Cygnet Kenney House

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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 newly registered service. This key question has been rated Requires Improvement.

Requires improvement: This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

We scored the service as 3. 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 knew and understood the provider’s vision and values and how they were applied in the work of their team. Supervision and appraisals were aligned with the vision and values and staff that we spoke with said that they tried to work within the spirit of these.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. There were posters throughout the service displaying the vision and values and staff that we spoke with were able to recall them.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. This included discussions at morning meetings, staff meetings, clinical governance and during appraisal and supervision. The staff survey had been open between 15 April to 10 June and there was a response rate of 73%. The results of the survey had not been collated at the time of the assessment.

Staff could explain how they were working to deliver high quality care within the budgets available. The interim registered manager told us that they could refuse an admission if there was concern that there would be a negative impact on existing ward acuity or if they could not meet the needs of the patient.

We do not always have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

We scored the service as 2. The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leaders generally had the skills, knowledge and experience to perform their roles. They were familiar with the patient group and were working towards embedding clinical governance processes into practice. Leaders were supportive of the ward teams and aware of the need to assist them to carry out their roles effectively.

Leaders had a good understanding of the services they managed. They could explain how the teams were working to provide high quality care. Managers were realistic about the fact that this was a new service and were committed to working towards improving both patient and staff experiences. However, there were examples of incidents where leaders were not fully aware of the impact on patients such as delayed responses to patients in distress and restrictions on neurodivergent patients.

Leaders were visible in the service and approachable for patients and staff. Both patients and staff told us that they knew who the senior leaders were and that they regularly walked the wards and encouraged staff and patients to approach them with queries or concerns.

Leadership development opportunities were available, including opportunities for staff. There were leadership courses for managers and support workers were encouraged to work towards senior support work roles.

We create a positive culture where people feel that they can speak up and that their voice will be heard.

We scored the service as 3. 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.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Patients had given feedback about the service. Areas of concern included restrictions being harsh and patients being bored on the wards due to a lack of varied activities. There had been two responses to the carers feedback survey since the service opened. The responses were varied; one carer said that that it was hard to get through on the telephone and one carer said that they were given information about their loved one. Both carers said that they were satisfied that they had been identified as a key person in the patient’s life.

There was a freedom to speak up guardian (FTSU) to support staff to raise confidential concerns. We saw that one concern had been raised with the FTSU guardian since the service had opened.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. The feedback was reviewed and there was an action plan in place which identified areas of concern and plans to address these.

Patients and carers were involved in decision-making about changes to the service. Patients routinely raised issues and suggestions at the community meeting and staff documented these and provided “you said, we did” feedback on a weekly basis. This included patients requesting more gardening activities which had been referred to occupational therapy staff for development. Patients had also said that the food was generally good, but care needed to be taken with patient allergies. As one patient had a nut allergy there was a universal ban on nuts on the ward.

Patients and staff could meet with members of the provider’s senior leadership team and governors to give feedback. Leaders had an open-door policy and were visible on the ward for patients and staff to speak with them.

We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

There were equality and diversity champions within the service. Staff were trained in equality and diversity, and leaders were aware of recent legislative changes for transgender patients and how that might impact on risk assessment.

Staff were able to apply to work flexibly by requesting working agreements to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff members to help them carry out their role. This included supporting staff to reduce their hours to maintain a better work life balance.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group.

We do not always have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a clear framework of what must be discussed at a ward, team or directorate level to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. There was a monthly clinical governance meeting attended by senior hospital managers regionally, heads of directorate and directors.

There were handovers at each shift change, daily morning meetings, weekly ward rounds and monthly staff meetings which provided a robust system of communication and accountability at all staff levels. Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. Managers had dashboards which showed mandatory training levels, supervision and appraisal compliance and staffing levels. This enabled them to have oversight of when tasks were due. However, there was insufficient oversight of some mandatory training courses which were below compliance levels a lack of evidence of agency staff inductions and a lack of awareness of enhanced observations which were over and above two hours.

Staff had implemented recommendations from reviews of incidents, complaints and safeguarding alerts at the service level. There was a clear audit trail of investigation and recommendations arising from incidents, complaints and safeguarding.

Staff maintained and had access to the risk register at ward level. Staff at ward level could escalate concerns when required. We reviewed the risk register during the assessment and saw that it was up to date and contained relevant issues in keeping with the service and it was routinely reviewed and updated.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. Some of the audits included care plans, cleaning, clinic room, medicines, Mental Health Act and environmental audits.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. Staff engaged with local housing services, children’s services, community mental health teams and commissioners as well as the local safeguarding board.

The service had plans for emergencies including adverse weather conditions or flu outbreaks. There was standing agenda item on the staff meeting agenda on business continuity.

We were not aware of any cost improvements that were taking place at the time of the assessment.

We do not always understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

We scored the service as 2. The evidence showed some shortfalls. The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Directorate leaders engaged with external stakeholders such as commissioners and Healthwatch. Commissioners routinely attended the wards to see specific patients, and the service escalated notifications to commissioners following incidents or changes to a patients care and treatment. However, there was an occasion when the advocate was not brought into a patient meeting and evidence that patients and external professionals were not fully included in participating in patient meetings.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. The interim registered manager and interim clinical services manager were on the wards daily and readily available to patients and staff.

We do not always focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Staff were given the time and support to consider opportunities for improvements and innovation and this led to changes. Staff discussed ideas and career development in supervision, appraisal and at team meetings.

Staff did not yet have the opportunity to participate in research as this was a new service.

Staff used quality improvement methods such as audits and knew how to apply them.

Staff participated in national audits relevant to the service and learned from them. Examples of these were highlighted at the clinical governance meetings whereby there were audits for weekly observation and engagement with patients, business continuity and emergency planning and national cleaning standards.

Wards had not started participation in accreditation schemes relevant to the service.