Cygnet Nield 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

We reviewed all 7 quality statements in the responsive key question. This means we looked for evidence that the service met people’s needs. At our last inspection we rated this key question as Good. At this assessment the rating has remained Good.

Patients had access to information about their care and treatment that could be provided in a format suitable for them. Patients were aware of how to complain and told us they would be confident that any complaint they raised would be managed appropriately.

We observed care being provided in a person-centred way. This was visible in the patient and staff interactions we witnessed.

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 were involved in their care, which was discussed and reviewed at multidisciplinary team meetings. Patients felt they were treated as individuals, and that their views were listened to. Carers and family members were involved in the person’s care, as much as the person wanted them to be, and attended multidisciplinary team meetings.

Staff we spoke with demonstrated a good understanding of individual patients. They were able to give examples of how they delivered personalised care and how they considered patients individual needs, goals and preferences.

An expert by experience had regularly visited the ward to get feedback from patients. The provider had a carers lead. Managers told us that feedback from an expert by experience who had regularly visited the ward and the carers’ lead had helped them get an improved view of patients’ and carers’ experiences.

Patients had personalised their bedrooms. Some patients were restricted in the items they could have in their rooms because of the risks presented by them. However, other patients had a range of items such as laptops or pads, craft items, and food.

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

Policies and procedures were in place to protect and promote equality, diversity, inclusion and human rights.

We did not ask patients specific questions about care provision, integration and continuity. However, no concerns were raised in this regard.

Staff were able to explain the process and pathways for admissions and discharges. Staff liaised with each patient’s local commissioners or services to support their discharge back to their home area.

The local host commissioners requested feedback from commissioners for each patient on the ward, in order to any identify any themes and trends, or areas of positive or concerning practice. The hospital managers and local host commissioners met every 3 months, and reviewed information submitted by the managers. No issues were raised about this quality statement.

People were referred to the service from across the United Kingdom. The length of stay of a person on the ward varied, but the service aimed for 18 months to 2 years. Discharge planning was incorporated into the model of care, and patients were usually detained under the Mental Health Act so were entitled to statutory provision of aftercare if they were from England or Wales.

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

Staff provided relevant information to patients and were able to provide that information in different formats dependent on need and preference. The service had access to translation services and provided information leaflets in languages spoken by the patient and local communities. Managers made sure staff and patients could access interpreters and signers where required.

Referral and admission documentation captured patients’ communication needs. The provider had contracts in place with an interpretation and translation service to provide phone and face to face interpreters, and translation of documents when required.

Patients were involved in decisions on the ward. They attended community meetings where they were able to give feedback and make suggestions. Patients were supported by an independent advocate, and an expert by experience who looked at patients’ experiences on the ward. Patients’ feedback had led to the development of a sensory room, patients’ kitchen, and murals on the walls.

Patients knew how to raise concerns or complaints. Carers also knew how to complain, and felt able to raise their concerns.

Staff understood the provider’s complaints policy. They were able to explain the complaints process and how they would support patients who wished to raise a concern. However, staff informed us that they do not receive feedback following complaints. The hospital manager told us that individual performance concerns would be raised in supervision, but the detailed outcome of this may not be fedback directly to the complainant.

We observed a patients’ community meeting which was chaired by a patient. This included following up on actions from the previous meeting.

Information for patients was on display throughout the ward. This included information about restrictions, the advocacy service, and how to make complaints including to the Care Quality Commission under the Mental Health Act.

There was a complaints policy and process in place. Managers and senior staff had been trained to complete complaint investigations when this was required. Complaints were monitored at a hospital and provider level to identify themes and trends and monitor responses.

There had been 4 formal complaints made on the ward in the last 6 months. These were investigated, and 1 was upheld and 3 were partially upheld. Following the complaints, actions were taken and concerns responded too which included involvement of other professionals and organisations where required. The responses to the complainant were clear, and gave information about how to get further advice and support.

We did not ask patients specific questions around equity of access. However, no concerns were raised regarding the referral and admission process or any discriminatory behaviour.

Staff were aware of the reasonable adjustments they could make and how to source additional specialist advice or equipment when required.

The ward was for women-only, but would accept non-binary patients. Managers acknowledged that the provider’s policy on the admission of transgender people could be clearer, but that people would be assessed on a case by case basis.

The local host commissioners requested feedback from commissioners for each patient on the ward, in order to any identify any themes and trends, or areas of positive or concerning practice. The hospital managers and local host commissioners met every 3 months, and reviewed information submitted by the managers. No issues were raised about this quality statement.

Referral, assessment and admission processes considered the needs of people with different protected characteristics and the service made reasonable adjustments to avoid discrimination and meet need. The service had specific admission and exclusion criteria to ensure they could provide the correct care and treatment to patients. For example, they could not meet the needs of people below a certain body weight or body mass index (BMI).

Staff had access to interpretation services and were able to produce information in different formats, for example easy read.

Staff completed equality and diversity training as part of their mandatory training programme. At the time of our assessment compliance with the training was 97%.

We did not ask patients specific questions around equity of experience or outcome. However, none of the patients we spoke with raised concerns about discriminatory behaviour by the staff or the service and we saw no evidence of concerns. Patients we spoke with generally felt involved in their care and treatment.

Staff were able to give examples of where adjustments had been made or were in place to support patients with mobility concerns. Staff supported patients with religious or spiritual needs including supporting access to places of worship and offering cultural and religious foods.

Referral, assessment and admission processes considered the needs of people with different protected characteristics and the service made reasonable adjustments to avoid discrimination and meet need. The service had specific exclusion criteria to ensure they could provide the correct care and treatment to patients.

Staff had access to interpretation services and were able to produce information in different formats, for example easy read.

Staff completed equality and diversity training as part of their mandatory training programme. At the time of our assessment compliance with the training was 97%.

Patients attended multidisciplinary team meetings where their ongoing care and treatment, and plans for the future were discussed. Patients were at different stages of their care pathway, and this impacted on how developed their discharge plans were. Patients had mixed views about how well planned their future support was. Some patients felt it was very organised and that hospital and community teams worked well together, but others were not clear on what would happen when they were discharged.

Staff were able to discuss long term plans for patients in terms of treatment goals and objectives for discharge or the transfer of care to a different service.

There were processes in place to facilitate the planning and delivery of discharge or transfer of care. The fourth and final stage of the model of care focused on transition and discharge. The multidisciplinary team worked with patients and their families, and with commissioners of care and local community teams to facilitate a successful discharge.