Cygnet Kidsgrove Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

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

Staff understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Staff involved patients in care planning and risk assessment through their ward rounds and actively sought their feedback on the quality of care provided. The service made adjustments for disabled patients and met patients’ specific communication needs.

We have not awarded this service a score for Caring.

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

The evidence showed some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

We received mixed feedback about staffs’ attitudes and behaviours when interacting with patients. Patients told us that some staff were kind and knew how best to support them whilst others were not and did not recognise their triggers. One patient told us how support workers would speak in their own language whilst caring for them which made them feel uncomfortable. They also felt that their privacy was not always respected as a male staff member had once entered their room without knocking. Another patient shared a recording of staff using abusive language towards them. This had been shared with staff after the event. Leaders told us that they had managed these allegations and spoken to the staff members involved about the appropriateness of their response to challenging behaviours. Staff had also had supervision around the concerns about managing challenging behaviours and how to respond appropriately to this, managing their own emotions and resilience at work. The patient had also been offered a debrief but had declined.

The advocate told us that staff could be dismissive of how people were feeling using phrases such as ‘you are fine’ or ‘you will ok’ when the patient was trying to communicate that they were not.

Family members told us that they were not consistently invited to ward round, and they only found they were happening through their loved one. They also stated that care plans were not shared with them. One patient stated they were not aware if they had been involved in the development of their care plan but did not feel that staff were following it even if they had been.

One patient told us that their religious needs were not consistently met. They gave the example of staff members speaking over the broadcast of the Pope’s funeral which they had found disrespectful.

We observed that staff were very busy whilst we were on the ward. Interactions were witnessed were mainly positive; however, we saw on multiple occasions patients knocking on the nurse’s office door and not receiving a response.

Leaders said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. We were not able to speak to many staff on the ward due to them being unable to spare the time due to caring for patients. Two patients told us how they had reported disrespectful or abusive behaviour but were not made aware of the outcome and still saw those staff members working on the ward.

Staff maintained the confidentiality of information about patients which was stored on the electronic system or in paper files on the ward.

The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service made adjustments for disabled patients and met patients’ specific communication needs. There was an accessible room with wider door frames and bathrooms for ease of use.

We saw evidence that patients had access to advocates and other additional communication resources to support them in communicating their wishes. Information provided was in a form accessible to the patient group.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, and how to complain. Information was displayed on the walls of the wards, such as general advocacy details and ward activities. Leaders were aware of how to access interpreters and/or signers although there had not been a need for this service since opening on the ward.

Multidisciplinary patient reviews we observed were person centred and holistic.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances.

There was not a multi faith room available on the ward although there were quiet rooms that could be accessed. The ward had made links with local the churches to support patients who wanted to attend services based on their preference.

The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients reported being involved in their care through attendance at ward rounds. Patients knew how to complain and were able to give feedback. We saw that patients had completed feedback forms and given them to the ward manager whilst on site.

Staff made sure patients could access information on their rights and how to complain. Information about the Mental Health Act and complaints was displayed on a noticeboard. Patients could access their own mobile phone and were able to make calls in private.

Staff supported patients to maintain relationships and networks that were important to them. The service had visiting rooms off the ward, which could be booked for visits.

The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

All patients we spoke to told us that staff were not always responsive to their needs. Two patients explained that staff were too busy to support them until they reached crisis point due to the level of need of other patients on the ward. We observed patients waiting at the nurse’s office door or being unable to get staff attention due to the lack of available staff present on the ward or due to staff attending to incidents on the ward. All patients stated that there were not enough staff to meet their needs. One patient stated that it was only patients who were on 1 to 1 support who got attention and support. Another patient commented that staff were too busy dealing with incidents to provide the support they needed until they reached crisis point.

We observed staff using de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened.

The psychology team considered people's needs such as neurodiversity and introduced sensory toys to help people when needed and had a quiet room where lights could be dimmed.

We saw that specific risk issues were considered in safety summaries and observations were used to help reduce risks. These levels were regularly reviewed to ensure they were the least restrictive option.

Staff were developing skills through the diamond framework which was being introduced on the ward to develop and utilise de-escalation skills to support patients and reduce incidents.

The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

Staff took part in both managerial and clinical supervision with 100% of staff having received clinical supervision and 92% managerial supervision across the hospital in the month prior to our visit.

Staff told us how they were supported by the leaders and regional leaders were frequent visitors on the ward. Staff had access to support for their own physical and emotional health needs through an external health service.

However, due to staffing levels and patient support needs on the ward reflective practice session was not accessible for all staff. The lead psychologist was considering other ways to support staff. Staff told us that members of the MDT were busy and felt burnt out.

Staff told us they had conversations about career development and how it could be supported. Some of the leaders within the service had worked their way up through the company recently taking on their leadership role.

There was an employee of the month scheme where staff were recognised for their work. The votes were open to all that used the service including staff, visitors, external professionals, patients and their relatives. Even those that did not win that month, received an email to inform them that they were voted for and why.