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Inspection Summary


Overall summary & rating

Good

Updated 5 October 2018

We rated Cygnet Brunel as good because:

  • Staff completed thorough assessments of patients. Assessments were holistic and staff used these to inform individualised care plans for patients. Staff ensure that all assessments, including risk assessments and care plans were updated regularly.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • The service provided treatment and care for patients that followed a recovery focused model. Staff supported patients with their physical health and encouraged them to live healthier lives. They ensured that patients were offered a minimum of 25 hours of therapeutic activity each week.
  • Staff had appropriate training that enables them to meet the needs of patients and keep them safe.
  • The team included or had access to the full range of specialists required to meet the needs of the patients on the ward.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983, the Mental Health Act Code of Practice and the Mental Capacity Act.
  • Staff treated patients with compassion, kindness and supported their individual needs. Staff involved patients and those close to them in decisions about their care, treatment and changes to the service.
  • The service was accessible to all who needed it and took account of patients’ individual needs. Staff helped patients with communication, advocacy and cultural support. Patients had their own bedrooms where they could keep personal belongings safely.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
  • The culture at the hospital was developing. Most staff felt supported and respected by managers. Staff worked well together as a team despite experiencing lots of staffing changes since the unit opened in October 2017.

However:

  • The physical environment of the wards was not suitable for the patient group. It did not support the needs of the patients or the model of care. There were blind spots and a lack of space for patients to freely walk around in. We observed several near misses where patients almost walked into each other. Some communal rooms could not be observed from outside the room and doors did not have observation panels meaning a door could be opened onto another patient.
  • The process for making best interests decisions for patients was not well documented. When patients lacked capacity to make their own decisions, staff made and recorded decisions in the patients’ best interests. However, there was no evidence that staff were involving family and carers in this process.
Inspection areas

Safe

Good

Updated 5 October 2018

We rated safe as good because:

  • All staff had completed mandatory training. Staff completed and updated risk assessments for each patient and used these to understand and manage risks individually. They minimised their use of restrictive interventions and followed best practice.
  • Staff knew how to protect patients from abuse and worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • The physical environment of the wards was not suitable for the patient group. It did not support the needs of the patients or the model of care. There were blind spots and a lack of space for patients to freely walk around in. We observed several near misses where patients almost walked into each other. Some communal rooms could not be observed from outside the room and doors did not have observation panels meaning a door could be opened onto another patient.

Effective

Good

Updated 5 October 2018

We rated effective as good because:

  • The service provided treatment and care for patients that followed a recovery focused model. Staff supported patients with their physical health and encouraged them to live healthier lives. They ensured that patients were offered a minimum of 25 hours of therapeutic activity each week.
  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans and updated them when needed.
  • Managers supported staff with appraisals, supervision, and opportunities to update and further develop their skills.

  • The team included or had access to the full range of specialists required to meet the needs of the 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 Capacity Act 2005.

However:

  • There was a lack of clarity from nursing staff about the service model and the expectations for the client group.

  • The process for making best interests decisions for patients was not well documented. When patients lacked capacity to make their own decisions, staff made and recorded decisions in the patients’ best interests however there was no evidence that staff were involving family and carers in this process.

Caring

Good

Updated 5 October 2018

We rated caring as good because:

  • Staff treated patients with compassion, kindness and they supported their individual needs.

  • Staff involved patients and those close to them in decisions about their care, treatment and changes to the service.

However:

  • Staff did not maintain patient confidentiality. We observed staff discussing patient care in front of other patients. Nursing staff noticed that this was happening and rectified this immediately.

Responsive

Good

Updated 5 October 2018

We rated responsive as good because:

  • Patients had their own areas or rooms where they could keep personal belongings safely. There were quiet areas for privacy and facilities that supported patients’ treatment.

  • Staff supported patients with activities outside the service, such as work, education and family relationships. In addition to this, the hospital employed patients to complete certain tasks through a therapeutic earnings scheme.

  • Staff planned for patient’s discharge from the point of admission.

  • The service was accessible to all who needed it and took account of patients’ individual needs. Staff helped patients with communication, advocacy and cultural support.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Well-led

Good

Updated 5 October 2018

We rated well-led as good because:

  • Managers had the right skills and abilities to run a service providing high-quality sustainable care.

  • The culture was developing. Staff felt supported and respected by managers. Staff worked well together as a team despite experiencing lots of staffing changes since the unit opened in October 2017.

  • The provider had a comprehensive schedule of meetings and reporting systems to ensure good governance of the service.

  • The hospital had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

  • The hospital collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

However:

  • There was a lack of clarity of the hospitals vision and strategy. Nursing staff felt unclear on the vision of the service, with managers providing extra training sessions on the service model, neuro-rehabilitation and how this was different to rehabilitation.

Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 5 October 2018