Cygnet Hospital Oldbury

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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.

This is the first assessment for this newly registered service. This key question has been ratedGood

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

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.

We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 6 patient care records. Staff completed a comprehensive mental health assessment of the patient at, or soon after admission.

Staff developed care plans that met the needs identified during assessment. They were comprehensive, personalised and holistic. Staff discussed patient care and treatment regularly and updated the care record following incidents and multidisciplinary review. However, they were not written in the patient's voice and appeared to be written for staff so were task orientated, rather than recovery focused.

Staff completed positive behavioural support plans (PBS) for patients which detailed early warning signs and described ways in which staff could help to alleviate any distress when patients became agitated. However, 1 patient did not have a plan in place.

We plan and deliver people's care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment suitable for the patients in the service. The service had a full multidisciplinary team and a comprehensive staged model of care which staff were able to explain. Posters were displayed throughout the hospital which were designed to help patients understand the staged model of care.

The team included a full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, there was full complement of multi-disciplinary staff including occupational therapists, clinical psychologists, social workers, activity coordinators and an expert by experience.

Staff provided a range of care and treatment which was in line with best practice and national guidance. A range of staff from different disciplines completed assessments and planned care and treatment well that met their psychological, medical and physical health needs. They used a range of assessment tools and offered a range of different therapies including Dialectical Behaviour Therapy (DBT) Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing Therapy (EMDR)

There was a comprehensive occupational therapy programme in place which offered a variety of recovery-based activities for the patients. Patients were involved in planning activities relevant to their goals. These included activities that focused on daily living skills, healthy lifestyles, and social skills.

Patients told us that there were a wide range of activities that took place daily which met their needs, however they would like more activities in the evening. Activities that took place included arts and crafts, cooking classes, music, animal and pet therapy, and they had access to allotments within the local community.

Staff identified patients' physical health needs and recorded them in their care plans. Records showed that all patients had a physical examination on admission and individual needs were continually monitored and reviewed. We saw evidence and liaison with local primary health including GPs and dental treatment.

Staff met patients' dietary needs and assessed those needing specialist care for nutrition and hydration. Staff told us that they were aware of dietary needs through information given in admission and through ongoing health care monitoring.

Dietary needs were held in care plans and in the kitchen of the ward, where religious needs were also accounted for.

Staff helped patients live healthier lives by supporting them to take part in programmes or giving advice. The hospital promoted healthy eating by encouraging a healthy diet. Menus viewed showed a range of healthy options. Some patients told us that they did not always enjoy the food as it was too traditional and the options did not always meet their preference. Patient also told us that mealtimes were not flexible.

There was also an onsite gym which was available for patients to use. Patients told us that they could not always use this if there were not sufficient staff available to support them.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. Staff discussed clinical audit findings in monthly governance meetings and shared findings and learning across the service group. Managers used results from audits to make improvements and discussed these with staff at team meetings

Most staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers recruited new staff who were caring and compassionate. They acknowledged that it had taken some time for new staff to gain experience and confidence in their roles, however there was an appropriate blend of skill mix and experience amongst the teams. At the time of our inspection there had been some changes to the leadership on the wards. Staff told us they viewed these changes as positive. Managers provided new staff with an appropriate induction and ensured that shadowing opportunities took place.

Managers provided staff with supervision and appraisal of their work performance. At the time of inspection managerial supervision compliance was at 97% however clinical supervision was 76%. The manager told us that an action plan was in place to increase this rate. This was evidenced within clinical governance meetings.

Managers dealt with poor staff performance promptly and effectively. Ward managers investigated concerns around practice and appropriate actions were taken including disciplinaries and support for learning and development.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff told us that they received specialist training which met the needs of patients and were confident that if they asked for additional training managers would support them with this. Managers ensured that staff had access to regular team meetings to provide feedback and discuss items related to the safe functioning of the ward.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

Staff held regular multidisciplinary meetings to discuss patients and improve their care. Daily multi-disciplinary meetings took daily with a range of staff from psychiatry, psychology, nursing and occupational therapy. These meetings were effective in discussing a range of issues including changes to clinical risk, incidents, changes in observation levels, leave, medication and patient views. We observed that during this meeting staff took the opportunity to discuss and celebrate the progress and achievements of patients. Issues related to the safe running of the service were also discussed including staffing, training and environmental issues.

Multi-disciplinary ward rounds took place weekly, and each patient had a monthly review. These were attended by patients and external stakeholders.

Staff made sure they shared clear information about patients and any changes in their care, including during handover meetings. We saw evidence of effective handovers between shifts and detailed handover notes which included a brief overview of the patient’s presentation, concerns, risks and activities. Handover notes also included actions to be taken on the following shift such as additional health monitoring or planned appointments.

The manager and senior clinicians attended regular regional meetings. Ward teams had effective working relationships with external teams and organisations. Staff told us that that they had positive working relationships with the local authority safeguarding teams and community mental health teams.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Patients’ physical health needs were assessed and documented within care plans. These were routinely monitored and reviewed.

Staff told us they understood the importance of ensuring patients’ physical health needs were met. Staff had appropriate training to ensure that they were able to effectively assess and monitor physical health needs and had access to other healthcare professionals.

Patients had access to healthy snacks and drinks, health and wellbeing activities were available and there was access to a dedicated gym.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

Leaders told us that the organisation uses the‘Global Assessment of Progress’ to measure and score outcomes of patients at admission and discharge. We were unable to review any scores at the time of inspection due to issues with collecting data internally. Leaders had discussed this issue at clinical governance and had escalated this within the organisation.

Managers 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 psychology team ran a Dialectical Behaviour Therapy (DBT) Skills group twice weekly on Rosa Ward (PICU). The group aims to teach skills to promote emotion regulation and tolerance of distress to service users who were presenting with self-harming behaviours, harm to others, or difficulties managing their emotions.

On completion of the course the team collated feedback. The feedback we saw was overwhelmingly positive. Patients said that they had found the strategies and skills taught as helpful and useful. Feedback also suggested some areas for improvement around sensory needs that would be implemented in the future.

Staff discussed clinical audit findings in a monthly governance meeting and shared findings and learning across the service group. Managers used results from audits to make improvements and discussed these with staff at team meetings.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

Staff understood the importance of ensuring that people fully understand what they are consenting to and the importance of obtaining consent. We saw evidence in care plans of staff seeking consent to care and treatment. Staff explained rights to patients detained under the Mental Health Act and ensured they understood them. Patients told us that they were regularly informed of their rights.