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Inspection Summary


Overall summary & rating

Good

Updated 20 July 2018

We rated Cygnet Aspen House as good because:

  • The hospital had undergone significant organisational changes and there was limited impact on patient care and on frontline staff. Patients and staff reported clear and stable leadership from managers who were visible, supportive and approachable.
  • Staff morale was high and staff demonstrated the provider’s values. There were low sickness rates at 3% and no shifts had been left unfilled. The hospital did not use agency staff.
  • The service managed risk appropriately through comprehensive individual patient risk assessments completed and reviewed by the multi-disciplinary team. Incidents of restraint were low and there was no use of prone restraint.
  • Staff had developed and ran a physical health clinic that fed into patients’ care and treatment well. Staff had developed documentation to record physical health monitoring which had been shared across the provider’s services.
  • Patients had access to a range of care and treatment interventions and activities to promote their recovery and rehabilitation needs. The hospital had full multi-disciplinary team.

However:

  • Out of hours an on-call doctor was available but would not be able to attend the hospital promptly following incidents of restraint.

  • The provider trained staff in basic life support, automated external defibrillation and registered nurses received oxygen training. The provider did not provide staff with training in immediate life support.

  • Team meetings did not take place regularly so it was unclear how all information was cascaded fully to all staff.
  • The appraisal rate had improved significantly but at the time of our inspection was 71%.
  • Even though staff planned and discussed patient discharge regularly, care plans did not contain clear discharge planning information.


Inspection areas

Safe

Requires improvement

Updated 20 July 2018

We rated safe as requires improvement because:

  • A doctor would not be able to attend the hospital promptly when required following incidents of restraint.
  • Staff were provided with basic life support, automated external defibrillation training and in addition, registered nurses received oxygen training. The hospital had not provided any staff with training in immediate life support.
  • Staff did not have access to regular team meetings.

However:

  • Staff practiced safe and proper medicines management. The hospital had two clinic rooms that contained all of the required equipment which was tested and ready to use when required. Staff maintained medication records accurately and had an effective system to support patients to self-administer their own medication. The hospital had robust arrangements for the oversight of medicines management through daily checks and audits.
  • The multi-disciplinary team completed comprehensive patient risk assessments prior to and following admission. They also completed daily risk assessments.
  • Restrictions in place were appropriate for mental health rehabilitation services. Restrictions were based on individual patient risk and were reviewed regularly by the patients’ multi-disciplinary team.
  • The hospital was well-maintained and cleaned to a high standard. Staff had involved patients in the refurbishment and replacement of soft furnishings.
  • The hospital had no vacancies and a healthy bank of staff. There were no shifts left unfilled and the hospital did not use agency staff.
  • In a six-month period, there were 33 incidents of restraint. None of these were in the prone position and none resulted in administration of rapid tranquilisation. All restraints were low level and mainly consisted of supportive arm holds.

Effective

Good

Updated 20 July 2018

We rated effective as good because:

  • Physical healthcare was well embedded into patients’ care and treatment. The hospital ran a weekly physical health clinic and care and treatment records showed staff completed comprehensive monitoring of patients’ physical health. They escalated concerns where appropriate.
  • Patients’ care plans were individualised, holistic and recovery orientated. Staff wrote care plans in simple language that was easy for patients to understand.
  • The multi-disciplinary team consisted of all the required disciplines to meet the needs of patient receiving care and treatment at the service.
  • Staff understood and carried out their responsibilities outlined by the Mental Health Act and the Mental Capacity Act and their associated codes of practice. Staff had received training in the Mental Health Act (86%) and the Mental Capacity Act (81%).
  • The hospital had a robust audit schedule and system to ensure that staff had the right skills and registrations required to perform the roles they were employed to.
  • The hospital had increased the appraisal rate significantly from 27% to 71% between the submission of the provider information return and the time of our inspection.

However:

  • Team meetings did not always take place regularly. Although other methods to cascade information were used, it was not clear how all information would be fully cascaded down to frontline staff.

Caring

Good

Updated 20 July 2018

We rated caring as good because:

  • The hospital had co-produced a welcome guide with patients. The guide had pictures and information about what patients could expect from the hospital and the services provided.

  • Staff placed patients at the centre of their care and treatment. Patients were involved in creating and updating their care and treatment plans. They were encouraged to attend meetings about their progress. Patients could attend morning meetings and community meetings to be involved and share their views.

  • Observations of interactions and feedback from patients showed that staff treated patients well; they understood their individual needs and offered appropriate practical and emotional support.

  • Patient representatives attended the hospital’s clinical governance meetings and took part in recruitment panels to interview prospective staff.

  • Patients had access to advocacy and staff encouraged patients to maintain relationships with their families and carers.

Responsive

Good

Updated 20 July 2018

We rated responsive as good because:

  • The hospital facilities and environment promoted rehabilitation and recovery. Patients had access to ample space to complete activities and therapies. Patients could personalise their own rooms with their own personal items and could decorate to their own style or taste.
  • Patients had their own individualised activity and therapeutic timetables that consisted of a range of sessions aimed to meet their recovery, rehabilitation, skill development, recreational and educational needs. Staff had access to information on patient interests to provide ad hoc activities to patients outside of the scheduled therapeutic day.
  • Patients had access to a range of choice and good quality food which was cooked from fresh ingredients. Staff involved patients in designing the menu for the week ahead. Patients and staff ate meals together in the dining room. The hospital provided patients with a small budget to shop and cook meals of their own choice with the appropriate level of assistance from staff.
  • Patients knew how to raise concerns and complaints and staff understood their responsibilities when handling complaints. There were only two complaints in the 12 months between 1 February 2017 and 1 February 2018, none of these were upheld or referred to the ombudsman.
  • Twenty four compliments were received in the same time period which all related to positive experiences of the service including the approach of staff and staff placing patients at the centre of their care and treatment.
  • The hospital reported no delayed discharges.

However:

  • Although staff discussed and planned discharge involving patients regularly in meetings to review their progress through care and treatment, patients’ care plans did not contain clear discharge plans.

Well-led

Good

Updated 20 July 2018

We rated well-led as good because:

  • All staff and patients reported that the hospital had clear and stable leaders who were visible, supportive and approachable. The service had low sickness absence rates at 3% and staff were highly motivated and enthusiastic about their work.
  • The service had involved staff in developing the physical health clinic and designing documentation for recording physical health monitoring. This was adopted and shared across all of the provider’s services.
  • Despite the hospital being part of significant organisational changes, there was limited impact on the service. Staff felt that managers had communicated changes clearly and openly and had implemented changes gradually.
  • The hospital had a clear model of care to deliver a high-dependency mental health rehabilitation service. It had the appropriate level of restrictions and provided a full multi-disciplinary team to meet the rehabilitation and recovery needs of patients.
  • The hospital had systems and processes to monitor performance and implemented actions to address issues identified in audits and performance. They had increased the appraisal rate from 27% to 71% in a short time.

However:

  • Team meetings did not always take place frequently and it was unclear how all information would be fully cascaded to all staff.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 20 July 2018