Cygnet Hospital Maidstone

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• 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 six patient care records. In all cases staff had completed a comprehensive mental health assessment of the patient at, or soon after, admission and updated this regularly. Staff assessed patients’ physical health needs in a timely manner after admission and at regular intervals. We noted in two records that the last annual health check had not been recorded. This was rectified on the same day we raised this.

Staff developed care plans that met the needs identified during assessment. The provider used nine standardised care plans to detail patient’s needs. The care plans we reviewed were personalised, holistic and recovery-oriented. We saw evidence of, and patients confirmed that, they were involved in their care planning. Care plans were updated as required. However, we saw no documented evidence that patients had been offered a copy of their 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 were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Staff received a full induction and were required to complete relevant training prior to working on the ward. Staff received regular management and clinical supervision and had access to regular team meetings.

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 both medication and psychological therapies, as well as meaningful activities and work opportunities intended to help patients acquire living skills.

Patients spoke positively about the range of activities offered. The service employed activities coordinators to support patients with a range of activities.

The team included the full range of specialists required to meet the needs of patients, including doctors, nurses, occupational therapists, clinical psychologists, social workers, pharmacists, speech and language therapists, and dieticians.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Patients were supported to attend opticians and dentistry appointments.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration, where applicable.

Staff participated in clinical audit, with identified staff completing regular clinical audits. The service also took part in quality improvement initiatives. For example, the service was in the process of setting up a patient working group to improve the design of the space where activities were routinely held.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff had received training in the Mental Health Act and the ward was 100% compliant.

Staff had easy access to administrative support and legal advice on the implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

The provider had relevant policies and procedures that reflected the most recent guidance; which staff had easy access to.

Patients had easy access to information about independent mental health advocacy.

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.

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, such as, Section 17 leave forms, correctly so that they were available to all staff that needed access to them. We reviewed Section 17 leave forms and they were in good order. These were also regularly audited.

The service audited adherence to the Mental Health Act every six months.

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.

Staff shared information about patients at effective handover meetings within the team.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. The teams had effective working relationships with teams outside the organisation. For example, local authority social services and the Ministry of Justice.

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, through participation in smoking cessation schemes, healthy eating advice, managing cardiovascular risks, screening for cancer, and dealing with issues relating to substance misuse.

Ward activities helped promote a healthy lifestyle for patients, for example staff organised walking groups, sports activities and healthy meals cooking.

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 used recognised rating scales to assess and record people’s mental health and the outcomes of treatment. In all six patient records reviewed we saw the use of the Health of the Nation Outcome Scales.

Staff used technology to support patients effectively. For example, patients who were unable to read were provided with a tablet which had technology installed that could speak text aloud. This meant that patients weren’t reliant on staff to read information to them, allowing them privacy with regards to sensitive or personal information.

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 took all practical steps to enable patients to make their own decisions.

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