Cygnet Appletree

On this page

• 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. At our last assessment we rated this key question as good. At this assessment the rating has remained good.

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

Staff managed bed availability well and there was clear rationale for delayed discharges from the service.

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. Patients could get help from interpreters, signers or independent advocates when needed. The service provided a variety of food to meet the dietary and cultural needs of individual patients. Patients had access to spiritual, religious and cultural support.

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.

The patients and carers we spoke with said that care and treatment had been arranged around individual needs and preferences. Staff involved patients and families in decisions about care and treatment.

Staff supported, informed and involved people using the service and their families or carers. There was a social worker within the hospital who supported carers and also sought to facilitate smooth transitions to other placements when the patient was ready to be discharged.

During our tour of the wards, we saw that patients could personalise their bedrooms. Patients had lockers in which to securely store their possessions. There was a multi-faith room onsite and religious leaders such as imams and chaplains visited the wards to conduct services.

We saw evidence in care records that decisions around care and treatment were made in co-creation with the patient and their carers where appropriate. We saw evidence of discharge planning and that patients were supported to move on with the next steps of their recovery journey.

The service employed an expert by experience who attended the site each week. They attended situation report meetings (a situation report, more commonly known as a SITREP, is a form of status reporting that provides a quick understanding of the current situation, such as the status of a project, or an operational challenge) and visited the wards to speak with patients, staff and undertook observations of what was happening on the wards. Their feedback was shared with senior managers within the service.

Work had gone into the carers’ strategy within the hospital. A new carers' lead had been appointed and a review of the information sent out to carers upon admission was being undertaken. This included a document to complete and return providing any information that may be beneficial in planning care and supporting a positive patient experience.

Staff supported patients to maintain contact with their families and carers. Staff provided patients with telephones to call their loved ones and gave patients access to computers so they could contact them via video link.

Staff supported patients to access their chosen place of worship within the community and there was a multi-faith room within the hospital.

Staff did not always make notifications to external bodies as needed. Serious incidents including self-harm and threats to kill and a complaint alleging abusive behaviour by staff and an injury sustained during restraint had not been referred to the local authority. This is a concern that we will endeavour to look into separately to the inspection process as reporting is a condition of the registration of the service. However, following our inspection, the provider quickly devised an action plan which included processes to address some of these issues.

Information governance systems included confidentiality of patient records. The provider’s electronic systems required staff to use a login name and password which needed to be made up of lower-case and upper-case letters, numbers and special characters. Staff received information governance training which highlighted the need to maintain patient confidentiality and safeguard patients’ data.

The service complied with the Accessible Information Standard.

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

Staff ensured carers, families and commissioners were regularly updated about the patient’s progress.

Patient noticeboards on the wards contained a good level of information including:

• Safeguarding
• Staffing information
• ‘You said, we did’ posters
• How to complain to the provider, Parliamentary and Health Services Ombudsman and Care Quality Commission
• Meal options
• Local services and helplines
• Activities timetables
• Advocacy services.

Overall, staff knew how to handle complaints appropriately and received feedback on the outcome of investigation of complaints and acted on the findings. However, a decision had been made for complaints not to be logged for one patient until they were feeling better because they had been deemed to lack capacity around making complaints. We had concerns that this could place the patient at risk if any of their complaints were genuine and related to issues around their care and treatment or safeguarding concerns. We fed this back to the manager at the time of the inspection.

In the last 12 months, there had been 24 complaints, 8 of which were informal and 16 of which were formal. Following investigations, 3 of the informal complaints were upheld; 7 of the formal complaints were upheld and 4 of the formal complaints were partially upheld. None of the complaints had been referred to the Parliamentary and Health Services Ombudsman.

Managers used findings from investigating complaints to improve the service. A complaint had been made by a patient about a lack of blood tests being taken in relation to their lithium medication. The provider found no evidence that bloods had been taken so the complaint was upheld. All clinical staff were made aware of the situation and potential risks involved and were reminded of the importance of documentation. Following this, a new process was introduced including:

• A monthly physical health audit.
• The requirement for staff to take bloods, including for patients on lithium medication, within 48 hrs of admission.
• The requirement for staff to complete associated documentation (including if the patient has refused to consent to giving bloods) and upload it to the patient's care record as soon as possible.
• Spot checks to be completed by the responsible clinician.

Patients knew how to complain or raise concerns. During our tour of the wards, we saw posters in patient noticeboards explaining how to make a complaint to the provider or externally to the Care Quality Commission and Parliamentary and Health Services Ombudsman.

When patients complained or raised concerns, they received feedback. Staff protected patients who raised concerns or complaints from discrimination and harassment. If the complaint was against another patient on the ward, staff presence in the communal areas could be increased and, the patient at the centre of the complaint could be moved to another bedroom further away from the complainant. If the complaint was against a staff member, the staff member could be moved to another ward or, if the complaint was of a serious nature, they could be suspended pending an investigation.

Staff made reasonable adjustments for patients. People with mobility issues could be provided with walking aids or shower chairs. Neurodivergent people had options to stay in rooms with dimmable lighting off the ward if this was supportive for their sensory needs and staff could provide people with specific food choices to account to any sensitivities to textures.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.

Staff ensured patients had access to post-discharge care such as Section 117 aftercare, community mental health services and crisis services.

In the last 12 months, there had been 13 delayed discharges; 7 on Pippin ward and 6 on Bramley ward. The reasons for the delays included a lack of an appropriate placement for the patient to be moved to, ongoing concerns about the patient’s mental health and Ministry of Justice restrictions.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

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.

Staff were trained in equality, diversity, inclusion and human rights.

Staff supported patients to make decisions about their care and treatment and their future.

Overall, staff created personalised care plans to account for the patient’s needs, wishes and feelings though we found some omissions of information and staff referred to patients by their Cygnet reference number in documentation, rather than their name.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs.

Staff planned for patients’ discharge from the service. Any plans for discharge were made in collaboration with other interested parties such as home teams, community mental health teams, housing services, social services and GPs.