Cygnet St. Williams Also known as Cygnet Behavioural Health Limited

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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

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

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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 looked at 6 patients’ care records during our inspection.

We saw evidence that staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Staff assessed patients’ physical health needs in a timely manner after admission.

Staff developed care plans and positive behaviour plans that met the needs identified during assessment which were in line with national guidance and best practice.

Care plans were personalised, holistic and recovery-oriented. We saw evidence that the patient and, where applicable, their loved ones, were involved in decisions about care and treatment. They also contained the patient’s views, goals and wishes. Care plans evidenced the involvement of a speech and language therapist, an occupational therapist and also evidenced specific care plans such as medication administration and provision of sensory equipment such as a mood lamp.

Staff updated care plans when necessary.

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 medication and psychological therapies and activities, training and work opportunities intended to help patients acquire living skills.

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

Staff participated in clinical audit, benchmarking and quality improvement initiatives. In the last 12 months, staff had participated in the following audits and quality improvement checks:

• Regular reviews of capacity, consent, and safeguarding
• Blanket restriction audits
• Audits of cleanliness and infection control within the service prevention
• A regional quality management audit of the service.

The team included or had access to the full range of specialists required to meet the mental and physical healthcare needs of patients within the service. Within the service itself, there was a speech and language therapist, a consultant, a physiotherapist, nursing staff, a dietician, a psychologist, occupational therapists and activities coordinators. Patients also had access to dentists, GPs, opticians and other primary healthcare professionals within the community.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff with appropriate induction. All new starters, including bank staff, completed an induction booklet with the support from an induction buddy allocated to them on their first day within the service. The staff member completed a range of online courses and face to face training courses as part of their induction. Agency staff who were new to the service were asked to commence their shift an hour before they were due on duty, to allow the nurse in charge to go through the agency induction form with them. They were then fully supported during their shift by all staff. The provider routinely requested a profile of all agency staff prior to them completing a shift within the service to check what training they had completed.

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. At the time of our inspection, all eligible staff had been appraised and the average compliance rate for staff supervision was 97%.

Managers ensured that staff had access to regular team meetings.

Managers identified the learning needs of staff during supervision and appraisal sessions and provided them with opportunities to develop their skills and knowledge.

Managers ensured that staff received the necessary specialist training for their roles. This included smoking cessation, wound assessment, leg ulceration, flu vaccine administration, cognitive rehabilitation, talking mats, social stories, trauma informed care and peg feeding.

Managers dealt with poor staff performance promptly and effectively. The provider had a performance management policy which provided advice and guidance for dealing with poor performance in an appropriate, supportive and timely manner.

Mental Health Act

All staff within the service had completed their mandatory training in the Mental Capacity Act.

Staff had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

The provider had a policy on the Mental Health Act which staff were aware and had access to.

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 the Mental Health Act administrator was within the service.

The Mental Health Act administrator monitored staff adherence to the Act via audits and shared any identified learning with staff when needed. They also provided advice and guidance to staff about the use of the Act when required.

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.

We saw evidence in patients’ care records that staff explained to patients what their rights were under the Mental Health Act in a way that they could understand.

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

We saw evidence in patients’ care records that staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records correctly 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.

Care plans made reference to the need to identify Section 117 aftercare services for patients who had been subject to a Section 3 detention or equivalent Part 3 powers authorising admission to hospital for treatment.

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. We observed 1 morning meeting and 2 multidisciplinary team meetings during our inspection, the latter of which the patient attended. The multidisciplinary team discussed supporting patients’ communication needs, dietary needs, changes in observation levels, assistance with coping skills and managing emotions and encouraging patients to engage more. Attendees were also informed about who the fire warden and first aider was that day; any visits from family members, ongoing maintenance works and upcoming care programme approach 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 and outside the organisation.

We scored the service as 4. The evidence showed an exceptional standard. The service always supported people to manage their health and wellbeing to fully 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. Three patients within the service had stopped smoking following the smoking cessation support they had received from staff within the service. There was a wellbeing clinic within the service which promoted healthy lifestyles such as the nutritional benefits of certain food types. Staff referred patients to the service’s dietician when there were concerns about their weight and food choices. There was a physical health nurse within the team who provided relevant information and advice to both staff and patients when required.

Ward activities helped promote a healthy lifestyle for patients. Staff encouraged patients to participate in walking groups, sports activities and cooking healthy meals. Staff encouraged patients to attend gymnasiums and physiotherapy to help support their health and wellbeing.

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 severity and outcomes. These included National Early Warning Scores (NEWS) 2, Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS), the Lester tool, the UK functional independence/assessment measure (FIMFAM), the Model of Human Occupation Screening tool (MOHOST), quality of life after brain injury (QoLIBRI) as well as a host of other tools appropriate for the patient group.

Staff used technology to support patients effectively. Patients had their own mobile devices so they could stay in contact with the people who mattered them. Managers within the service agreed to provide a patient with an e-reader so they could pursue their wish to improve their reading following their brain injury.

We scored the service as 4. The evidence showed an exceptional standard. The service always carefully explained to people what their rights around consent were,

and staff made sure they fully understood them and always fully 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. For example, when a patient was unable to understand or communicate decisions about long-term feeding options, staff conducted a formal capacity assessment which confirmed the patient could not make an informed choice regarding peg feeding. The multidisciplinary team held a best interests meeting involving the acute medical team, neuropsychiatry, speech and language therapist, an independent mental capacity advocate, family members, a social worker, safeguarding representatives, and the service managers hospital management. The meeting considered the least restrictive alternatives, including modified diets and nasogastric feeding, alongside the patient’s wishes and values. After reviewing clinical risks, the team reached a consensus that PEG insertion was in the patient’s best interests. Despite the patient’s lack of capacity, staff made efforts to explain the decision in an accessible way, including showing them a video of the procedure to enhance their understanding.