Cygnet Raglan 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 this key question good. At this assessment the rating has remained good.

Good: This meant people’s outcomes were good, and people’s feedback confirmed this.

Good: Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through MDT 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.

We have not awarded this service a score for Effective.

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

The evidence showed a good standard. The service made sure people’s care and treatment were 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. We identified a patient who was non-compliant with physical health assessments since their admission. Staff told us that they had implemented mitigation strategies by using the 6-element framework for monitoring the physical health of patients with severe mental illness (SMI). This framework helps clinicians to carry out non-invasive observations, such as assessing physical appearance, Body Mass Index (BMI), skin integrity, and other clinical signs of physical deterioration. This was all documented in care records.

Staff developed personalised, holistic and recovery-oriented care plans, that met the needs identified during assessment. Care plans were recovery focused and identified patients’ immediate risk and needs. Staff updated care plans, when necessary.

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 (NICE). These included medication and psychological therapies and activities, training and work opportunities intended to help patients obtain living skills.

Group workshops were run by a team of different staff members. A variety of therapies and activities were offered to patients during these sessions. These activities were included in individual care plans to guide each patient's treatment.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. The provider had a GP attended the hospital weekly.

Staff participated in clinical audits, benchmark and quality improvement plans. Managers used results from audits to make improvements and discussed these with staff at team meetings. We also saw that they carried out monthly observation and engagement and CCTV audits.

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 (using the care certificate standards as the benchmark for healthcare assistants).

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) This included the appraisal of their work performance and ensured that staff had access to regular team meetings.

We observed that the provider supported professional development through secondment opportunities. Four staff members, including a Senior Nurse, an Assistant Psychologist, and an Administrator, enrolled in accredited enhancement courses. Management ensured that staff completed specialist clinical training tailored to their specific roles and responsibilities.

97.7% of staff had an appraisal in the last 12 months.

All staff received supervision, managerial is every 3 months and clinical supervision is monthly (for clinical staff).

Managers dealt with poor staff performance promptly and effectively.

We saw posters on the walls notifying patients about their detention rights displayed in communal areas and the visiting room.

Mental Health Act

All staff had completed their mandatory Mental Health Act (MHA) Awareness training. Staff had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. The Mental Health Act administrator was based on site, and staff knew how to access their support.

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 recorded where they had discussed with patients their rights under the Mental Health Act.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted.

Staff sought the opinion of a Second Opinion Appointed Doctor (SOAD) when necessary. The SOAD's role is to provide an additional safeguard to protect the patient’s rights, primarily by deciding whether certain treatments are appropriate.

Audits showed that staff ensured that the Mental Health Act was being applied correctly, and we saw evidence of learning identified from the audits.

We saw posters on the walls notifying patients about their detention rights displayed in communal areas and the visiting room.

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. We saw evidence of team working through our review of meeting minutes and an observation of a multidisciplinary team meeting. Staff held morning meetings daily to discuss patients’ care and treatment needs, progress and any risks associated.

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

The teams worked effectively with external teams (for example, local authority social services and GPs). We were told that social workers were involved in helping with social issues safeguarding and discharges.

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, reduced their future needs for care and support.

The provider promoted healthy eating and supported patients to make healthier choices. Patients had access to a good variety of food and told us the quality was good. Staff offered options that met different cultural and dietary needs, including Halal, Caribbean, vegetarian, and low-salt meals. Special dietary needs were also considered.

Staff encouraged patients to choose healthier options, including reducing sugar and processed foods. Alternatives such as sweeteners, fruit, and vegetables were available. Patients were supported to limit takeaway food, although staff used a least restrictive approach by offering advice, rather than imposing rules. Staff often ate with patients, which helped build positive relationships and encouraged healthy habits.

Staff supported patients to improve their health in other ways. This included support with stopping smoking, managing physical health risks, cancer screening, and substance misuse.

Staff used technology to support patients, including access to blood test results and online self-help tools. Patients could use mobile applications for support with stress, smoking cessation, and healthy living. Patients also worked with the psychology team and used sensory approaches to support their wellbeing.

Health promotion information was displayed on noticeboards in communal areas to support patients to make informed choices about their health.

Staff supported patients to take part in activities that promoted a healthy lifestyle. Patients had access to a range of activities based on their needs and preferences. This included walking in the community, using the onsite gym, swimming, sports, cooking, and arts and crafts.

Patients took part in activities such as shopping, music, and community litter picking. Access to some activities, such as the gym, was based on individual risk assessments to ensure safety.

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 (for example, Health of the Nation Outcome Scales).

Leaders told us that the organisation uses the ‘Global Assessment of Progress’ to measure and score outcomes of patients at admission and discharge. The manager told us they tracked complaints and compliments to monitor outcomes for patients. They also tracked patient feedback from other sources, for example, community meeting minutes and discharge surveys.

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.

Staff enabled patients to make advance decisions (to refuse treatment, sometimes called a living will) when appropriate and we were also told that patients had access to advocacy on a weekly basis.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. We saw evidence of this in the care records we reviewed. They did this on a decision-specific bases regarding significant decisions.

We saw evidence in the records that staff checked if patients could make their own choices. When a patient lacked capacity to make a specific decision for themselves, staff made best interest decisions, recognising the importance of the person’s wishes, feelings, culture and history.