Cygnet Lodge Salford

We rated this service as Good.

Bank and agency staff were receiving an induction to the service and records confirmed this. Staff were receiving appropriate support and guidance in their role, including supervision and training.

Medicines were stored safely, records were complete and contemporaneous. Risk assessments were updated following incidents. Risks were shared within the team, including at handovers. Staff were following the uniform policy and were bare below the elbow.

Furniture and décor had been updated to a high standard following our last inspection and patients were involved in the decision making of these changes. The lift was working and the ligature risk assessment reflected risks within the hospital environment.

Staff told us of the changes in the culture since the last inspection, they felt valued, supported and listened to.

However, we identified a breach of Regulation 18 Staffing in relation to staff not being provided with tier 2 autism and learning disability training and staff not conducting enhanced observations within the best practice guidance recommendations. We have asked the provider for an action plan in response to the concerns found at this inspection.

Mental Health Act and Mental Capacity Act Compliance Summary

Staff received training in the Mental Health Act and Mental Capacity Act. Compliance for the service was 95% for Mental Capacity Act and 98% for Mental Health Act.

There were policies and procedures in place for both the Mental Health Act and Mental Capacity Act. Staff we spoke with understood their role in relation to the legislation.

Medicines administration records were clearly completed and where needed the appropriate Mental Health Act authorities for prescribing were in place.

Records evidenced examples of capacity assessments completed for decisions including treatment for physical health conditions.

Mental Health Act

Ninety-seven per cent of staff including nurses and health care support workers had received training in the Mental Health Act (MHA) including bank staff that was 83% compliant. Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice, and the guiding principles. However, some support worker staff we spoke to told us they had not received any training in the Mental Health Act.

Staff had 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. 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 usually 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. Audits showed Section 132 rights had not always been completed as outlined in paragraph's 4.28 and 4.29 of the MHA Code of Practice.

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 (for example, Section 17 leave forms) correctly so that they were available to all staff that needed access to them. Audits showed there were gaps in the Section 17 leave forms and risk assessment in place that had not been signed and dated by the patient's responsible clinician. The service displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment. Staff did regular audits to ensure that the Mental Health Act was being applied correctly.

Mental Capacity Act

Ninety-seven per cent of substantive staff had received training in the Mental Capacity Act (MCA) With 83% of bank staff having received training. Some staff had a good understanding of the Mental Capacity Act. However, some support worker staff we spoke to told us they had not received any training in the Mental Capacity Act.

There were no Deprivation of Liberty Safeguards (DoLS) applications made in the last 6 months to protect people without capacity to make decisions about their own care. The provider had a policy on the Mental Capacity Act, including Deprivation of Liberty Safeguards. Staff were aware of the policy and had access to it. Staff knew where to get advice from within the service regarding the Mental Capacity Act, including Deprivation of Liberty Safeguards. 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 regarding 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. The service had arrangements to monitor adherence to the Mental Capacity Act. Staff audited the application of the Mental Capacity Act and acted on any learning that resulted from it.