Cygnet Cedars

Updated 29 May 2019

Cygnet Cedars provides a rehabilitation service for up to 24 men with a learning disability and other complex needs, who may be detained under the Mental Health Act 1983. Many of the patients are referred to Cygnet Cedars from secure facilities. Cygnet Cedars provided inpatient beds within the main body of the unit and two self-contained ‘step down’ flats, allowing for further community integration and a focus on independent living skills. Cygnet Cedars’ philosophy was that everyone has a personal best.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Cygnet Cedars is registered to provide the following regulated activities:

• assessment or medical
• treatment for persons detained under the Mental Health Act 1983, diagnostic and screening procedures,
• and treatment of disease, disorder, or injury.

There have been three previous inspections at the hospital, the most recent inspection being March 2016. Following this inspection, the hospital was rated outstanding. The hospital was rated good for safe, caring and well led. It was rated outstanding for effective and responsive.

Updated 29 May 2019

Our rating of this service stayed the same: We rated it as outstanding because:

Patients were protected by a strong and comprehensive safety system and a focus on openness, transparency and learning when things go wrong. Cygnet Cedars had a genuinely open culture in which safety concerns raised by staff and patients who use the service were highly valued as integral to learning and improvement.

Staff took a positive approach to risk management. Patients and those close to them were actively involved in managing risks. Positive risk taking and least restrictive practice was embedded within the culture of the unit. Patients were actively involved in managing their own risks using risk assessments, positive behavioural support plans and worked collaboratively with staff.

Staff understood and focussed on least restrictive practice. Cygnet Cedars had a least restrictive practice group, completed restrictive practice audits and sought to use the least restrictive approaches when managing challenging behaviour. Patients were involved in shaping least restrictive practice through governance and community groups. We found no evidence of blanket restrictions. The providers had a transparent policy on the use of restrictive interventions, with an overarching restrictive intervention reduction programme with a board-level lead.

Staff supported the national STOMP pledge to reduce the long-term use of anti-psychotic medicines without the use of appropriate clinical justification. All patients at the hospital who were on anti-psychotic medicines had a care plan in place with the prescribing rationale, reduction plan and side effect monitoring.

Staff used a truly holistic approach to assessing, planning and delivering care and treatment to patients. The staff were actively supported by management to use innovative approaches to care. The model of care promoted patients’ recovery, comfort and dignity. Staff worked with patients to create excellent care plans that were holistic, recovery focussed, and person centred. They wrote these care plans in the voice of the patient. Staff reproduced care plans and other documentation in easy read formats for each patient. The multidisciplinary team provided a clear care pathway through the service from admission to discharge. Care plans fully reflected individual circumstances and preferences.

Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients, families and carers in care decisions to make sure patients were active participants in their care and treatment. We saw positive, professional and respectful interactions between staff and patients during our inspection. Staff showed patience and warmth. Staff and patients shared humour and were relaxed with each other whilst maintaining professional boundaries. Patients knew the staff well and were complimentary about all the staff at Cygnet Cedars.

The continuing development of staff skills, competence and knowledge was recognised as being integral to ensuring high quality care. Staff were proactively supported to acquire new skills and share best practice. All staff engaged in clinical audits to evaluate the quality of care they provided and learned from these to improve their practice.

We saw evidence of best practice in the application of the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). All staff we spoke with had a comprehensive understanding of the Mental Health Act, the Mental Capacity Act, Deprivation of Liberty Safeguards (DoLS) and the associated Codes of Practice. Staff had excellent understanding of capacity. They fully involved patients in decisions about their care. All patients had a file that documented what reasonable adjustments to communication should be considered when assessing the patient’s capacity. This ensured staff undertaking the assessment clearly understood the patient’s communication needs and was aware of any communication tools needed to support the patient.

The staff team were committed to providing active support to patients. Staff helped patients to be actively, consistently and meaningfully engaged in their own lives regardless of their support needs. One example of this was staff supporting patients to exercise their civil rights to vote and become active members of society. They supported patients to get involved with projects at the hospital and in the wider community. For example, helping staff with clinical audits and undertaking voluntary work in the local community.

Staff empowered patients to have a voice and to realise their potential. They showed determination and creativity to overcome obstacles to delivering care. Staff ensured that patients’ individual preferences and needs were always reflected in how care was delivered.

There was a holistic approach to planning people’s discharge, transfer or transition to other services, which staff started on admission. Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason. The service took patients that had already spent a long time in care and enabled them to move into lesser dependant services in a reasonable time frame. This is the aim of Transforming Care

Governance structures were clear, well documented, followed and reported accurately. There were controls for managers to assure themselves that the service was effective and being provided to a high standard. Managers and their teams were fully committed to making positive changes. We saw changes had been made to maintain improvements in quality using audits. The service had clear mechanisms for reporting incidents of harm or risk of harm and we saw evidence the service learnt from when things had gone wrong.

The staff team were committed to improving and taking part in innovative practice. We saw excellent evidence of learning and developing projects within the hospital and throughout the provider region, staff shared ideas and good practice across sister units. Staff were supported to undertake research and present findings at national conferences.

Updated 29 May 2019