Cygnet Elowen Hospital

On this page

• 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

Effective- 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. At our last inspection we rated this key question requires improvement. The service was in breach of legal regulation in relation to consent to treatment. The service had made improvements and is no longer in breach of the regulation. Staff had strengthened their understanding and application of the Mental Capacity Act and Mental Health Act, and patients were more involved in decisions about their care and treatment. Staff used recognised assessment and outcome measures to monitor patients’ needs and progress and had access to relevant clinical guidance. The service had also strengthened its multidisciplinary team and specialist input, including dietetic and occupational therapy support. At this inspection, the rating has changed to good.

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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 5 patients’ care records during the inspection. Staff completed comprehensive mental health assessments in a timely manner, either at or soon after admission, and assessed patients’ physical health needs promptly. Staff assessed patients’ communication needs and considered their holistic needs when developing care plans. Care plans were recovery-oriented, with clear goals and actions to support patients to achieve them. Assessments and care plans were completed and kept up to date.

Patients mostly felt involved in their care and that staff understood their individual needs. While some patients told us they would have liked greater involvement in the assessment of their needs, staff generally incorporated patients’ views into care planning and demonstrated a good understanding of their individual circumstances.

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 planned and delivered care and treatment in line with current guidance and best practice. Patients had access to a range of psychological and therapeutic interventions that supported their recovery. Activities were tailored to patients’ needs and preferences, and patients told us that staff provided meaningful opportunities for engagement.

Staff supported patients to access physical healthcare, including specialist services when required. Staff focused on patients’ nutritional and hydration needs as part of their care. Leaders had taken action to improve the quality and consistency of meals and strengthen the support available to patients around nutrition. Patients had access to appropriate nutritional advice and staff worked with the multidisciplinary team to support individual dietary needs.

The service had strengthened its multidisciplinary team and ensured patients had access to the specialist skills required to meet their eating disorder needs. Staff have received additional training, for example specialist training on eating disorders care and development to improve their knowledge and confidence in providing specialist care. Staff demonstrated an understanding of patients’ individual needs and were able to apply their learning in practice. We saw evidence of strong specialist dietetic input within the service. The dietitian contributed to the development of the Adult Eating Disorder Model of Care Pathway audit tool, which was recognised by colleagues as a comprehensive framework to support quality and consistency in eating disorder care. This demonstrated the dietitian’s contribution to developing specialist practice and supporting the wider multidisciplinary approach.

Managers provided staff with induction, supervision, appraisals, and regular team meetings. Staff had good access to supervision and appraisal, and managers had systems in place to identify learning needs and support staff development. Leaders continued to develop staff skills and knowledge to ensure the workforce could meet the complex needs of patients.

Mental Health Act

Staff had received training in the Mental Health Act and demonstrated a good understanding of their responsibilities, including the Code of Practice and guiding principles. Staff knew how to access Mental Health Act administrative support, legal advice and local policies and procedures.

Patients had access to information about their rights under the Mental Health Act and independent mental health advocacy. Staff explained patients’ rights in a way they could understand and recorded these discussions. Staff also understood the arrangements for Section 17 leave and supported patients to access leave when authorised.

We found improvements in the management of patients’ legal status and Mental Health Act documentation since the previous inspection. Detention papers and associated records, including Section 17 leave documentation, were appropriately maintained and accessible to staff. Staff understood when a second opinion appointed doctor was required and how to access this.

The service had arrangements to monitor compliance with the Mental Health Act, including regular audits and oversight by the Mental Health Act administrator. Learning from these processes was used to improve practice. Informal patients were provided with information about their right to leave the ward freely. Where applicable, care plans identified patients’ Section 117 aftercare arrangements.

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.

Leaders had strengthened the multidisciplinary team (MDT) provision and ensured patients had access to the range of professionals needed to support their care and treatment, including psychological and specialist eating disorder support.

Staff held regular and effective MDT meetings, where relevant professionals shared information and contributed to decisions about patients’ care and treatment. Staff shared information effectively through handovers between shifts, supporting continuity of care. Teams had effective working relationships with other services within the organisation and with external partners, including community services, GPs and other relevant professionals. Staff shared information appropriately when patients moved between services and involved relevant professionals in referrals, transitions and discharge planning. This supported continuity of care and ensured patients’ individual needs were considered when arrangements were made.

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.

Staff supported and empowered patients to manage their health and wellbeing and promoted healthier lifestyle choices. Staff monitored patients’ physical health and involved relevant professionals where required. Given the nature of the service, staff provided comprehensive meal support tailored to patients’ individual needs and supported patients to develop healthier relationships with food.

Patients had access to a range of groups and activities that promoted healthy lifestyles, wellbeing and recovery. These included activities that encouraged positive routines, physical activity and social engagement. Patients also had access to occupational therapy input to support their independence and wellbeing. Patients spoke positively about the activities coordinator and occupational therapy support, who were committed to helping patients improve their health and wellbeing.

Patients attended numerous groups and activities focused on promoting healthier lives. One patient told us, “The activities and groups are really very good. I go to lots of them, and they have really helped me loads.”

Staff also supported patients to consider their wider health needs and provided appropriate advice and support around healthy eating and maintaining physical health.

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 monitored patients’ care and treatment to support positive outcomes. Staff used recognised assessment tools, including the Malnutrition Universal Screening Tool (MUST) and National Early Warning Score 2 (NEWS2), to assess clinical risk, monitor progress and identify changes in patients’ physical health. Staff responded promptly when patients’ needs changed and used this information to inform care and treatment.

Staff also used recognised outcome measures, including the Health of the Nation Outcome Scales (HoNOS), to assess patients’ needs and monitor changes over time. Digital systems supported staff to record and review patient information, and staff could access blood test results promptly.

Staff had access to relevant clinical guidance to support the safe monitoring and management of physical health risks. This approach supported care in line with national guidance and helped ensure patients’ individual needs were identified and responded to effectively.

Patients generally experienced positive outcomes from their care and treatment. Staff worked with patients to identify individual goals and reviewed progress through ongoing care and multidisciplinary team discussions. The service had strengthened its therapeutic and specialist support, including improvements to the multidisciplinary team and activities provision, which supported patients’ recovery and wellbeing.

The service told people about their rights around consent and respected their rights when delivering care and treatment.

Staff supported patients to make informed decisions about their care and treatment and respected their rights around consent. Staff took practical steps to involve patients in decisions and sought their views and preferences when planning and delivering care. One patient told us, “Staff do share information with my family, but they always ask me if it’s okay before they do.” This demonstrated that staff considered patients’ consent when sharing information with relatives.

For patients who required mental capacity assessments, staff assessed capacity on a decision-specific basis and considered the person’s ability to make the particular decision. Where patients lacked capacity, staff considered their wishes, feelings, history and preferences when making decisions in their best interests.

Staff understood the principles of the Mental Capacity Act and Mental Health Act and knew how to access advice and support when required. The service had relevant policies and procedures in place and patients had access to independent mental health advocacy. Staff explained patients’ rights and supported them to understand their choices and responsibilities.

The service had strengthened its processes for monitoring compliance with the Mental Health Act and Mental Capacity Act since the previous inspection. Staff demonstrated improved understanding of these safeguards and applied them to support patients’ rights, choice and control.