Cygnet Raglan House

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

Requires Improvement: This meant people were supported and treated with dignity and respect; and involved as partners in their care.

Requires Improvement: This was due to concerns regarding patients' privacy and dignity. While some staff understood individual needs and involved patients in care planning, these positive elements were undermined by staff failing to consistently respect people's privacy and dignity. All 7 patients we spoke with reported that staff did not knock on bedroom doors and wait for a response before entering, and some told us that they did not treat them with compassion and kindness

This service scored 65 (out of 100) for this area.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

The evidence identified concerns relate to privacy, dignity, kindness and respect. Five patients told us staff regularly failed to treat people with kindness and compassion, whilst three patients told us staff were kind. We also observed practice that did not fully respect patients' privacy and dignity, which reflected concerns raised by patients during the assessment.

This was due to concerns regarding patients' privacy and dignity. While some staff understood individual needs and involved patients in care planning, these positive elements were undermined by staff failing to consistently respect people's privacy and dignity. All 7 patients we spoke with reported that staff did not knock on bedroom doors and wait for a response before entering, and some told us that they did not treat them with compassion and kindness. During the inspection, we observed a bedroom being entered after knocking but before a response was received. During feedback, the Hospital Manager explained that the patient had agreed in advance for inspectors to view their room and was expecting the visit. While we acknowledge this explanation, the observation was consistent with concerns raised by patients, regarding staff entering bedrooms without waiting for a response. However, the provider's therapeutic observation policy states that privacy and dignity should be balanced with the need to keep people safe. While there may be occasions where staff need to enter a patient's room promptly to complete welfare observations or respond to identified risks, concerns about staff not knocking and waiting for a response were raised consistently by patients during the assessment.

Two patients told us that some staff spoke in a language they did not understand, which affected how respected and included they felt. The Hospital Manager told inspectors that the service had measures in place to address this issue, including staff reminders, posters within the service, support from the site's Multi-Cultural Network Ambassador and expectations set out within the provider's Code of Conduct and Policy regarding the use of English in the workplace.

Patient feedback about care was mixed. Three patients told us staff were caring and treated them well, while five said staff were not caring. We also reviewed evidence provided by the service of positive feedback from patients, carers and other stakeholders. However, feedback obtained directly from people using the service at the time of the assessment remained mixed.

Staff told us they aimed to be discreet, respectful, and responsive, and said they provided support and advice when needed. Staff supported patients to understand and manage their care and referred them to other services when appropriate.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. Another patient told us that staff respected her religious needs.

Staff told us they could raise concerns about, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

Staff told us they maintained the confidentiality of information about patients.

The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service accommodated disabled patients; by ensuring they had easy access to the premises and met their communication needs. We saw disabled parking bays on the car park, wheelchair access ramp, wider doors and corridors, an evacuchair in the stairs and an elevator to other floors.

Staff ensured that patients obtained information on treatments, local services, patients’ rights and how to complain. We saw that there were leaflets on the noticeboards reminding patients to contact the Independent Mental Health Advocate (IMHA) to help them with their detention concerns weekly.

The provider demonstrated a personalised approach for patients by planning activities suited to their individual preferences and interests. For example, a trip was planned for patients in May to visit Alton Towers amusement park and Weston-Super-Mare beach.

Staff made information leaflets available in languages spoken by patients.

The information provided was in a form accessible to the particular patient group (for example, in easy-read form on wards for people with a learning disability).

Managers ensured that staff and patients had easy access to interpreters and/or signers. They had access to translation services for different languages. Staff told us that they valued the people’s culture and history, and made sure that everyone felt included, and understood.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. Staff ensured that patients accessed appropriate spiritual support. We were told that patients accessed local mosques, churches, temples and synagogues in the local community. Staff also told us there was a religious leader who attended the hospital weekly, and patients had access to a multi faith room to cater for their religious needs.

The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment, and wellbeing.

Patients and carers said they could talk to staff about their needs, which had a positive impact on their well-being. The manager told us that patients had access to many services like the GP clinic and carers groups.

During our inspection, we saw that staff respected patients’ consent and properly recorded this in their care records. Staff told us that when patients were unable to make decisions for themselves, they helped them with choices in their best interests. They stated that they made sure to respect the person’s individual wishes and feelings during this process. We found evidence in the records that these important best interest decisions were managed carefully to protect the patients' rights.

The evidence showed a good standard. The service listened to and understood people’s needs, views, and wishes. Staff responded to people’s needs at the moment and acted to minimise any discomfort, concern, or distress.

Staff we spoke with were very passionate and caring about giving patients good care. Staff told us that they made effort to know each patient individually to understand their early warning signs or triggers. During our visit, we observed staff assisting patients and taking them on escorts outside the ward.

Five patients told us there were not always enough staff available, and staff appeared busy. They said responses to non-urgent requests were sometimes delayed.

We saw evidence that staff supported each other during our inspection to make sure patients remained safe. The manager told us that when things got difficult, they use a "team approach" to manage incidents and stay on top of their tasks.

Staff told us that they knew their patients well and prioritised de-escalation techniques over restrictive physical interventions when managing patients.

The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Staff told us they felt respected, supported, and valued by the management team and that they can raise concerns at any time. Staff said that the manager and team leaders were highly supportive, with one person describing the support they received after a difficult incident with a patient as "overwhelmingly positive."

Staff told us they felt positive and proud about working for the provider. The manager told us that team morale was high. Staff were proud of their hard work regarding their training and development. We were told by the leaders about supporting a Trainee Nurse Associate through their university award, and staff told us they felt empowered to be creative and engage in their roles.

The manager created a peer support group to encourage staff across the network to help and connect with each other.

The manager also told us that staff had access to extensive support for their physical and emotional health needs. The provider organised staff wellbeing events outside of the hospital, and introduced staff support groups during the day, which staff can attend to relax.

The service provided 2 staff support sessions per week, on Tuesdays and Fridays, led by hospital management or members of the Multi-Disciplinary Team. The service provided staff with initiatives like staff pamper sessions, celebration days (such as international nurses' day), team building days (such as the Big Quiz) and staff rewards day. Managers booked extra staff to cover the shifts where necessary. Staff stated that these sessions, along with employees of the month's awards, made them feel supported and cared for in their roles. We were told that patients and visitors were encouraged to vote and get rewarded. The manager also said they send emails monthly with recognition of the feedback.

The service’s staff sickness and absence were similar to the national average for the provider.

The provider recognised staff success within the service – for example, through staff awards. Staff appraisals included conversations about career development and how it could be supported.