Cygnet Kidsgrove Hospital

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• 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.

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

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

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 looked at 6 patient care records during the assessment. All 6 patients had comprehensive mental health risk assessments completed upon admission, with regular reviews carried out throughout their stay.

Staff developed care plans that reflected the needs identified during assessment. These plans were comprehensive and holistic. However, they did not consistently incorporate the patient’s voice and were not written in the first person. Staff reviewed and discussed patient care and treatment regularly, updating records following incidents and after multidisciplinary ward rounds, which took place weekly for each patient.

Most patients did not recall being offered a copy of their care plan, and care plans did not document whether copies had been offered or provided. However, plans were in place for patients to be more involved in their care planning through monthly meetings, although we did not see evidence that this had yet started.

Crisis plans were present but often generic. Discharge and Section 117 planning were documented but lacked detailed, person centred actions. Physical health monitoring was inconsistently recorded on admission, and nutrition, hydration, and protected characteristics were rarely addressed.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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 (NICE). These included medication and psychological therapies and activities intended to help patients acquire daily living skills.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed.

An occupational therapy programme was in place, offering a range of recovery‑focused activities for patients. These included craft sessions, coping skills groups, yoga, pamper sessions, and walking groups.

The ward held monthly staff meetings that staff could attend either in person or online. Attendance had been higher when the hospital first opened, but leaders recognised a recent decline due to staffing pressures and the timing of meetings. Minutes were shared with all staff, and the ward manager was reviewing the timing and structure of the meetings to maximise attendance.

Staff communicated with patients in a manner that supported their understanding of care and treatment, including adapting communication approaches for individuals with identified communication needs. For example, one patient with no verbal communication had a detailed and individualised communication plan incorporated within their care plan.

Mental Health Act

The provider reported 94% of staff had received training in Mental Health Act Awareness.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. 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.

Patients had easy access to information about independent mental health advocacy which was displayed in communal areas and discussed in ward rounds.

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. However, one staff member told us that Section 17 leave was sometimes delayed, due to staff shortages. The staff member made it clear that it was not cancelled due to staff shortages, only delayed.

The service did not display a clear notice to tell informal patients that they could leave the ward freely. When speaking to patients who were informal, they were able to leave the ward upon request.

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 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. Morning meetings included representatives from all disciplines of the MDT. These were effective forums for discussing key issues such as changes in clinical risk, incidents, observation levels, leave, medication and patient views. During our observation of a morning meeting, staff were fully engaged and demonstrated detailed knowledge of each patient and any changes in their needs.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. They also worked well with care co-ordinators, community mental health teams, and the crisis team. They had good links with the local GP surgery and all patients were registered with a GP.

Commissioners told us there was good communication from the ward, and staff were open and honest about incidents. They were receptive to feedback and made changes following discussions.

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.

Patients physical health needs were assessed and documented; however, records were not kept consistently, with some information recorded electronically and other elements, such as bowel management charts, held in paper format. Staff did not have easy access to patients physical health files. There was unclear and inconsistent physical health monitoring observed in 1 patients file.

The service was in the process of recruiting an additional physical health nurse, although one nurse was already in post. It remained unclear who had been fulfilling the wider physical health role during the recruitment period.

Ward activities helped promote a healthy lifestyle for patients – for example sports activities and cooking. There was occupational therapy support to help people develop their skills, where cooking healthier meals was encouraged.

The hospital has one physical health nurse that was employed and had recently recruited 2 further physical health nurses.

The hospital promoted healthy eating by encouraging a healthy diet. Catering staff took onboard feedback and would provide alternatives for patients who did not like the first option. Patients were able to make their own food and drinks in the activities of daily living (ADL) kitchen on the ward. Patients had access to facilities to make themselves drinks, and where necessary, access to these had been individually risk assessed.

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 patient severity and outcomes, including the Global Assessment of Functioning (GAF) scale and the provider’s risk assessment tool, which aligned with recognised tools used in the mental health sector. Outcomes were also monitored through one‑to‑one sessions with named nurses and through community meetings on the wards.

Staff used technology to support patients, who had access to phones and video links to maintain contact with family and friends.

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 had good awareness of patient’s rights around consent to care and treatment. Staff took all practical steps to support patients in making their own decisions. They ensured patients had the relevant information to fully understood what they were consenting to.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis regarding significant decisions. Consent to care and treatment was discussed and recorded with each patient on admission.