Cygnet Appletree

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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.

At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant people were supported and treated with dignity and respect; and involved as partners in their care. The provider employed its own expert-by-experience who visited the wards; spoke with patients and staff, observed care and practice on the wards and provided feedback to managers within the service about what was working well and what could be improved.

However, 3 of the 6 patients we spoke with told us they did not have regular 1 to 1 time with their named nurse.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 6 patients and 2 carers during our inspection. Other patients we approached were either too unwell to engage or declined to speak with us.

Feedback from patients was mainly positive. Patients said staff were kind; polite, caring, treated them fairly and were good at their jobs. Staff provided patients with help, emotional support and advice at the time they needed it. Patients told us staff were good at de-escalation when patients' behaviours became heightened. Staff provided them with advice on leading healthier lives and were interested in their wellbeing. The food at the hospital was good and there were a good range of meal choices. One patient commented that staff went the extra mile in helping them to reduce their stress levels. Another patient had reported being abused by a peer on the ward and staff had addressed this to their satisfaction. Patients had been offered a copy of their care plan and said staff explained things in a way they could understand.

However, one patient on Pippin ward was unhappy there was no accessible water cooler on the ward and that some of the furniture had sharp edges which needed to be replaced. Three patients we spoke with said they did not have regular 1-to-1 time with their named nurse.

Both carers we spoke with told us that staff kept them regularly updated about their loved one's progress and said the ward was clean when they visited it. They said staff considered both their own and their loved one's needs and were given information about how the ward operated. However, one carer said staff did not encourage their loved one to maintain contact with them. The second carer said staff arranged for their loved one to maintain contact with them via video link.

During our inspection, we observed staff interacting with patients in a discreet, respectful and responsive way.

Staff were required to refer to patients using their Cygnet reference number within documentation on the provider's care records system. This was not in-keeping with a person-centred approach and could be perceived as `dehumanising' the patients concerned.

We looked at patient feedback provided about the service via minutes of people's council and Safewards meetings that had taken place (Safewards is a model and a set of interventions designed to make mental health inpatient wards safer and more therapeutic by reducing conflict and the use of restrictive practices such as restraint and seclusion). Patients had been complementary about staff and appreciated their help. Most patients knew who their named nurse was. Patients gave positive feedback about the quality of therapeutic activities they had access to.

The provider employed its own expert-by-experience who visited the wards; spoke with patients and staff, observed care and practice on the wards and provided feedback to managers within the service about what was working well and what could be improved.

Staff supported patients to understand and manage their care, treatment or condition.

They also supported patients in identifying what benefits they were entitled to and in completing benefit application forms.

We saw evidence in care records that staff directed patients to other services when appropriate and, if required, supported them to access those services.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

Staff maintained the confidentiality of information about patients.

Patients had a choice of food to meet their dietary requirements. This included meals to account for their religion, allergies, intolerances and health issues such as diabetes.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain etc. The information provided was in a form accessible to the particular patient group and could be provided in easy-read form on wards for people with a learning disability or other languages.

Staff ensured that staff and patients had easy access to interpreters and/or signers. Staff ensured that patients had access to appropriate spiritual support.

Patients could talk to staff when they needed to, which helped with their wellbeing.

Independent advocates could attend the ward in person within 24 to 48 hours should they be required. They could also liaise with the patient via telephone or video link.

Staff used various tools and methods to communicate with patients on the wards. Information could be provided in easy read for patients with a learning disability. Online translation services could be used to produce information in different languages.
Staff gave patients access to activities, such as pool, board games, movie nights, use of the gymnasium and arts and crafts. We saw activity timetables displayed on patient noticeboards on the wards.

The occupational therapy team devised therapeutic activities following discussions with patients and staff on the wards. Care records evidenced staff provided both group and individualised activities for patients.

Patients care plans included the patient's choices and preferences, allowing for activities to be arranged accordingly.

Staff were aware of and dealt with any specific risk issues and care planned for these accordingly.

Staff identified and responded to changing risks to, or posed by, patients. We observed two morning meetings in which escalation in risk in respect of patients on the ward was discussed and staff took appropriate action in response such as changes in medications, levels of observation and engagement and Section 17 leave arrangements.

Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened.

Staff felt respected, supported and valued. They felt positive and proud about working for the provider and within their team.

Staff had access to support for their own physical and emotional health needs through an occupational health service as well as a range of other wellbeing support schemes. Staff had access to counselling and staff told us managers had an open-door policy. One staff member told us their manager had been very supportive when they had a personal issue which they really appreciated.

The provider recognised staff success within the service. Patients could nominate a staff member for a star of the week award. The provider held employee of the month awards. Good news and evidence of good practice could be submitted by staff for inclusion on the provider's intranet.

Staff appraisals included conversations about career development and how it could be supported.