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: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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

We 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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 3 care records during the assessment and 3 care plans following the on site assessment.

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 in a timely manner after admission.

Staff developed care plans that met the needs identified during assessment.

Care plans were personalised, holistic and recovery-oriented. Care plans included the view of the patients. However, patients told us they had seen copies of their care plans and had given feedback on the content of them and were waiting for a response from the service.

Staff 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 medicines, psychological therapies and, activities intended to help patients acquire living skills. Psychological interventions took place with patients. Activities included shop and cook, walking and going to the gym.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Patients told us and records showed staff supported patients to access the acute hospital for treatment and appointments related to their physical health needs. A district nurse also attended the ward to meet the physical health needs of a patient.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. We saw audits were discussed in the daily managers meetings.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. The team consisted of doctors, nurses, occupational therapists, clinical psychologists and social workers. We saw they attended the daily morning meetings to review patients.

Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new permanent staff with appropriate inductions, there was a corporate induction and a ward-based induction, including shadowing more experienced staff.

Managers did not always provide staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. Clinical supervision dates were recorded on the system from the debrief book. The only record of clinical supervision was the debrief book. Staff recorded in the debrief book at the end of each shift their summary of the shift. We saw the entries for 7 dates, these entries were very negative with staff reporting feeling stressed, unsupported, burnt out, short staffed and unable to take their break. This was not clinical supervision which usually provides an opportunity for staff to reflect and seek support and guidance from peers in how to support patients effectively.

Managers ensured that staff had access to regular team meetings. Meetings took place in an evening and in the daytime to accommodate staff that worked day and night shifts.

The percentage of staff that received regular managerial supervision was recorded as 84%. However, there were not always minutes to evidence these meetings took place.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

94% of staff had received training in the 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. Support staff understood their role in relation to escorting patients on Section 17 leave.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

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.

Patients had easy access to information about independent mental health advocacy. Details were displayed in the ward.

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.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Although patients told us this could be delayed or did not take place as frequently as prescribed due to staffing challenges.

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

Staff did not always store 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. There was a patient who had been administered intra muscular medicine under section 62 of the Mental Health Act and the documentation was not available in the patient’s record to support this.

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 and effective multidisciplinary meetings. We observed the morning meeting, which was attended by the full multidisciplinary team, all patients were reviewed at this meeting.

Staff shared information about patients at effective handover meetings within the team (for example, shift to shift). However, risk was not always shared and the level of observations was not always accurate.

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). Records showed and stakeholders told us that they were involved in patient reviews. Daily managers meetings took place, which we observed and found information regarding staffing, incidents, medicines, audits, environmental and maintenance issues were discussed.

The teams had effective working relationships with teams outside the organisation (for example, local authority social services and GPs). Records showed that safeguarding alerts were raised and liaison took place with care coordinators.

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 engagement with acute services to meet physical health needs.

Ward activities helped promote a healthy lifestyle for patients – for example walking groups, sports activities and cooking healthy meals. There was a gym and outdoor track for patients to use. Patients told us of the walking activities they enjoyed and the shop and cook sessions.

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 recognised rating scales to assess and record severity and outcomes. The occupational therapy team completed activities of daily living assessments, interest checklists, kitchen assessments and community assessments. The Model of Human occupation screening tool (MOHOST) was used by the occupational therapy team for their assessments of patients.

The service had a model of care that they worked to. This was the high dependency rehabilitation models of care, we saw this was available in easy read format for patients that required this. The 5 stages were; referral, understanding me, my skills, my independence and my future. Within the multidisciplinary team, patients were recorded in 4 stages of the model of care: 1. Assessment and engagement, 2. Recovery, 3. Consolidation and 4. Transition and discharge. The models of care were displayed within the service and patients were aware of them.

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.

They did this on a decision-specific basis with regard to significant decisions. We saw a detailed capacity assessment completed regarding access to a mobile phone.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Clear rationales were included for the use of restrictive interventions, including enhanced observations.