Cygnet Nield House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We reviewed all 5 quality statements in the caring key question. This means we looked for evidence that the service involved patients and treated them with compassion, kindness, dignity and respect. At our last inspection we rated this key question as Good. At this assessment the rating has remained Good.

Staff treated patients with dignity, respect, compassion and kindness. They respected their privacy and followed appropriate policies to maintain confidentiality.

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 mostly positive about staff, and felt they were very caring and supportive. This included both clinical and support staff.

Staff treated patients with compassion and dignity. Staff we spoke with discussed patients in a respectful and caring manner. They could identify their needs, and discuss their care and treatment.

Staff were respectful of patients’ privacy and dignity. Male staff worked with female patients, and this included on one-to-one observations. If a patient’s level of risk required them to be observed in the bathroom or whilst carrying out personal care, they would be supported by female staff.

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.

The interactions we observed between staff and patients during our assessment were positive and respectful. Patients approached staff to ask for support or practical help, and staff were seen to proactively speak to patients about their needs.

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 and respected.

Staff understood patients’ individual needs and preferences. Staff were able to access interpreters and translated written information for patients who could not easily communicate in English. Staff provided support for patient’s personal, cultural, social and religious needs.

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 distressed.

Staff had access to interpreting services, and could get documents translated if required.

The service had a regular independent mental health advocate (IMHA) who visited the ward and was involved in multidisciplinary meetings and best interest decisions.

Autistic people and people with a learning disability had some of their care documents in an accessible format. This included positive behavioural support plans, communication grab sheets and hospital passports. These were individualised to each patient, and described how they wanted to be communicated with and supported.

Patients had open access to the sensory room, which was kept unlocked.

Feedback forms for patients were available in easy read formats.

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. Patients attended community meetings on the ward and were able to provide feedback and ideas for improvements and activities.

Staff supported patients with activities and leave off the ward. Managers and staff discussed this in the daily morning meeting, so they could ensure that there were enough staff available.

Staff were aware of the independent mental health advocacy services that visited the ward and how to refer patients to them.

Staff helped facilitate patient involvement and choice by providing information in different formats as appropriate including translation services, easy read and large print.

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.

The service had a vehicle, and staff were signed off to drive patients and staff to appointments, on leave, and on day trips.

Patients had access to independent mental health advocacy (IMHA) services to support their involvement in decisions about their care and treatment. The service held weekly community meetings where patients had the opportunity to feedback and make suggestions or a choice around planned activities.

Patients told us that they were able to access staff when they required them, and that staff were responsive to their needs. However, some patients felt that when the ward was busy or if there was an incident, then there were not always enough staff available to support patients who were not on one-to-one observations.

Staff demonstrated a good understanding of the patients they supported and their needs. Staff described individual risks and how they responded to them. This included knowing how to communicate with a patient when they were distressed, and what may help to calm them. Individual information and updates were shared at shift handovers to ensure staff understood each patient and how to support them effectively.

The interactions we observed between staff and patients during our assessment were positive and respectful. Patients approached staff to ask for support or practical help, and staff were seen to proactively speak to patients about their needs.

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

Staff maintained a detailed record of the daily morning meeting, which were completed live on a screen for all staff to see. 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.

There were appropriate systems and guidance in place to support staff in responding to immediate needs. There were nurse call alarms in bedrooms and staff carried personal alarms to summon help when required. The service had implemented silent alarms, in response to patient feedback that the sound of the alarms caused distress. Staff had carried out training and had access to emergency equipment in the event of a medical emergency.

Staff were generally positive about the service and felt that the teams worked well together, across all professionals. Overall, staff thought that morale was good at the moment, but acknowledged that this could dip when the ward was very busy and there were staff shortages.

The staff were aware of their freedom to speak up guardians and felt they had a voice and could raise concerns.

The provider carried out an annual staff survey, but the findings were for the whole hospital, not just this ward. Overall the feedback from the survey was mixed, but there were a lot of responses in the positive/satisfactory range with some negatives. High levels of staff who responded to the survey knew how to report incidents and raise concerns, and were aware of the Freedom to Speak Up Guardian. However, over half of the staff who responded said they had come into work in the last three months despite not feeling well enough. Managers had spoken with staff and developed an action plan following the survey.

There were provider-level policies for occupational health. Staff had access to an employee assistance programme.

There were processes for staff to feedback, raise concerns and suggest ways to improve the service. This included through supervision, team meetings, a provider staff survey, and the freedom to speak up champion and guardian.