Cygnet Paddocks

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this registered service. This key question has been rated good. This meant service leadership had aspired to create a service culture that drove and improved high-quality, person-centred care.

Managers and staff had a shared direction, vision and values. Leaders were inclusive, accessible and visible at the service. There was a clear management structure and staff understood their individual roles and responsibilities and how these interacted with the wider teams. There was strong and effective leadership throughout the service. Staff were very positive about the service, managers and the culture, they were encouraged to feedback to managers and action was taken on concerns that they raised. Managers had a good understanding of the service, the challenges they faced and were effective in addressing these challenges. The service was focussed on continuous learning and shared this learning across local systems. Systems and processes for governance and quality monitoring were effective. Staff collaborated with partner agencies to ensure patients had access to the services they required and to achieve good outcomes. There was a strong focus on learning and improvement.

We have not awarded this service a score for Well-led.

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

The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff we spoke to told us the leaders of the service, were visible, open and supportive, creating a positive culture for staff to work in. The vision and values of the service were embedded into the therapeutic and treatment model. Managers engaged staff in decisions about the service, as part of the open culture of the service and patients and staff were encouraged to give feedback where possible. Feedback from a commissioner in relation to quarterly quality submissions received by an integrated care board (ICB) supported this key question summary.

Staff were highly motivated and proud of the service and worked collaboratively internally and externally to provide high quality care and treatment. All three wards at Cygnet Paddocks Hospital were operating at the time of this assessment. Occupancy was increasing and the registered manager demonstrated through governance reports and patient feedback how the service had evolved in the twelve months since opening. This included an additional ward manager post for Roan ward, which was not in the initial staff budget and to support the successful discharge of patients to community living. Staff feedback during interviews was changes to the service had been based on their feedback and working in partnership with the MDT to continue with improvement of the service. Staff we spoke with shared this vision and were motivated to provide person cantered care and support for all patients. Staff were proud of improvements made and how this improved outcomes for patients and the service culture.

Communication between managers, staff, relatives and patients was effective and facilitated via regular meetings and care and treatment reviews.

The evidence showed a good standard. The service had motivated inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They demonstrated integrity, openness and honesty in their approach to patient care and inclusion in their care and treatment.

Leaders had a good understanding of the service they managed, and the patient group which they served. Senior leaders worked closely with staff, and were onsite, meaning patients and staff could access them, ensuring communication was open. We observed that leaders were knowledgeable about the patients using the service. The registered manager and clinical lead worked flexibly including late and twilight shifts to promote their visibility, be available for support and listen to concerns across all shift patterns. In addition, the registered manager completed one unannounced visit to the service per month between the hours of 20:00 and 07:00 as per the provider guidance. In addition, leaders fulfil their roles by supporting the clinical team through active role modelling, support and succession planning, which we would expect a good service to do.

Leaders were visible in the service, approachable and accessible for patients and staff. Staff reported they could raise any concerns they had with them. Patients and relatives could contact the registered manager directly to share any feedback with them.

The service ensured patients goals and aspirations were present within care records and work to ensure patients and relatives concerns were heard and acted on. The service had a ‘you said, we did’ process which highlighted what actions had been taken in response to patient and staff feedback

Staff told us that they felt supported by leaders and senior staff members and could approach them to raise concerns or support when needed. Staff were motivated by and proud of the service. There was consistent levels of constructive engagement with patients and staff. There were regular team meetings, training days and clinical supervision. These forums allowed staff to feedback on how to improve service and discuss concerns openly.

Staff were encouraged to access training opportunities and supported to attend to help improve the variety of therapies on offer to clients.

Staff told us they were supported by their managers and by the provider. A staff member said “As a housekeeper I am an important part of the whole team and valued. The management team have an ‘open door’ policy, very visible and approachable”.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service had policies in place to support whistleblowing, which established a clear procedure for the investigation of concerns raised.

Staff told us that they felt confident to raise concerns, and that management were open and available to speak to. Staff told us there was a culture of openness and honesty in the service. Feedback from a commissioner was the ICB received quarterly quality submission for the service and the ICB were assured regarding workforce and freedom to speak up were not identified as an outlier within that assurance.

Managers told us that staff were encouraged to share with their feedback in team meetings and supervisions, to discuss collectively, or staff could discuss concerns directly with senior management through their open-door approach. Staff feedback was used to influence the service’s practices and working environments.

No concerns had been raised by staff via the provider’s freedom to speak up channels. The provider had a whistleblowing management process. There was a central e-mail for any concerns staff wished. Staff were able to submit concerns on an anonymous basis if they wished to. Some staff had additional responsibilities such as ‘speak up champions’.

The provider had developed a speak up approach across the wider organisation and leadership teams. This included a ‘freedom to speak up’ organisational structure with leads and champions across staff grades and a speak up forum.

The evidence showed an outstanding standard. The service valued diversity in their workforce and protected staff from discrimination. They work towards an inclusive and fair culture by improving equality, equity and safety for people who work for them.

We spoke with the registered manager about their inclusive staff recruitment policies and three recently recruited staff gave us examples of the recruitment process. Staff gave examples of how reasonable adjustments had been made to support staff to carry out their roles, for example, to accommodate childcare responsibilities, and flexible working. Staff described a positive open culture and an improved morale amongst the team.

The service had policies in place for equality and diversity and had systems in place to monitor equality practices. Staff had training in equality and diversity.

Senior leaders responded to concerns of racism and staff were supported during August 24, during civil unrest and were fearful of travelling to and from work on public transport, as staff had experienced racial discrimination. Staff were supported through drop-in sessions facilitated by senior leaders and supported by psychologist to allow them a safe space to discuss their feelings and concerns. Staff were supported by the service paying for taxis to work or picking them up in service minibus during this time to ensure staff were safe travelling to and from work.

The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The provider governance was well established into the running of the service. There was a framework of accountability to monitor performance and risk leading to the delivery of quality improvements to the service. There were systems and procedures in place to ensure effective oversight of performance, including that staff were compliant with training, had access to regular supervision, appraisals and were involved in MDT meetings. There were routine audits of care records to ensure assessment and treatment of patients was compliant with organisational internal procedures, and findings from these audits were discussed with the team. The service also completed quality reports to external partners and funding bodies, which provided additional monitoring and communication with partners.

The governance structure included clinical governance, safeguarding, health and safety, infection prevention and control and quality-meeting cycles. Governance included themed audits based on the CQC five key questions. Staff understand their responsibilities through clear job descriptions and supervision, and managers could account for performance and behaviours.

Care records were clear and detailed and identified patients’ risks, and mitigation actions and processes that had been put in place and there was clear evidence of discharge planning as part of the assessments.

The service had an operational risk register in place, which had regular quarterly reviews which updated the current position of risks. Senior managers were aware of areas where improvements could be made and had taken mitigating actions to improve care and treatment for patients. This included filling 3 vacancies that had occurred due to internal promotion and appointing a permanent medical director. There were no vacancies within the service, and there was an action plan in place to respond to referrals, anticipated admissions and to increase staffing as patient numbers increased.

Governance meetings were held monthly. A standard agenda included a review of previous meeting minutes; patient and carer experience; participation and engagement; incidents; staffing; clinical effectiveness; continuous improvement; health and safety; risk register and lessons learnt.

The service had a plan for ongoing maintenance across the site, which included all communal areas as well as patient bedroom areas. Each task has a priority rating, staff recorded updates as applicable, and completion dates were entered as appropriate. This enabled managers and staff to keep a track of progress.

The provider had an external survey completed by contractors during the refurbishment of the building, which included a grounds improvement plan, enhanced the outside space, and provided security and privacy to patients. The registered manager was in the process of having a survey of the car park completed to increase parking space, due to increased car parking.

The evidence showed a good standard. The service understood and carried out their duty to collaborate and worked in partnership, and services worked smoothly for people. They shared information, learning and collaborated with partners for continued improvement.

The registered manager and staff worked well with healthcare professionals, commissioners and independent care boards regularly. Feedback from external partners was generally positive and highlighted the service had improved since opening to work in improving the service provision, however, further improvement could be made in communicating with case managers, when changes to patient’s care and treatment change, for example transfer to an acute hospital. The service had also set up weekly online meeting with commissioners to feedback from the MDT or discuss individual patients. The treatment model had been refined and improved partnership working with through commissioners and other visiting professionals feedback, which increased the patients’ access to therapeutic activities such as caring for chickens on site.

The service had worked to improve engagement with patient’s families, their carers, commissioners and patient’s health care professionals to provide information on treatment and recovery. They sought updates to ensure care coordinators were doing everything they could to secure new placements so patients could move on and there were no delays in discharge.

Leaders, managers and staff strived for improvement through consultation, therapist led innovation, research and reflective practice. Patients had access to the services they required, an independent advocate and to care coordinators.

Feedback we reviewed showed that staff and leaders were open, transparent, and worked well with system partners.

The evidence showed an outstanding standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome, and quality of life for people. They actively contribute to safe, effective practice and research.

Staff and leaders were motivated to learn and improve. They told us they planned to employ permanent staff to substantive therapy team posts. Improvements were planned for IT systems and to the staff induction process.

The service had a strong emphasis on continuous improvement, and the treatment approach reflected a person-centred approach and a learning culture based on listening and engagement with patients, families, carers and stakeholders. Feedback from stakeholder was learning lessons at the service had improved and provided examples of reduction in the level of patient observations, medicine checks, social media privacy and contraband and identified actions for each area provided.

There was a systematic monitoring of incidents, audits, outcomes and staffing levels. Innovation was supported within safe boundaries, for example, trialling new therapeutic tools with risk oversight).

Co-production included quality improvement (QI) projects, for example, updating menus and ward round documentation based on patient feedback. A QI project was the service had 5 chickens on site, which patients cared for and feedback on this was how it improved patient’s confidence social skills.

There was a bespoke peer support volunteer providing support for patients by acting as a role-model and supported patients’ long-term rehabilitation.

The provider had a complaints procedure. All complaints were recorded and responded to by the ward manager or hospital director appropriately.

An action plan and progress tracker was used to make improvements to issues identified by patients, their families, staff and stakeholders.

The service had developed its own audits processes outside of the provider policies in response to the needs of the service and included, lessons learned and learning from incidents. Examples included a weekly named nurse session audit, weekly medicine and clinic audit schedule and weekly medicine management meetings. In addition, the provider policy for the neuropsychiatric service line, patient and family surveys should be completed twice per year. Cygnet Paddocks completed these surveys quarterly to enhance and develop the service and to provide more frequent feedback to patients/carers.

Cygnet Paddocks provided a weekly nursing update email from the clinical services manager containing relevant policy changes, local procedures and lessons learned for the staff team. The service also received a weekly visual dashboard from their operations manager which rated their performance across various key performance indicators. This information was shared with the leadership team within the service to guide them in monitoring and improving performance. This information was also communicated via clinical governance meetings and supervisions where necessary.

Additional examples of local innovation included the agenda of the service daily operational meeting which was attended by senior management and departmental leads. This was regularly reviewed to ensure optimum governance across site. For example, the introduction of a daily review of blanket restrictions to ensure a least restrictive approach. Additional data collection regarding incident management to ensure both staff and patients were receiving debriefs with a member of the psychology team and an MDT review and a care plan review if required, and DOL’s condition monitoring.