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Inspection Summary


Overall summary & rating

Good

Updated 9 January 2019

We rated Cypress Hospital as good because

:

  • 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 staff group were very engaged with and positive about working with the patients. The person centred nature of the service ran through the care plans, face to face interactions and the language used in handovers and meetings
  • Staff completed thorough assessments of patients which were holistic and used these to inform individualised care plans for patients. Staff ensured 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, stored securely 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

  • Staff had appropriate training that enabled them to meet the needs of patients and keep them safe

  • Cypress was a single site service which accepted male and female patients. It was able meet the guidance on same sex accommodation by accommodating men and women in separate corridors.

  • The team included or had access to the full range of specialists required to meet the needs of the patients in the service

  • Staff understood their roles and responsibilities under the Mental Health Act 1983, the Mental Health Act Code of Practice and the Mental Capacity Act

  • The service 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. The service shared these lessons with all staff.

  • The culture at the hospital was positive, most staff felt supported and respected by managers.

However:

  • Although the service had recently moved to a purpose built environment that was designed to minimise ligature risk, there were risks posed by several ligature points that were not being managed fully. When made aware of these the senior management team immediately put in place a plan to address the risks.

  • Staff were not able to easily see all parts of the service, when we discussed this with managers they made arrangements for convex mirrors to be put in place to ensure staff could see all areas.
Inspection areas

Safe

Good

Updated 9 January 2019

We rated safe as good because:

  • The service environment was clean and well maintained.

  • Patient’s risk assessments were of a good quality and were reviewed and updated regularly in care plans, during handovers and other meetings.

  • Staff completed appropriate observations of all patients. Patients received higher levels of observation when required. The team consistently adhered to the services risk and observation policies.

  • There were adequate numbers of staff on duty at all times. The service had a stable workforce team, and turnover was low.

  • Staff knew how to raise incidents and there are processes in place to feedback learning. Debriefing sessions were undertaken following incidents and information was shared across the team. Staff were aware of and involved in changes and improvements in practice because of incidents.

  • Staff had received safeguarding training and understood the process for raising a concern.

  • Staff had access to notes from Cypress and those from the local mental health provider which ensured always had the information they required to support the delivery of patient care

  • Medicines management was robustly audited and overseen by a pharmacist from the local mental health trust.

However:

  • Although the service had recently moved to a purpose-built environment that was designed to minimise ligature risk, there were some ligature points that were not fully mitigated. This was raised with the senior management team at the time of the inspection and the service immediately actioned a plan to mitigate the risk of ligature points.
  • Staff were not able to easily observe all parts of the service. This was raised at the time of the inspection and the manager raised a request to put in place to mount convex mirrors.

Effective

Good

Updated 9 January 2019

We rated effective as good because:

  • Patients had access to physical health checks on admission and throughout their stay.

  • Staff provided a range of recovery focused interventions and activities to support patients to move on to more independent accommodation. Care and treatment was delivered in line with national guidance and best practice.

  • Staff working in the hospital had the skills and experience to deliver care and treatment to patients. The hospital also had access to a wide range of other professionals to support care.

  • There was a long-standing staff group with a high level of expertise.

  • All new staff had received a thorough induction to the hospital.

  • Staff received regular supervision and appraisal meetings.

  • The service held effective handover meetings and demonstrated positive multi-disciplinary working and cross agency working.

  • Staff applied the Mental Capacity Act appropriately to the needs of the patients.

  • Staff used a mood rating tool which was recorded in the patient record such as the health of the nation outcome score to measure patient outcomes.

However:

  • Only 8 out of 23 staff had completed Mental Health Act training although all demonstrated an ability to apply the Act appropriately

Caring

Good

Updated 9 January 2019

We rated caring as good because:

  • Feedback from all patients was positive. Patients said that staff responded compassionately to their needs and were skilled in dealing with vulnerable individuals with complex physical and mental health needs.
  • Staff were hard working, caring and committed to delivering a good quality service. They spoke with passion about their work and were proud of what they did.

  • Staff attitudes and behaviour when interacting with patients showed they were discreet, respectful and responsive. Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes to patients without fear of consequences.
  • Staff understood the needs of patients; including their personal, cultural, social and religious needs. Staff kept the confidentiality of information about patients and supported them to make choices about sharing information.
  • Patients were supported to manage their own health and care when they could, and to maintain their independence. The interim service manager was visible so that relatives and patients could speak with them as necessary.

  • Patients were included in decision-making and staff listened to their wishes. We saw staff discussing care options and treatments, and provided choice to patients.

  • Staff listened to patients and gave them emotional support via regular and impromptu one to one time. Staff overcame communication obstacles. These were overcome compassionately when working with people living with cognitive impairment.

  • Patients had access to advocacy services and staff promoted it is use.

  • Generally, relatives said they felt involved and had the opportunity to speak with medical and nursing staff when needed.
  • The service collected patient feedback and used these to make improvements. Patients and carers were involved in and consulted on developments and changes to the day to day running of the service

However:

  • One carer told us that it was sometimes difficult to get through to the hospital at night on the telephone.
  • Staff had only documented that they gave patients a copy of their care plan in three records.

Responsive

Good

Updated 9 January 2019

We rated responsive as good because:

  • The hospital catered for the specific dietary requirements of patients.

  • There was a strong focus on discharge planning which was reflected in the skill based care plans developed by the staff. Discharge planning was aided by the involvement of team from the local NHS trust who attended care reviews regularly.

  • The service had a separate female lounge to the main communal area. The area was sparsely decorated and not personalised to the client group.

  • Patients had their own rooms where they could keep personal belongings safely. There were quiet areas for privacy
  • The design, layout, and furnishings of the service supported patients’ treatment, privacy and dignity

  • Staff supported patients with activities outside the hospital, such as work, education and building family relationships

  • 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 9 January 2019

We rated well-led as good because:

  • The service was well led at service level and by the service provider executives. Executives were visible and accessible to staff and patients. They could discuss the present and future vision for the service.

  • There was a commitment to services continual improvement and innovation.

  • The service was responsive to feedback from patients, staff and external agencies.

  • The service manager and senior staff from the provider had recently recognised that some staff morale was low due to issues with the former manager. The recent changes to the manager of the service seems to have addressed this issue.

  • There was clear learning from incidents.

  • The service had been proactive in capturing and responding to patients concerns and complaints. There were attempts to involve patients in all aspects of the service.
  • Staff had lead roles within the unit and conducted audits.