Cygnet Alders Clinic

Updated 9 June 2023

Cygnet Alders Clinic is overseen by Cygnet Clifton Limited and has been open since 2015. It provides specialised locked rehabilitation services for patients with a personality disorder and/or complex trauma in Gloucestershire. The 20 bedded unit is managed over 3 wards namely, Severn, Avon and Coln.

The rehabilitation model provided is based on best practice principles in line with national guidelines. This is made of 5 stages; pre-admission/preparation, assessment and admission/getting to know you, stabilisation/feeling safe, active treatment and rehabilitation which includes individualised therapy and improved quality of life and finally transition and discharge/preparing to move on.

At the time of the inspection there were 12 patients using the service: 5 patients on Severn ward, 5 on Avon and 2 on Coln wards.

The service is registered for the following activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983.
• Treatment of disease, disorder, or injury

There was a registered manager in post at the time of this inspection.

The last full comprehensive inspection was in 2019 where the service was rated as good overall with outstanding in caring. A focused inspection of safe and well-led was completed in June 2022 where the ratings for both safe and well-led went down and were rated as required improvement.

What people who use the service say

During the inspection patients declined to speak with us on a one-to-one basis. However, we completed a Short Observational Framework (SOFI) during the inspection. The SOFI tool provides a framework to enhance the observations we already make at inspections about the wellbeing of people using the service and staff interaction with them.

Group feedback from patients during the SOFI observation was that they felt intimidated by the number of male staff on duty, especially on Avon ward. This was also reflected in the feedback from a family member we spoke with.

A relative we spoke with said that they believed their family member was receiving effective care and that staff were good, attentive, and understood the patient’s needs. They felt their relative had formed a “trusting relationship” with staff.

Updated 9 June 2023

We carried out a comprehensive inspection of Cygnet Alders Clinic due to concerns about some areas of service quality.

Cygnet Alders Clinic is in Gloucestershire and is a specialised locked rehabilitation service for patients with a personality disorder and/or complex trauma.

We rated this service as good because:

• The service had enough nursing and medical staff, who knew the patients well and received training to keep patients safe. While there were some staff vacancies, all shifts had been covered by either bank or agency staff. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• Patients were supported by staff who managed risks well. Staff followed best practice in anticipating, de-escalating, and managing challenging behaviour. They minimised the risk of restrictive practices and managed medicines safely.
• Staff developed holistic, recovery-orientated care plans informed by a comprehensive assessment. These were reviewed daily in the morning meetings and updated as needed. Patients were supported in a range of treatments suitable to their needs and cared for in line with best practice and national guidance. Staff engaged in clinical audits to evaluate the quality of care provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients. While there were upcoming vacancies for therapy staff, provision had been arranged from another hospital site as a temporary measure.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• Managers ensured they had staff with the range of skills needed to provide high quality care. They supported staff with supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them. Staff helped patients with communication, advocacy, cultural and spiritual support.
• Patients were treated with compassion and kindness. Staff respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment, or condition.
• Staff planned and managed discharges. They liaised well with services that would provide aftercare. Staff did not discharge patients before they were ready and ensured they did not stay longer than they needed to.
• While leaders were new in post, they had the skills, knowledge, and experience to perform their roles. They had a good understanding of the service they managed and were visible and approachable for patients and staff.
• Staff felt respected, supported, and valued. They said the service promoted equality and diversity and provided opportunities for development and career progression. They could raise any concerns without fear of retribution.
• Outcomes data and quality improvement opportunities and evidence-based policies and procedures were reviewed within the clinical governance framework. The teams demonstrated that performance and risk were managed well. They had plans to cope with unexpected events.

However:

• Record keeping systems were not always easy to navigate and information was stored in multiple places. This meant that staff may not have easy access to information relating to patients’ care and treatment.
• Relatives we spoke with were not aware of the complaints process and said they had not received information on how to make a complaint. The management team acknowledged our concern and had arranged for all new relatives and carers to be given a copy of the new “Carer’s Passport” which provided all relevant information.
• Patients did not always engage in meaningful activity. We observed very little activities taking place throughout the day. The patient survey feedback regarding activities identified them as being “bored.”

Updated 9 June 2023

Updated 12 September 2017