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Inspection Summary


Overall summary & rating

Good

Updated 10 February 2020

We rated Cygnet Churchill as good because:

  • The service provided safe care. The ward environments were safe and clean. Juniper ward (an acute admissions ward) had recently been refurnished and was a suitable environment for its patient group. The wards had enough nurses and doctors to meet the needs of patients. 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 mental health high dependency rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • All the ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • 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.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. There were some instances of delayed discharges due to challenges in finding suitable placements in the community, but staff worked well with external organisations in the patients’ local area to solve this.
  • 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 and that patients were discharged to local community services or their home, within a reasonable timeframe.

However:

  • At the time of the inspection, the provider did not stock emergency Naloxone medicine despite admitting patients who presented with risks for illicit opiate and substance misuse. The provider had since sourced and stocked emergency Naloxone medicine. 
  • Staff on Maple Court did not always meet their responsibilities under the Mental Health Act 1983 Code of Practice. For example, ensuring a manager’s review hearing took place before the expiry of a patient’s section and having clear records of whether a patients’ nearest relative was informed of their detention under the Mental Health Act.
  • Staff did not make notifications to external bodies as needed. For example, between 01 January 2019 and 29 October 2019 we found 17 incidents of allegations of abuse in relation to service users that were not reported to the Care Quality Commission.
Inspection areas

Safe

Good

Updated 10 February 2020

We rated safe as good because:

  • All wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose.
  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm.
  • 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 and rapid tranquilisation minimally, and only after attempts at de-escalation had failed.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The wards had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • The service stored information about patient care in more than once place and this meant that staff might not be able to find essential information in a timely manner.
  • At the time of the inspection, the provider did not stock emergency Naloxone medicine despite admitting patients who presented with risks for illicit opiate and substance misuse. The provider had since sourced and stocked emergency Naloxone medicine.
  • Although staff used rapid tranquilisation rarely, we saw one example where staff had not followed the provider’s policy around follow up physical health checks in full.  

Effective

Good

Updated 10 February 2020

We rated effective as good because:

  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected a patient’s assessed needs, were personalised, holistic and recovery-oriented.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. This included access to psychological therapies, to support for self-care and the development of everyday living skills, and to meaningful occupation. Staff ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care.
  • Staff supported patients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

However:

  • On Maple Court, detention paperwork for patients detained under the Mental Health Act did not clearly show that all efforts had been made to inform the nearest relative of the patient’s detention. There were also examples where patients had not been offered the chance to have a hospital manager’s hearing before the end of their detention, which they should have had.

Caring

Good

Updated 10 February 2020

We rated caring as good because:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Patients told us staff treated them well. Patients complimented staff for their work and support. They told us staff were good and they liked them and that saff encouraged them to speak up when things were wrong. Patients said they felt listened to and said staff made improvements to the service when concerns were raised.
  • 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 in a patient’s care appropriately.

Responsive

Good

Updated 10 February 2020

We rated responsive as good because:

  • Staff planned and managed 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.
  • The design, layout, and furnishings of the ward/service supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.
  • 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.
  • 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.

Well-led

Requires improvement

Updated 10 February 2020

We rated well-led as requires improvement because:

  • Staff did not make notifications to external bodies as needed. We found a number of notifiable incidents, such as allegations of abuse in relation to service users, that had not been reported to the Care Quality Commission.
  • The service had not implemented the recommendation from a previous inspection of stocking Naloxone.

However:

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.
  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.
  • Staff said they 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. They felt able to raise concerns without fear of retribution.
  • Our findings from the other key questions demonstrated that governance processes operated effectively at ward level and that performance and risk were managed well.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 10 February 2020