Cygnet Hospital Maidstone

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

We reviewed all 6 quality statements in the effective key question. This means we looked for evidence that patients’ care, treatment and support achieved good outcomes and promoted a good quality of life, based on the best available evidence. At our last inspection we rated this key question as Requires Improvement. At this assessment the rating has changed and is now rated as Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of 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 Health Act Code of Practice and discharged these well.

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.

We scored the service as 3. The evidence showed a good standard. 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 10 care plans and found that staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. These initial assessments formed the basis of comprehensive care plans for each patient.

Staff assessed patients’ physical health needs in a timely manner after admission and where necessary created robust physical health care plans and took action to meet the needs of those that required it. All necessary physical observations were taking place, for example, blood tests and electrocardiograms. Staff ensured they monitored the side effects of medications that could be harmful to patients.

Staff developed care plans that met the needs identified during assessment. Care plans were person centred, incorporated the views of the patient and were written in a way that could be easily understood. Care plans were personalised, holistic and recovery oriented. Both wards had carer’s leads and social workers who ensured that carers and relatives were involved in planning the care of the patients. For example, carers were encouraged to attend ward round either in person or virtually.

Staff updated care plans when necessary. Patients told us they had regular time with their named nurse and this was reflected in regular updates to peoples’ care plans.

We scored the service as 3. The evidence showed a good standard. 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 provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medicines and psychological therapies as well as Dialectical Behaviour Therapy (DBT) which is a type of talk therapy for people who experience emotions very intensely. We saw activities timetable for a patient which included schedule to attend recovery college, DBT therapy and going to work.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. A GP attended the ward on a weekly basis.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration, for example where people had allergies to certain foods. Patients told us they could choose from a variety of food that the staff offered them.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Audits included physical health monitoring, health and safety and medicines management. These were comprehensive and included a range of comments and actions aimed at improving practice.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, there were occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists and health care support workers.

Staff were experienced and had the right qualifications, skills and knowledge to meet the needs of the patient group. Managers provided new staff with an appropriate induction, this included bank and agency staff.

Managers ensured that staff had access to regular team meetings. These were well attended by a range of staff, nurses and health care workers. We reviewed minutes from these meetings which showed that a range of topics were discussed for example lessons learnt, patient feedback, and safety and risk and cleanliness. Staff also attended reflective practice meetings and ad hoc meetings to address concerns if needed.

Managers provided staff with supervision. The percentage of staff that received regular supervision was100%. The percentage of staff that had had an appraisal in the last 12 months was 100%.

Managers of both Roseacre and Bearstead wards identified the learning needs of staff during supervision and ensured they provided them with opportunities to develop their skills and knowledge. Managers ensured that staff received the necessary specialist training for their roles. For example, two staff told us the provider offered lots of training opportunities, including annual and specialised sessions. The staff were waiting to be enrolled for training in finger-prick testing, which was part of a new clinical initiative. Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

The service admitted patients under the Mental Health Act 1983. All staff had completed face to face training on the Mental Health Act. Staff had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and advice on implementing the Mental Health Act and its Code of Practice.

Staff knew who their Mental Health Act administrators based at the hospital were.

The provider had relevant policies and procedures that reflected the most recent guidance and staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy. The service’s advocate regularly attended the wards. Patients could access independent mental health act advocates if needed.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. Records we reviewed demonstrated this.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.

Staff requested an opinion from a Second Opinion Appointed Doctor when necessary.

Staff stored copies of patients' detention papers and associated records correctly and so that they were available to all staff that needed access to them.

The service displayed a notice to tell informal patients that they could leave the ward freely. We saw signs throughout the wards showing this.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. The provider regularly completed audits on the Mental Health Act paperwork to ensure the correct and relevant paperwork was easily accessible and stored correctly.

We scored the service as 3. The evidence showed a good standard. 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.

Staff held regular and effective multidisciplinary meetings. Feedback from patients, staff, carers and other attendees was very positive about the work that was undertaken at these meetings. Staff told us that meetings were inclusive, well organised and happened on a regular basis. We observed one multidisciplinary meeting, and were assured that patients were at the centre of all the discussions. They were treated with kindness and compassion, and they were given choices about their treatment at every opportunity.

Staff shared information about patients at handover meetings which occurred at each change of shift. Staff told us these meetings enabled them to effectively share information to keep patients and others safe from harm.

The teams had effective working relationships with teams outside the organisation, for example, local authority social services and placing commissioners.

We scored the service as 3. The evidence showed a good standard. 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 patients to live healthier lives. For example, the wards had a specialist wellbeing team and therapists that provided patients with smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse. Staff offered 3-monthly weight monitoring checks for patients who took clozapine medicine to manage the side effects of taking this medication.

The ward activities helped promote a healthy lifestyle for patients, for example there was access to an onsite gym, yoga classes and other exercise classes. Patients were also supported to develop their independent living skills where this was appropriate.

We scored the service as 3. The evidence showed a good standard. 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 continuously monitored patients’ health, their mental state and well-being. At twice daily handover meetings, staff noted details of patients’ sleep, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. For example, clinicians completed the generalised anxiety disorder scale (GAD) to measure patient outcomes as well as Health of the Nation Outcome Scales (HoNOS) to assess and record severity and outcomes, potential malnutrition, side effects and overall wellbeing. Leaders monitored outcome measures at clinical governance meetings.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff assessed each patient’s capacity to consent to admission and treatment on admission. Capacity was monitored and recorded at multidisciplinary team meetings.

If a patient was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported patients to understand how the Mental Health Act applied to their situation and that patients understood their right to appeal.

Staff took all practical steps to enable patients to make their own decisions. Staff communicated well, presented options and kept patients informed about their treatment options.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis in relation to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. For example, we found evidence of best interest meeting which included the voice of a carer for a patient in Long Term Segregation.