Cygnet Maple House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This is the first assessment for this service. This key question has been rated Requires Improvement.

This meant people’s needs were not always met.

The service did not always meet the needs of all patients – including those with a protected characteristic. However, patients did not have to stay in hospital when they were well enough to leave. The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Staff supported patients with activities outside the service. Staff helped patients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result. Although patients gave feedback to say they did not always feel comfortable to raise a complaint.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

The evidence showed significant shortfalls. The service did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Staff at all levels spoke about patients with knowledge and awareness of their needs. However, when we reviewed patient documents, we found examples where staff had recorded incorrect pronouns. Patients told us how important it was to them that staff used the correct pronouns.

We reviewed the records of a patient who had additional support needs and spoke with them directly. Although staff had recorded these needs in the patient’s care plan and risk assessment, staff were dismissive of the patient’s diagnosis when we discussed it with them. We were not assured that this patient was receiving person‑centred care. Staff also told us that the patient would not require additional support during an emergency evacuation. The service did not have a personal emergency evacuation plan (PEEP) in place for this patient which demonstrated a lack of understanding of the patient’s needs and placed the patient at potential risk.

Staff we spoke with described how they provided person‑centred support. However, one patient told us that a staff member had said, that they are there to teach patients how to behave in the community. Another patient said that the staff are trying to help them in the main and that they try hard. They were unsure however that they understood them or could give the correct help.

The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service had made appropriate arrangements for patients to take part in activities that supported their hobbies and skills. The service had successfully fundraised for local charities, and leaders told us this had been a co‑produced initiative with patients. This work was displayed and celebrated on noticeboards within the service.

Patients told us they could join local choirs if they wished and could attend the local church.

We saw evidence in patients’ care plans and pink notes showing how the service supported them to maintain contact with their families and carers. Patients confirmed this when we spoke with them.

The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service had information points around the ground floor that provided patients with relevant information. We could see that the service had considered the most appropriate location for these displays, as they were situated next to the clinic room on one of the busiest corridors.

We also saw that the service had carefully considered how to present information by using easy‑read materials and by displaying content in a bright, informal format to make it more appealing to patients.

Although no patients required information leaflets in different languages at the time of our assessment, staff and leaders told us they knew how to access translated materials when needed.

Where appropriate, staff ensured that carers and families received regular updates about the patient’s progress.

Staff made notifications to external bodies as required. Local commissioning bodies were updated when needed, and relevant information was shared with them. However, the service did not always send the Care Quality Commission the correct and timely statutory notifications. This meant that we did not always have oversight of incidents happening in the service. We raised this with service leaders, who were committed to making improvements.

The evidence showed some shortfalls. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

Information about how to make a complaint was displayed on notice boards for patients to read. The complaints procedure was accessible to patients.

Staff believed patients felt comfortable raising complaints or concerns with them. The service also held regular community meetings where patients could raise issues.

However, five patients did not feel comfortable raising complaints or concerns because they feared retribution from staff. One patient said that they would never make a complaint due to feeling that they would be ‘told off’ and that their treatment would change. They said that they didn’t trust any member of the team.

We informed service leaders that several patients had told us they felt unsafe on the ward. Leaders then asked each patient how they felt following our assessment. We were not assured that patients would have felt comfortable being fully honest with staff after the concerns they shared with us. We found that these conversations took place during the evening and that each patient was interviewed individually which could have been construed as intimidating.

The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff ensured that the needs of patients with mobility issues were met. At the time of our assessment, two patients required wheelchairs to support their mobility. Both patients had bedrooms on the ground floor and had access to lifts if required. However, we found that the dining room did not have designated wheelchair spaces, and staff had to remove a chair to allow a patient to access a table. We raised this with leaders, who told us they would consider removing chairs in advance so that wheelchair users could enter the dining area without obstruction.

The service had adequate medical cover both day and night, and that a doctor could attend the ward quickly in an emergency. They also explained that the hospital was within a reasonable travelling distance of the local acute hospital. We reviewed rotas and spoke with doctors at the service, which confirmed this.

The service had strong links with care managers and was able to plan effectively for patients’ discharge.

The evidence showed some shortfalls. Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Staff felt the service promoted a culture in which people using the service were empowered to share their views. Staff gave examples of gathering patient feedback through community meetings and one‑to‑one sessions. However, some patients were afraid to speak to staff about their views of the service because they feared possible repercussions.

We were not assured that the service fully recognised how patients with protected characteristics were affected by staff projecting their own moral and religious beliefs, or the impact this could have. Examples shared by patients demonstrated a disconnect in staff understanding the importance of recognising how people with protected characteristics may be particularly vulnerable to experiencing disadvantages in their care and support. Staff were trained in equality, diversity, inclusion and human rights, but this was not always reflected in practice.

The evidence showed some shortfalls. People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The service took a proactive approach to discharge planning and began discussions with patients as soon as it was appropriate. With involvement from the MDT, we saw how staff created discharge plans and updated them when required. Information about the patient pathway was displayed within the service so patients could refer to it.

Staff evidenced in patients’ pink notes how they engaged patients in discussions about making positive decisions and choices. When patients told staff they were going into crisis, staff recorded in pink notes or incident documentation how they attempted to de‑escalate situations and supported patients to make positive choices rather than choosing to harm themselves. However, due to the high number of self‑harm incidents recorded at the service over the past month, we were not assured that this approach alone was effective. We saw evidence that even after these conversations, some patients continued to self‑harm.

At the time of our assessment, no patients required end‑of‑life care or support at that level.