet Sherwood House Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 26 April 2019

We rated Sherwood House as outstanding because:

  • There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Staff actively involved patients, families and carers in care decisions to make sure patients were active participants in their care and treatment.
  • Feedback from patients, relatives and stakeholders was continually positive about the way staff treated patients. Patients told us that staff went the extra mile and their care and support exceeded their expectations.
  • The service was tailored to meet the needs of individual people and was delivered in a way to ensure flexibility, choice and continuity of care.
  • There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that meets these needs and promotes equality. This included patients with complex needs.
  • The service provided safe care. The environment was safe and clean. There were 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 high dependency rehabilitation ward and in line with national best practice guidance. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The hospital team included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. The staff worked well together as a multidisciplinary team and with those outside the hospital 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 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 high dependency mental health rehabilitation. It was well led, and the governance processes ensured that hospital procedures ran smoothly.

However:

  • There had been four consultant psychiatrists in the last two years and the current one was also leaving. Patients said this affected their wellbeing as they thought they had to explain how they felt repeatedly to a new doctor.
  • One medication prescribed to a patient for the side effects of their mental health medication was not included on their consent to treatment form.
Inspection areas

Safe

Good

Updated 26 April 2019

We rated safe as good because:

  • The hospital was 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 in order 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 hospital staff participated in the provider’s restrictive interventions reduction programme.
  • Staff understood how to protect patients from abuse and/or exploitation and 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 hospital had a good track record on safety. Staff managed patient safety incidents well, 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.

Effective

Good

Updated 26 April 2019

We rated effective as good because:

  • 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. 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, support for self-care and the development of everyday living skills, and meaningful occupation. Staff ensured that 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 hospital team included or had access to the full range of specialists required to meet the needs of patients. 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. Managers 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 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. Managers made sure that 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:

  • There had been several changes in consultant psychiatrists which meant that patients often had to get to know a new doctor during their stay.
  • Two of the 10 medication charts we looked at did not include up to date information on the patient’s consent to treatment form. One medication prescribed for a patient had not been included on this, so it was not clear whether the patient had consented to this.

Caring

Outstanding

Updated 26 April 2019

We rated caring as outstanding because:

  • There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between patients, those close to them and staff were strong, caring, respectful and supportive. These relationships were highly valued and promoted by staff.
  • Staff treated patients with compassion and kindness. Staff truly respected and valued patients as individuals and empowered patients as partners in their care, practically and emotionally. Patient’s individual preferences and needs were always reflected in how care was delivered.
  • Feedback from patients, those who are close to them and stakeholders was continually positive about the way staff treated patients. Patients said staff went the extra mile and cared for them in a way that exceeded their expectations.
  • Staff 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 saw patients’ emotional and social needs as equally important as their physical needs.
  • Staff recognised and respected the totality of patients' needs. They always considered patients' personal, cultural, social and religious needs into account.
  • Patients and those close to them were active partners in their care. Staff were fully committed to working in partnership with people and making this a reality for each patient.
  • Staff empowered patients to have a voice and to realise their potential. They showed determination and creativity to overcome obstacles to delivering care. Patients' individual preferences and needs were always reflected in how care was delivered.
  • Staff actively supported patients to access advocacy and support networks in the community. They ensured that patients' communication needs were understood, sought best practice and learnt from it.

Responsive

Outstanding

Updated 26 April 2019

We rated responsive as outstanding because:

  • Patients’ individual needs and preferences were central to the delivery of the service. Staff had embedded innovative approaches to provide care to meet patients' individual needs and preferences. Staff were flexible, provided choice and ensured continuity of care.
  • The involvement of other organisations and the local community was integral to how the service was planned and ensured the service met patients' needs. Staff used innovative approaches to providing patient-centred pathways of care that involved other service providers, particularly for patients with complex needs.
  • Staff had a proactive approach to understanding the needs of different groups of patients and delivered care in a way that met patients’ needs and promoted equality. This included patients with complex needs and patients with protected characteristics under the Equality Act 2010. Staff helped patients with communication, advocacy and cultural and spiritual support.
  • 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, patients did not have excessive lengths of stay and discharge was rarely delayed for any reason except for clinical reasons.
  • The food was of a good quality and met patients’ individual dietary and cultural needs. Patients could make hot drinks and snacks at any time. When clinically appropriate, staff supported patients to self-cater.
  • Facilities and premises met the needs of a range of patients. The design, layout, and furnishings of the hospital supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an ensuite shower room and could keep their personal belongings safe. There were quiet areas for privacy.
  • 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 26 April 2019

We rated well-led as good because:

  • Leaders had a good understanding of the service they managed, and it adhered to the high dependency 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 that 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 that governance processes operated effectively at ward level and that performance and risk were managed well.
  • Staff 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 quality improvement activities.
  • However:
  • There had been difficulty in retaining a consultant psychiatrist to work in the hospital and this had meant that these changed often during a patients stay. 
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Outstanding

Updated 26 April 2019