Cygnet Kenney House

On this page

• 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 rated Good.

Good: Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary 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 67 (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 maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We reviewed 8 care records during the assessment across the acute and PICU wards.

We saw that staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission.

Staff assessed patients’ physical health needs on admission. Patients met with the physical health doctor and received an electrocardiogram ECG, weight check and had bloods taken. Staff monitored patients’ ongoing physical health weekly, and all patients were able to access a local GP, dentist and optician.

Staff did not always develop care plans that met the needs identified during assessment. We saw that most care plans were personalised, holistic and recovery oriented. However, care plans for an autistic patient did not show reasonable adjustments for autism or identify that her own set of cutlery was restricted due to the risk of self-harm. Food and fluid charts were not completed in full, therefore staff did not accurately know her food and fluid intake.Staff generally updated care plans when necessary.

We do not always 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.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

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. These included medication and psychological therapies, activities, and opportunities for patients to take their prescribed section 17 leave.

Staff ensured that patients had good access to physical healthcare, including access to a dentist, optician and specialist healthcare providers.

Staff generally assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. However, food and fluid charts were not completed in full for a patient who was not eating, therefore staff did not accurately know her food and fluid intake.

Staff participated in clinical audit, benchmarking and quality improvement initiatives.

The team included the full range of specialists required to meet the needs of patients in the service. This included doctors, nurses, occupational therapists, clinical psychologists, social workers, pharmacists, support workers and activities co coordinators.

Some staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers had brought in more experienced staff from other local Cygnet services to support newer staff teams. However, the provider routinely used agency staff and we were not assured that they had all received an induction and achieved observation competence.

Managers provided staff with supervision to reflect on and learn from practice, and for personal support and professional development and appraisal of their work performance.

Managers ensured that staff had access to regular team meetings. Team meetings were held monthly on each ward and there was a standing agenda. Minutes of the meetings were circulated to all staff.

The percentage of staff that had had an appraisal in the last 12 months was 100% on Billington ward and 100% on Baldock ward.

We saw that supervision was provided in line with the providers supervision policy and that compliance rates for management supervision were at 96% for Billington ward and 100% for Baldock ward, and compliance rates for clinical supervision were 100% for Billington ward and 96% for Baldock ward.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff participated in appropriate mandatory training. They were also able to discuss training needs during supervision and appraisal. Staff that we spoke with told us that there was a wide variety of training courses available to them on the eLearning platform.

Managers ensured that staff received the necessary specialist training for their roles. However, two of the mandatory training courses were below the provider’s rate of compliance.

Managers dealt with poor staff performance promptly and effectively. We saw several examples of documented poor performance whereby staff had their probationary period extended or chose to step down from the service.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Mental Health Act training compliance was at 100% on Billington ward and 94% on Baldock ward.

Staff had easy access to administrative support and legal advice on the implementation of the Mental Health Act and the Code of Practice. Staff knew who their Mental Health Act administrators were. We spoke with both Mental Health Act administrators during the assessment and they described frequent positive communication with staff. There was a plan to provide additional, more formal training to staff to support their knowledge.

The provider had relevant policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. These were stored on the staff intranet.

Patients had easy access to information about independent mental health advocacy. There were posters and leaflets on the wards and patients said that they were aware of the advocacy service.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We reviewed 8 patient records and saw that in all cases this had been done and staff told us that they revisited patients' rights until they were sure that they had been understood.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. The leave was planned at the beginning of the shift and staff were allocated to support the leave where patients needed to be escorted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

The service displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment. Section 117 aftercare is a legal duty under the Mental Health Act 1983 that requires local health and social services to provide free aftercare to individuals who have been detained under specific sections in hospital.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. The Mental Health Act administrators sent the Responsible Clinicians and ward managers a weekly tracker with an overview of everything that they were monitoring so that they had good oversight of all areas of the Mental Health Act, including sections due to expire, patients’ rights, section renewals and mental health tribunal applications.

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.

We scored the service as 3. 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 weekly effective multidisciplinary meetings (MDT). These were attended by all disciplines including nurses, psychology, occupational therapy, care co coordinators and the advocate. We attended two MDT meetings during the assessment.

Staff shared information about patients at effective handover meetings within the team for example, shift to shift. We attended a handover for Billington ward and saw that all patients, incidents and changing risks were discussed with the incoming team. There was also a daily morning meeting on each ward at which all patients were discussed. We attended a morning meeting for Billington ward during the assessment.

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 had effective working relationships with teams outside the organisation for example, the local authority, social services, GP’s and housing providers.

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.

We scored the service as 3. 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, reduce their future needs for care and support.

Staff supported patients to live healthier lives, for example, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse. Staff took advice from the local diabetes team to more effectively manage a patient's diabetes.

Ward activities helped promote a healthy lifestyle for patients for example walking groups, sports activities and choosing healthy meal options. There was an on-site gym and activities coordinators supported patients with healthy lifestyle activities.

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.

We scored the service as 3. 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 a rating scale to assess and record severity and outcomes. This was a structured judgement tool which looked at current and historical risk on a scale of low, medium and high.

The staff used technology to support patients effectively for example, for prompt access to blood test results and online access to self-help tools. This was completed on admission and updated every two weeks and after incidents.

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

We scored the service as 3. 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

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately, and assessments were seen in the patient records.

They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Where patients had given consent, staff spoke with relatives who knew the patient's history.