Cygnet Kenney 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.

This is the first assessment for this newly registered service. This key question has been rated Requires Improvement.

Requires improvement: This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We do not always treat people with kindness, empathy and compassion and respect their privacy and dignity. We do not always treat colleagues from other organisations with kindness and respect.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

Staff attitudes and behaviours when interacting with patients showed that they were generally discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it.

Staff generally supported patients to understand and manage their care, treatment or condition. They provided one to one sessions and provided information to patients on request.

Staff directed patients to other services when appropriate and, if required, supported them to access those services. This included escorting them to hospital for their physical health needs.

We spoke with six patients during the assessment. Two patients said that staff did not respond quickly when they were distressed or needed help and one patient said that she had waited over three hours to be taken on her leave. The other three patients said staff treated them well and behaved appropriately towards them.

Staff did not always understand the individual needs of patients, including their personal, cultural, social and religious needs. An autistic patient felt that staff did not always support her in the best way to meet her needs.

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

Staff maintained the confidentiality of information about patients.

We do not always treat people as individuals and make sure their care, support and treatment meets their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service was able to make adjustments for disabled patients, for example, by ensuring disabled people’s access to premises and by meeting patients’ specific communication needs. Staff used visual aids to support communication and there were disabled bathrooms on each ward. There were care plans, a positive behaviour support plan and OT assessment in place which included strategies for staff to use if patients were distressed. However, staff did not always provide reasonable adjustments for an autistic patient and there was a lack of understanding of how this might impact upon her.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on. There were patient notice boards on each ward. They contained information on patients’ rights, complaints, advocacy, safeguarding and mental health law.

The information provided was in a form accessible to the patient group for example, in easy-read form on wards for people with a learning disability. Staff told us that they provided easy read leaflets to assist patients.

Staff made information leaflets available in languages spoken by patients. They did this using translation services on the internet.

Managers ensured that staff and patients had easy access to interpreters and/or signers. Staff requested an interpreter for patient meetings and explaining their rights to them.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. The service provided halal, kosher, gluten free, vegan and vegetarian meals to meet individual patient needs.

Staff ensured that patients had access to appropriate spiritual support. Staff contacted different religious leaders to attend the ward to meet with patients. If patients had leave staff supported them to attend local places of worship in the community. There were quiet rooms, a multi faith room and prayer mats available on the wards for patients.

We do not always promote people’s independence, so they know their rights and have choice and control over their own care, treatment. and wellbeing.

2. We scored the service as 2. The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Staff read patients’ rights to them in a way that they could understand. This was repeated until staff were assured that patients had understood. Staff explored consent to treatment, types of medication and side effects with patients, and we saw that this was recorded in patient records.

All patients were encouraged to attend their ward rounds and all other meetings relating to their care and treatment. They could request support from the advocacy services to represent their wishes and feelings and carers were invited with the patient’s permission. However, patients were not aways fully included in the discussion at ward rounds and not all disciplines were included in giving feedback.

There was a range of activities on and off the wards seven days per week. Patients could participate in areas of interest and those with leave could visit the local community, escorted by staff. There was smoking cessation support, a gym and an activities room for art and craft-based activities.

We do not always listen to and understand people’s needs, views and wishes. We do not always respond to these in that moment and will act to minimise any discomfort, concern or distress.

We scored the service as 2. The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff were generally aware of and dealt with any specific risk issues. Examples of this were ensuring the safety of the patients’ bedroom and safe management of items that could be used to self-harm; monitoring of physical health risks such as blood sugars for diabetes and crisis plans for if staff were outside or on leave with a patient.

Staff identified and responded to changing risks to, or posed by, patients. Of the eight risk assessments that we reviewed we saw that all had been updated at least weekly and again after every incident. This included a review of levels of observation. However, two patients told us that staff were slow to respond when they were distressed. We carried out a specific review of the CCTV and saw that this was the case.

Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. All patients had a personal behavioural support plan in place which identified patient triggers, best methods of communication and patients preferred support methods for de-escalation. Staff used verbal de-escalation, use of sensory objects and sensory boxes, reassurance and distraction and only used restraint as a last resort when all other methods had failed.

We care about and promote the wellbeing of our staff, and we support and enable them to always deliver person centred care.

We scored the service as 3. 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 felt respected, supported and valued. They said that things were improving and that managers were open and supportive of their concerns. Managers that we spoke with were aware of the challenges that teams faced and were working to support them.

Staff felt positive and proud about working for the provider and their team. They told us that the teams were developing cohesion and staff morale was generally good. Staff described a culture of teamwork and support from colleagues and managers.

Staff had access to support for their own physical and emotional health needs through an occupational health service. There was an employee assistance programme which provided staff with access to counselling. Staff also spoke highly of the psychology team who provided regular reflective practice sessions and proactively checked in on staff wellbeing, particularly after incidents.

The service’s staff sickness and absence were similar to the average for the provider. The provider recognised staff success within the service. At weekly community meetings, patients and staff identified a staff member of the week.

Staff appraisals included conversations about career development and how it could be supported. Senior managers were sent on leadership courses and given a buddy from other Cygnet services. Ward staff were supported with flexible hours if they wished to undertake a course. Support workers were supported to work towards senior support work roles and some staff that we spoke with had achieved this.