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 this quality statement 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 5 patients’ care records. Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward.

Staff developed comprehensive care plans for each patient that met their mental and physical health needs. The provider used 9 standardised care plans. Care plans were personalised, holistic and recovery orientated. Staff regularly reviewed and updated care plans when patients' needs changed. Patients were aware of their current care plans and what their goals were for achieving discharge. However, it was not always recorded whether a patient had received or refused a copy of their care plans.

We scored this quality statement 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, 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 suitable for the patients in the service, which were delivered in line with best practice and national guidelines. Care and treatment on offer included both medication and psychological therapies. The ward had access to a range therapeutic activities that were now suitable to the needs of the patient group on the rehabilitation ward. We observed patients participating in off-ward activities available to the whole hospital. Managers monitored patients' engagement with therapeutic activities and took action when this fell below targets.

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.

The ward had their own dedicated occupational therapist who could provide assessments on a range of daily living skills. However, at the time of the assessment the ward did not have an activities co-ordinator in place. This was being covered by bank staff who were familiar with the ward.

Staff identified patients’ physical health needs and recorded them in their care plans. Staff made sure patients had access to physical health care, including specialists as required. The service had 2 physical health leads and a regular visiting GP. Staff supported patients to attend regular dental and optician appointments.

Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group. Staff were proactively supported and encouraged to acquire new skills and share best practice. Staff had access to a range of specialist training courses such as dialectical behavioural training, venepuncture, substance misuse training and HOPE(s) training. HOPE(s) is a clinical model with a human rights-based approach to working with individuals in segregation developed from research and clinical practice. Its aim is to reduce the use of long term segregation sometimes experienced by autistic adults, adults with a learning disability and children and young people. The hospital had a visiting GP that offers diabetes and Chronic Obstructive Pulmonary Disease (COPD) training to staff.

Staff had access to a range of apprenticeship schemes supported by the provider. These include a leadership apprenticeship, data technician, Occupational Therapy apprenticeship, aspiring hospital manager training and a ward manager development programme.

The hospital had a culture of co-production. Staff could give examples of where patient feedback influenced the training being delivered. A patient suffering from Tourette's Syndrome co-produced a training package for staff with support from the hospital’s training team. This was now an available module for all staff.

Managers made sure all new, bank and agency staff had a full induction and understood the service before starting their shift.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. All staff on Kingswood ward had received up to date clinical, managerial, and/or safeguarding supervisions. All staff had received an up-to-date yearly appraisal.

Managers ensured that staff had access to regular team meetings. There was a clear framework of what must be discussed at a ward level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

Staff had received training in the Mental Health Act and the ward was 100% compliant. 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 legal advice on 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. 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.

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 and 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. These were to ensure the Mental Health Act had been applied correctly.

We scored this quality statement 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 multidisciplinary meetings to discuss patients and improve their care. Staff made sure they shared clear information about patients and any changes in their care, including during handover and daily multidisciplinary meetings.

Ward teams had effective working relationships with other teams in the organisation.

Ward teams had effective working relationships with external teams and organisations. For example, local authority social services, local NHS trusts and Integrated Care Boards.

We scored this quality statement 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. The hospital had a smoking cessation scheme, healthy eating advice, advice on managing cardiovascular risks, screening for cancer, and help dealing with issues relating to substance misuse. The hospital employed a dietician who worked closely with the ward teams and patients to support their dietary and nutritional needs. The hospital employed a substance misuse specialist.

Ward activities helped promote a healthy lifestyle for patients, for example walking groups, sports activities and cooking healthy meals. The hospital employed a fitness instructor, who offered one to one work with patients and group activities. The hospital had an onsite gym and organised sporting events such as a ward cycling competition and cricket workshops.

We scored this quality statement 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 severity and outcomes. These were used for both mental and physical health outcomes. Staff were able to show how patients were progressing through their treatment.

Staff took part in clinical and benchmarking audits. They were supported by audit, assurance and performance monitoring teams within the service and wider organisation. Results from audits and quality assurance processes were used to make improvements.

Staff used technology, for example accessing and storing medical results electronically where needed and patients’ records were stored electronically which made information sharing easier and quicker. Staff told us that the computer systems were slow on the ward and often stopped working. This meant that staff sometimes had to write paper copies of nursing notes and then night staff would enter them on the system. Staff could not look at patient records during these times.

Data on patient outcomes was reviewed and analysed within the hospital and provider wide governance structure and in external governance and performance meetings with commissioning bodies.

We scored this quality statement 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