Cygnet Lodge Salford

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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

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.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing, and communication needs with them.

We looked at 8 care records during the assessment. Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Communication needs were also assessed.

Staff assessed patients’ physical health needs during their admission in a timely manner. The multidisciplinary team (MDT) reviewed patients regularly after admission. The assessments of need started prior to admission and continued throughout the patients stay.

Staff developed care plans that met the needs identified during assessment. Care plans were mostly personalised, holistic and recovery oriented.

Staff did not always update care plans in a timely manner when necessary. The head of care completed monthly checks to ensure the care plans where needed had been updated. Daily morning communication meetings discussed the needs for staff to complete care plans specific to patient’s needs. An example of this was where a sleep care plan was needed for a patient to promote good sleep hygiene.

We did not always plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

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, in rehabilitation wards, activities, training and work opportunities intended to help patients acquire living skills. Physical health care monitoring was monitored using National Early Warning Scores (NEWS2) to monitor patients’ degree of illness and to prompt critical care intervention.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. A registered nurse and support worker had developed a group around health promotion. They provided one to one input to every patient each month as well as group sessions. Examples of this was dental hygiene sessions. All patients are registered with a local GP on admission.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. However, staff were not always aware of the risks relating to each patient’s care. For example, one patient had increased choking risks and was on a modified diet and not all staff were aware of this.

Staff participated in clinical audit, benchmarking, and quality improvement initiatives.

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, this also included occupational therapists, clinical psychologists, pharmacists, speech and language therapists, dieticians, peer support workers and advocates.

Staff were experienced, qualified, and had the right skills and knowledge to meet the needs of the patient group. However, some support workers told us they did not feel they had the right training to meet the needs of the current patients.

Managers provided new staff with appropriate induction. We found there were some gaps for agency staff induction. There were no records available to demonstrate that bank and agency staff, including staff who were working on the ward on the day of our assessment, had received an induction when they first started work on the ward.

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. The specialty doctor had not received any clinical supervision since June 2024.

Managers ensured that staff had access to regular team meetings. Providing access to all staff via teams and giving staff time back if they attend who were not in work. The percentage of staff that had had an appraisal in the last 12 months was 75% and this was a continued programme with staff. Staff received regular supervision.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge in supervision and appraisals. Staff had support lead roles. Some of support leads included equity and diversity inclusion leads, family and carer ambassadors, infection control leads, reducing restrictive practices and safety intervention leads as well as ambassadors for freedom to speak up.

Managers dealt with poor staff performance promptly and effectively.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

Staff held regular and effective multidisciplinary meetings. Staff shared information about patients at handover meetings within the team (for example, shift to shift). One of the handover documents we reviewed did not always align with people’s current needs, for example confusion over detention status.

The teams had effective working relationships, including good handovers, with other relevant teams outside the organisation for example, care co-ordinators, community mental health teams, crisis teams and health improvement teams within the local area.

The teams had effective working relationships with teams outside the organisation for example, local authority social services and GPs. As well as good links with local Integrated Care Boards and commissioners.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, 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 walking groups, sports activities and cooking healthy meals.

Patients could access life skills sessions provided by the local health improvement team this included how to be a good tenant, smoking cessation, healthy eating women’s health (cervical screening, menopause, etc) exercise groups (yoga, dance classes, Zumba) cooking groups. Slow cookers were provided free of charge to those that attend the cooking groups and who were on the discharge pathway. Monthly pet therapy was provided, and dogs visited the unit, and chickens were due to be delivered.

GPs had been contacted for the ongoing monitoring of patients with asthma, chronic obstructive pulmonary disease, and diabetes. This was to ensure where patients were on the appropriate pathway.

Physical health monitoring was implemented for patients, and a spreadsheet was produced to show an oversight of the previous months. The consultant psychiatrist had been proactive in contacting the GPs to ensure an accurate list of patients last tests for cervical, breast and bowel cancer screening were provided.

Occupational therapy provided weekly “women’s hour” sessions that explored women’s health and wellbeing.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes for example, the Health of the Nation Outcome Scales (HoNOS). The Model of Human Occupation Screening Tool (MOHOST) was used to determine the patient’s occupational functional ability and the Monthly Global Assessment of Functioning (GAF) was completed for all patients rating how serious their mental illness is and how their symptoms effect their day to day lives.

Occupational therapists delivered various sessions in relation to self-care, productivity and leisure as well as supporting patients to access paid therapeutic/vocational roles within the hospital. These included managing the tuck shop, dining room assistant, community meeting leader and a gardener.

We tell people about their rights around consent and respect these when we deliver 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 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. We saw that the safeguards set out in the Mental Health Act were in place where treatment for mental disorder was being provided. Mental Capacity audits were completed quarterly.

We also saw evidence that staff had recorded which parties’ patients had agreed for staff to share information with about their care, treatment, and current health status.