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Cygnet Fountains Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 31 December 2019

We rated Cygnet Fountains as Outstanding 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 longer-term high dependency mental health rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • There was an effective and creative approach to understanding the needs of different groups of people and to deliver care in a way that meets these needs and promoted equality. This included patients with complex needs.
  • There was a mix of highly skilled staff who used a wide variety of recognised tools and rating scales to support patients in their recovery. Staff were involved in clinical audits and in quality improvement initiatives to improve their practice and outcomes for patients.
  • Managers ensured that staff received training, supervision and appraisal. The continuing development of the staff’s skills, competence and knowledge is recognised as being integral to ensuring high quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills and share best practice.
  • Staff were committed to working collaboratively and had found innovative and efficient ways to deliver more joined up care. Staff worked well with external agencies 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. Patients who used the service were active partners in their own care and the staff team were fully committed to working in partnership with patients. Staff empowered patients to have a voice and to realise their potential in their rehabilitation and recovery pathway.
  • The Fountains had employed a peer support worker to work alongside patients to enable patients to share and discuss their issues with someone who has had lived experience. They had developed a people’s council where patients were encouraged and supported by advocates to make decisions about the service and where patients could give feedback about the Fountains. This was then developed into an action plan to make improvements for the patients.
  • Patients emotional and social needs were highly valued by the staff team and imbedded in their care and treatment.
  • 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 that ward procedures ran smoothly.
  • There was a systematic and integrated approach to monitoring, reviewing and providing evidence of progress against the strategy and plans. Plans were consistently implemented and had a positive impact on quality and sustainability of services.
  • There was a demonstrated commitment to best practice performance and risk management systems and processes. The organisation reviewed how they functioned and ensured that staff at all levels had the skills and knowledge to use those systems and processes effectively. Problems were identified and addressed quickly and openly.

However;

  • There were limited rooms available for patients to access that were quiet and provided a therapeutic space. This also included the lack of suitable space to see visitors in.
  • Patients we spoke with told us they would prefer more male staff.
Inspection areas

Safe

Good

Updated 31 December 2019

  • There were enough staff with the right skills to meet the needs of the patients.

  • The unit was safe, clean, well equipped, well furnished, well maintained.

  • Staff assessed and managed risks to patients and themselves well. They 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 ward staff participated in the provider’s restrictive interventions reduction programme.

  • Risk assessments and management plans were thorough, easy to understand and individual to the patient.

  • Staff managed medicines safely and effectively. Medication was monitored effectively through regular internal and external audits. Medicines were stored safely, and fridge and room temperatures were monitored. Medication errors were reviewed and managed effectively.

  • Staff had received training in safeguarding and reported concerned appropriately.

  • Incidents were investigated thoroughly. Staff and patients received debriefs and incidents were used as a learning opportunity. Changes were made as a result of incidents.

Effective

Outstanding

Updated 31 December 2019

We rated effective as outstanding because:

  • There was a truly holistic approach to assessing planning and delivering care and treatment to all people who used services. Staff comprehensively assessed the physical and mental health needs of patients on admission to the service and throughout their stay. Care plans were person-centred, recovery focused and truly holistic. They were also goal orientated and had clear and measurable goals which were reviewed and adapted regularly. Records contained self-assessments in which patients reviewed their own concerns, strengths and feelings.

  • There was a mix of highly skilled staff who used a wide variety of recognised tools and rating scales to support patients in their recovery. Staff were involved in clinical audits and in quality improvement initiatives to improve their practice and outcomes for patients.

  • The continuing development of the staff’s skills, competence and knowledge is recognised as being integral to ensuring high quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills and share best practice.

  • Staff were committed to working collaboratively and had found innovative and efficient ways to deliver more joined up care. Staff worked well with external agencies to provide increased support for patients.

  • There were a variety of meetings to enable staff to review patents progress and concerns. Meetings were goal orientated, effective and provided the opportunity for staff to share their expertise for the benefit of the patients.

  • Staff engaged in reflective practice and formulation meetings which provided an opportunity to reflect on their practice and improve how they worked with patients.

  • Staff were consistent in supporting patients to live healthier lives including identifying those who needed extra support through a targeted and proactive approach to health promotion and prevention of ill health. All patients had a separate physical health file where their health was monitored and there was a full range of opportunities for improving physical health.

Caring

Outstanding

Updated 31 December 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 by staff and promoted by leaders.

  • Staff 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. They ensured that patients had easy access to independent advocates.

  • Staff informed and involved families and carers appropriately.

  • Staff always empowered patients to have a voice and to realise their potential in their rehabilitation and recovery pathway. Patients who used the service were active partners in their own care and the staff team were fully committed to working in partnership with them. They showed determination and creativity to overcome obstacles to delivering care. People’s individual preferences and needs were always reflected in how care was delivered.

  • Patients emotional and social needs were highly valued by the staff team and were imbedded in their care and treatment. Patients felt really cared for and that they mattered.

Responsive

Good

Updated 31 December 2019

We rated responsive as good because:

  • Staff planned and managed admission and 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 other than a clinical reason.

  • Each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe.

  • The food was of a good quality and patients could make hot drinks and snacks at any time.

  • The wards met the needs of all patients who used the service – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support and responded to the needs of patients within the LGBT plus community.

  • There was a proactive approach to understand the needs of different groups of patients and to deliver care in a way that meets their needs and promotes equality This includes people who are in vulnerable circumstances or who have complex needs.

  • 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.

  • The fountains had employed a peer support worker to work alongside patients to enable patients to share and discuss their issues with someone who has had lived experience.

  • The fountains had developed a people’s council where patients are encouraged and supported by advocates to make decisions about the service and where patients could give feedback about the fountains. This was then developed into an action plan to make improvements for the patients.

However:

  • There were limited quiet and therapeutic areas available.

  • The visitor's room was not fit for purpose because the server to the building was kept there making it noisy and distracting for patients and their families.

Well-led

Outstanding

Updated 31 December 2019

We rated well-led as outstanding because:

  • There was compassionate, inclusive and effective leadership at all levels. Leaders at all levels demonstrate the high levels of experience, capacity and capability needed to deliver excellent and sustainable care.

  • Comprehensive and successful leadership strategies were in place to ensure and sustain delivery and to develop the desired culture. Leaders had a deep understanding of issues, challenges and priorities in their service, and beyond.

  • There was a systematic and integrated approach to monitoring, reviewing and providing evidence of progress against the strategy and plans. Plans were consistently implemented and had a positive impact on quality and sustainability of services.

  • There were innovative approaches to providing integrated person-centred care.

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

  • Staff were proud of the organisation as a place to work and spoke highly of the culture. Staff at all levels were actively encouraged to speak up and raise concerns, and all policies and procedures positively support this process.

  • 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.

  • There was a demonstrated commitment to best practice performance and risk management systems and processes. The organisation reviewed how they functioned and ensured that staff at all levels had the skills and knowledge to use those systems and processes effectively. Problems were identified and addressed quickly and openly.

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

  • There was a great commitment toward continual improvement and innovation and the service was very responsive to feedback from patients, staff and external agencies.

  • There was clear learning from incidents.

  • The service had been proactive in capturing and responding to patients concerns and complaints. There were creative attempts to involve patients in all aspects of the service.

Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Outstanding

Updated 31 December 2019