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 Good.

This meant people’s needs were met through good organisation and delivery.

The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. The service met the needs of all patients including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

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.

Three out of 4 patients we spoke too said that some staff did not tailor their responses to distress in a personalised way and some responses were not helpful, with them offering platitudes instead of acknowledging the way they felt. Most patients also told us that there were not enough staff to support them when needed, especially to sit and talk. Staff and 3 patients told us that they did not have regular one to one with their named nurse.

Care Plans were individualised and had been created using information from the preadmission information which had been provided. However, there was no evidence that patients had been involved consistently in their development as they were not written in the patients' voice.

One patient had expressed that they had felt rushed and that their concerns were not taken seriously by all staff members.

Patients had been able to provide feedback in community meetings and changes to the menu had happened as a result of patient feedback.

Some staff told us that there was more that could be done around personalising the care to individual patients. A patient told us that some staff were not autism informed and so did not always know how best to support. We did, see that adjustments were made for some patients who were neurodiverse such as a plate which could separate out food groups being provided.

The service was looking at ways to ensure that care was delivered in a person centred way. They were training to staff in the diamond framework which focuses on dialectical behaviour therapy (DBT) and cognitive dialectical therapy (CDT) informed interventions. They told us the feedback from patients involved in this work has been positive.

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. Where consent was given by the patient, family members were able to be involved in the person’s care. However, both family members we spoke to told us that communication with the ward was limited and despite the patient agreeing for full disclosure of their care information was not routinely shared.

The ward does have some out of area patients. During our visit a patient was discharged back to their area in line with their wishes. We saw evidence in care records that the whole MDT had been involved in discharge planning.

A patient told us how the ward was helping them to continue their studies. Whereas other patients told us that there were not enough activities for them to engage with. Staff also acknowledged that activities were regularly cancelled due to activity coordinators having to support with incidents and observations on the ward.

Staff ensured that patients had access to appropriate spiritual support although there was not a dedicated multi faith room. The service had links with the local churches in the local community. One patient had been supported to attend church regularly and volunteer at different events ran by the church.

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 recognised that they had not always made notifications to external bodies as needed. We saw that they service had not submitted notifications to the Care Quality Commission in accordance with the requirements of their registration for all incidents. They had also failed to submit safeguarding referrals to the local authority. Leaders had assured us that the necessary referrals had now been made and additional measures were implemented to prevent this from happening again.

The service could support and make adjustments for disabled people and those with communication needs or other specific needs.

Staff made sure patients could access information on treatment, local services, their rights and how to complain. Key information was displayed on noticeboards throughout the ward including, patient rights, safeguarding processes and activities available at the hospital. Patient information leaflets were written in an accessible format, and the service could access the leaflets in different languages when needed. Managers made sure staff and patients could get help from interpreters or signers when needed. One patient was supported to communicate with staff and other patients through the text facility on their mobile phone.

Wards rounds were used to ensure that other professionals were updated on the patient’s progress. Although family members told us that they were not consistently invited to ward rounds and were not always informed of incidents by staff. The provider shared that all reported incidents are investigated and the outcome of the investigation are communicated back to the patient verbally and in writing. However, consent from the patient is needed to share incident details with family and this is not always given.

External partner such as commissioners were happy with the level of information sharing and the responsiveness of the ward to feedback.

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. The policy provided detailed information on how to report a complaint and what to expect during the complaints process.

The service had received a total of 2 formal complaints for the 6 months prior to our visit.

We saw evidence of patient complaints on forms which were available on the ward. We were told wherever possible ‘low-level’ complaints were dealt with on the ward informally by speaking to the patient. Two patients told us that they had made complaints but did not feel that the outcome of their complaints has been clearly communicated to them. This level of informal complaint was not recorded to identify any themes or trends. Staff told us that they always offered feedback to complaints, but some patients declined to engage with them.

The ward held community meetings which was an opportunity for patients to feedback on their care. There was also an expert by experience who attended the ward and offered leaders information shared with them via patients or through their own observations. They stated that leaders listened and responded to their feedback.

Family members could complain directly to the service. Family members we spoke to stated they were not told how to complain but had found information through the website or shared their concerns with the patient’s community psychiatric nurse (CPN). One family member told us they were happy with the outcome of their complaint.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties. We saw that for 1 patient who had no verbal communication there was a detailed communication plan as part of their care planning.

Staff said they knew how to handle complaints appropriately and efficiently and managers provided feedback on the outcome of investigations and acted on any findings.

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. The ward was located on the ground floor and had facilities that met the needs of patients with mobility difficulties. All communal areas and bedrooms were spacious and accessible. Managers told us they would always assess whether they could meet a patient's needs safely prior to admission. Rooms on the ward were on the ground floor suitable for patients with mobility issues, although lift access was available if required to go upstairs in the building for any reason.

There was medical cover day and night, a doctor could attend the ward quickly in an emergency.

Staff carefully planned patients’ discharge although most patients were not yet at the discharge planning stage. When discharge planning was discussed, it was done in partnership with community services. During our visit, we saw that a patient was discharged back to their local area in line with their wishes.

Staff told us how they would allow patients to stay on the ward for as long as they needed to ensure that they were discharged to a suitable placement. We saw staff supporting individual patients to consider future housing options and apply for appropriate housing.

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 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 views being fed back through complaints forms, the advocate and expert by experience. However, 1 patient told us that they had not received feedback from their complaints. They stated that they did not feel that they were listened too.

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. However, we found that cultural awareness was sometimes lacking on the ward. They had commented that a white member of staff had delivered a talk on black history day. This had been about lived experience of black history which they felt should have been done from a member of staff with lived experience.

The provider reported 97% of staff across the hospital were trained in Equity and Diversity. The Oliver McGowan Mandatory Training on Learning Disability and Autism E-learning was 86.8% however, only 24.2% of staff had received training on learning disabilities and autism Tier 2. This was reflected in feedback from patients that not all staff demonstrated an awareness of autism. One patient felt that the ward environment was not autism friendly with only the dimmable lights being an adjustment that they could see. We also heard that other patients had made similar comments to the advocate.

The provider told us that the service had been designed to include a sensory room and dimmable lights across the ward and an adaptable multi-faith room. Patients on the ward were encouraged to personalise their bedrooms to meet any of their needs including autism needs. There is also an isolated quiet lounge to help meet individual needs.

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 a good standard. People were 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 patients to make decisions about their care and treatment and their future. Care plans were personalised to the patient using information from detailed assessments that were completed prior to admission. The hospital had a dedicated social worker whose work mainly focused on the acute ward. However, we saw that they also worked closely with patients to support them with certain aspects of their care planning such as housing.

For patients who had multiple needs we saw that staff ensured that all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment.