Cygnet Nield House

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 Good. At this assessment the rating has remained Good.

The teams included or had access to the full range of specialists required to meet the needs of patients. Managers ensured staff received training, supervision and appraisal. Care was delivered in line with national guidance and best practice. Staff worked well together as a multidisciplinary team. Staff worked collaboratively with stakeholders to deliver joined-up care to patients.

Patients had up to date and comprehensive assessments in place. These were reviewed regularly. Patients’ physical health was assessed and monitored.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients had a clear understanding of their care and treatment and were confident in who to approach for information. Carers had been involved in their relative’s care and treatment, with the patient’s consent, which included attending multidisciplinary team meetings.

Staff could describe the assessment process and their role in it. Patients had specialist assessments carried out by the psychology and occupational therapy teams, and by the dietitian. This informed each patients’ care plans and risk assessments. On admission patients had their physical health assessed, and this continued to be monitored throughout their stay.

The service had a model of care and a process for reviewing people who were referred to the ward, to ensure it could meet their needs.

We reviewed 5 care records and found each had a comprehensive assessment in place which captured information about the person and demonstrated the involvement of the patient, their family members, and other services involved in the patient’s care.

Patients told us that they had access to psychological therapies. For some patients they had accessed this throughout their time at the hospital, but for others there had been significant gaps though they had now restarted. Patients told us they had a similar experience with access to occupational therapy and activities.

Staff delivered care and treatment in line with best practice. Staff were able to describe the range of professional input, treatment and care options available to patients in line with national guidance.

Staff from all disciplines worked together to provide evidence-based care for patients. This included a range of individual and group psychological therapies. The dietitian provided guidance and support for working with patients with disordered eating including safe practices for nasogastric feeding. All patients had their physical health care assessed and monitored, and had access to a physical healthcare nurse.

Staff told us there had been limited psychology and occupational therapy available for patients due to vacancies, but these posts had now been filled.

The provider’s policies were written in line with national guidance. There were governance structures to review and disseminate new guidance. The ward completed clinical audits to ensure compliance with relevant standards and guidance.

The service had developed a model of care that took account of recognised guidance. It had four stages: assessment and engagement; recovery; consolidation; and transition and discharge. The multidisciplinary team worked across all four stages with patients, their families and their local community teams.

Staff used a range of tool to assess and monitor patients’ mental and physical health. This included National Institute for Care and Health Excellence (NICE) guidance, and guidance and tools from recognised bodies in relation to nutrition and medicines.

Patients generally felt informed about their care and treatment. They were confident they could speak with staff including the consultant when they wanted to. Patients attended their multidisciplinary team meeting to discuss their care, treatment and future plans.

Staff were part of a multidisciplinary team and were positive about how the different professions valued and respected each other. They were able to describe links with other services and organisations and explain how they worked together.

Staff had access to the information they required to appropriately assess, plan and deliver patients’ care and treatment. Staff were able to describe the processes and guidelines for sharing information within the multidisciplinary team and with external services. They were able to discuss examples where they had worked collaboratively with relevant staff, teams and services to deliver care and treatment, and to support patients’ pathways.

We observed a daily morning meeting, where managers and staff from all the disciplines discussed events on the ward, and from the wider hospital. This was held every weekday and had a standard agenda. Staff discussed recent events on the ward, such as incidents or restrictive interventions, as well as future planning for staffing, leave, patient’s meetings, and physical health monitoring. Ongoing actions were followed up from previous meetings. This included maintenance, training and supervision, and ongoing recruitment.

Staff updated the notes from the daily morning meeting throughout the meeting. These showed that there was progress throughout the week, and that there was monitoring of key areas including risk, the Mental Health Act, and patients’ leave.

Nursing staff and healthcare support workers attended a handover meeting at the beginning of their shift. A handover document was completed throughout the day, with key information about each patient and other events on the ward.

Managers and staff attended a daily meeting each weekday morning to review any incidents or events on the ward, and to plan ahead for future follow up or support.

Each patient had a multidisciplinary team meeting at least once every four weeks, to review their current care and future plans. These were attended by the patient and their relatives, staff from across the multidisciplinary team, and staff from the patient’s local community team.

Patients had access to a GP and a physical health nurse. Patients did not raise any specific concerns about this quality statement.

Staff made sure patients had support for their physical health needs and access to interventions and activities that promoted healthier living. These included access to smoking cessation programmes.

Staff completed regular physical health checks with patients. They used the National Early Warning Score (NEWS) system to flag any concerns. Staff discussed physical health with patients as part of those checks and in ongoing care reviews.

Patients had individual care plans to support them with their dietary and nutritional needs, and where relevant with their approach to exercise.

The service had processes to monitor physical health and identify possible healthy living interventions. These included physical health assessment on admission and ongoing physical health care.

Patients had mixed views, but were mostly positive about the progress they had made. Patients attended their multidisciplinary team meeting to discuss their care, treatment and future plans.

Staff used recognised rating scales to assess and record the severity of patient conditions and care and treatment outcomes. The service completed Health of the Nation Outcome Scales (HoNOS) for patients. The occupational therapists used a range of tools including interest checklists and the model of human occupation screening tool (MoHOST). The psychology team used a range of evidence-based rating scales and outcome measures with patients.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes.

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

Patients mostly felt informed about their care and treatment, and were confident they could speak with staff if they required further information or support. Patients were aware of advocacy service that visited the ward.

Patients were asked about how much information they wanted sharing with their relatives, and this was respected.

Staff had completed training in the Mental Health Act and Mental Capacity Act. Staff were familiar with the use of the Mental Health Act and could describe the limitations this placed on patients, and considerations with regards to least restrictive practice.

Staff supported patients to eat, and nasogastric feeding was only used when necessary, and followed a prescribed a nasogastric feeding care plan. Staff were clear that the development of a nasogastric feeding care plan did not mean that this would always happen, and alternatives would always be offered first.

Some patients had information on display in their rooms that told staff how they could support the person if they were struggling or in distress.

The service had policies for the implementation of the Mental Health Act. Most patients on the ward were detained under the Mental Health Act. The service had a Mental Health Act administrator to support staff in ensuring that the Act was implemented correctly, and that patients’ rights were upheld. An audit of Mental Health Act paperwork was carried out every six months. We did not identify any concerns with the implementation of the Act.

The service had clear policies on the rationale and process for using nasogastric feeding. Where required, each patient had a nasogastric feeding care plan written by the dietitian and agreed by the multidisciplinary team.

96% of staff in the hospital had completed training on the Mental Capacity Act. Managers carried out a quarterly audit on the services compliance with the Mental Capacity Act.