Cygnet Kidsgrove Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

This is the first assessment for this newly registered service. This key question has been rated Requires Improvement.

This meant people’s needs were met through good organisation and delivery. The service met the needs of all patients including those with a protected characteristic. Staff were committed to offering person-centred care to the patients. Staff helped patients with communication, advocacy, and cultural and spiritual support. Staff supported patients with activities outside the service, such as work, education, and family relationships. The design, layout, and furnishings of the ward supported patients’ treatment, privacy, and dignity.

We have not awarded this service a score for Responsive.

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

The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Patients reported that some staff did not always provide personalised or responsive support when they were in distress. They described occasions where interactions felt dismissive, with staff offering general reassurances rather than acknowledging or exploring their feelings. Patients also told us that staffing levels were not sufficient to provide the emotional support they needed, particularly when they required someone to sit with them or talk things through, including named nurse one to one sessions.

Patients had opportunities to provide feedback during community meetings, and they told us that some improvements, such as changes to the menu, had been made as a direct result of their feedback.

We reviewed a sample of 6 care plans during the inspection. These generally reflected patients risks and clinical needs, and all included crisis and safety planning as well as estimated discharge dates and Section 117 planning where relevant. However, care plans were mostly written by staff with limited evidence of involvement from patients or carers. They were largely clinically focused and did not consistently reflect patients views, preferences or recovery goals.

The evidence showed some shortfalls. There were some shortfalls in how The service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Staff supported patients to maintain contact with their families and carers. There was a well-maintained visitors room, that patients could utilise through a booking service. Patients were also able to utilise their own personal mobile phone to stay in contact with their relatives.

However, all relatives we spoke with told us that communication from the ward was very poor, and they expressed concern about the lack of updates regarding their family member’s care. Relatives also reported that they had not been invited to participate in multidisciplinary team meetings or other key discussions, despite wishing to be involved and feeling this would support the patient’s care and recovery.

The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made notifications to external bodies when required. The service also made safeguarding referrals to the local authority when concerns were identified. The service submitted statutory notifications to the Care Quality Commission in line with the requirements of their registration.

Information governance systems included confidentiality of patient records and the service complied with the Accessible Information Standard.

Wards rounds were used to ensure that other professionals were updated on the patient’s progress. However, family members told us that they were not consistently invited to ward rounds and were not always informed of incidents by staff. Staff did not always ensure carers and families were regularly updated about patients progress. External partners such as commissioners were happy with the level of information sharing and the responsiveness of the ward to feedback.

Staff ensured that patients had access to information about their treatment, local support services, their rights, and how to make a complaint. Key information was clearly displayed on noticeboards throughout the ward, including details on safeguarding procedures, and activities available within the hospital. Patient information leaflets were presented in an accessible format, and the service was able to provide these in different languages when required. Managers also ensured that patients could access interpreters when needed.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service had a complaints policy in place which outlined how individuals could raise concerns and what they could expect during the complaints process. Information on how to make a complaint was accessible to patients and relatives, and the policy provided clear guidance on the steps involved.

In the 6 months prior to our inspection, the service had received 2 informal complaints. There had been no complaints referred to the Parliamentary and Health Service Ombudsman.

Patient complaint forms were available on the ward, providing a clear route for patients to raise concerns. Staff told us that, where appropriate, low-level concerns were managed informally through direct discussions with patients.

Patients we spoke with told us they knew how to raise concerns or make a complaint. Information explaining how to do this was visible and accessible on the ward.

Staff told us they understood how to manage complaints appropriately. They said managers shared feedback following complaint investigations and took action in response to any learning identified. Staff also told us they offered feedback to patients who had raised concerns, although some patients chose not to engage in follow-up discussions.

Family members were able to submit complaints directly to the service. However, none of the relatives we spoke with had made a complaint.

The ward held regular community meetings, providing patients with structured opportunities to offer feedback about their care and the running of the ward. In addition, an expert by experience visited the ward and gathered views from patients as well as making their own observations. They told us that leaders listened to and responded to the feedback they shared.

The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff made reasonable adjustments for patients as and when necessary. Staff ensured the needs of patients with mobility issues were met – for example, patients with extra mobility needs had support access to the lift. All communal areas and bedrooms were spacious and accessible.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.

Staff ensured patients had access to post-discharge care such as Section 117 aftercare, community mental health services and crisis services. Staff planned for patients’ discharge, including good liaison with care managers/co-ordinators.

The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. We saw examples of patient views being fed back through complaint forms, as well as through the ward advocate and the expert by experience.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. One member of staff told us that diversity within the service was both celebrated and respected. They gave an example of an African themed event held the previous year, which they felt positively recognised and celebrated cultural diversity.

The provider reported 97% of staff across there hospital were trained in equity and diversity. However, only 24.2% of staff had received training on learning disabilities and autism Tier 2 which was reflected in feedback from patients that not all staff demonstrated awareness of autism.

The provider had a number of staff networks and groups, including: Equity, Diversity and Inclusion group, LGBTQ+ network, Cygnet Staff Carers network, Multicultural network, Disability network, Women's network and Men’s Health network.

The evidence showed some shortfalls. People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported formal patients to make decisions about their care and treatment and their future. We observed MDTs and reviews where this was discussed and reviewed, and we saw this evidenced in care records. The hospital had a dedicated social worker whose work mainly focused on the acute ward.

Staff planned for patients’ discharge from the service. Any plans for discharge were made in collaboration with other relevant parties such as home teams, community mental health teams, housing services, social services and GPs.

One family member told us that their relative had been discharged without their knowledge. They said they had not been involved in discharge planning and only became aware that the patient was no longer on the ward when the patient informed them. The family member reported that, during a visit, they had requested to speak to a nurse but no one attended. On another occasion, they asked to speak to a doctor and were informed that no doctor was available.

A carer also raised concerns that a patient had been discharged and were street homeless. They felt that further support should have been provided, as the patient appeared to remain unwell at the time of discharge. The service told us that this patient had left the ward of their own accord and that staff had assessed the patient as having capacity to make this decision. The service had worked with other services to put support in place for this patient at the time of discharge.