We rated Cygnet Lodge Brighouse as good because:

• Risks, such as patients absconding or using illicit substances, were mitigated with individual up to date risk assessments and observations as required. Emergency equipment was accessible and checked regularly by staff. Staff knew how to recognise different forms of abuse and how to report it.
• There were enough staff on each shift and this was sufficient to meet the needs of patients. This meant that no activities and escorted were cancelled.
• Detailed assessments of patients’ mental and physical health needs were made by staff, and used to inform care plans. Care plans were up to date, holistic and recovery orientated. Patients received physical health checks and could access a GP as required.
• Staff had completed mandatory training, with a 92% completion rate, and some staff had attended additional training to develop their skills.
• Patients had access to psychological therapies and a good substance misuse programme. A strong multidisciplinary team worked well together.
• Patients had access to therapeutic and social activities and benefited from active community integration work.
• We saw positive, kind, and caring interactions between staff and patients. Staff knew patients and understood their individual needs. Patients were routinely involved in their care planning and reviews. Patients had their rights under the Mental Health Act explained to them on admission and at regular intervals.
• Families and carers were welcomed in the hospital and involved in care planning and decision-making where appropriate. Staff treated patients respectfully. Hospital facilities were good and were used effectively to meet the individual needs of patients. The food was of good quality, and patients were satisfied with the menu.
• Staff recorded complaints and we saw that they were responded to appropriately. People were encouraged to complain if they were not satisfied.
• Staff understood and shared the values of the organisation; they were committed and passionate about the work they did. We saw examples of innovative practice such as each patient been allocated £1000 on admittance to personalise their bedrooms.
• The culture of the hospital was open and transparent. There was good leadership at a local level and a culture of and commitment to continual improvement.

The inspection team consisted of three inspectors and a specialist adviser who reviewed how the provider monitored and assessed the quality of the service the hospital provided.

We found before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where patients did not have the capacity to consent, the provider acted in accordance with legal requirements. Two patients told us they understood why they were at Cygnet Lodge, they said they were always involved in the regular reviews of their care and treatment.

We found patient’s needs were assessed, care and treatment was planned and delivered in line with patients’ individual needs. Two patients told us “They have helped me, they are one of the best hospitals I have been in” and the staff were “Really nice. They said the “Majority of the staff were good”.

We found the provider was working in co-operation with others health professionals to ensure patients physical health care. Patients told us their positive experiences of accessing other health professionals.

Patients were protected from the risk of infection because appropriate guidance had been followed. Two patients told us the hospital was always clean and explained how as part of their rehabilitation they helped with cleaning tasks.

However we found the provider did not have robust arrangements in place to monitor and assess the risks to the patients and the service.

We talked to three patients who used the service all told us they were informed about their care and treatment. Where they were detained under the Mental Health Act 1983 the staff had made them aware of their rights and provided them with the opportunity to seek the support of the advocacy service. They said they had regular meetings with the staff to discuss their care and were offered the opportunity to take part in meeting with other health professionals about their care and treatment. They said they attended multidisciplinary team meeting (MDT) and care programme approach meetings (CPA). All the patients spoken with told us they felt safe at Cygnet Lodge and were treated well by all the staff team. They also said they would feel confident that any issues of concern would be properly dealt with by the management.

Four people told us they were satisfied with the psychiatric support and treatment they had received during the day time. One told us it had been a “positive experience” and had “helped build their confidence”.

We carried out this inspection visit at Cygnet Lodge in Brighouse on 15 March 2012 after receiving information from an anonymous caller. The caller alleged that staff grabbed patients by their throats when their behaviour became difficult, and patients are left naked in their bedroom with the doors open. The caller also commented that two patients should not be in a locked rehabilitation unit although they did not explain why. We also followed up improvement actions made following the previous review of compliance at Cygnet Lodge in November 2011.

We spoke with three patients who told us they are involved in their care and are able to make their own choices about their daily routine. They told us about their named nurse who is responsible for organising their care and said they meet up regularly with this person to discuss their care and progress.

One patient told us how they could have privacy whenever they wanted and patients have their own bedroom keys. Each patient has a blind on their bedroom door to enable staff to carry out periodic observations of their wellbeing. All patients spoken with told us these blinds are always closed apart from at observation times.

All three patients spoke positively about the care and support they receive. One patient commented “The staff are great. They are always there to support you but are not in your face.” Another patient told us, “Staff are very good. I have been in other places but this is better”.

Patients explained their varied activity programmes and wishes to move on to more independent living in the future. One patient explained how they are developing their daily living skills to prepare them for living on their own in the future.

All the patient’s spoken with described how they have made progress since moving to the service.

All the patients spoken with told us they feel safe at Cygnet Lodge and are treated well by all the staff team. They also said they would feel confident that any issues of concern would be properly dealt with by the management.

Patients told us that they are involved in decision making about how the home is run.

Patients told us that they understood their care and are able to make their own choices about their daily routine. One patient told us how they could have privacy whenever they wanted. Patients were fully aware of the contents of their care plans and told us that they are actively involved in decisions about the care, treatment and support they receive. One patient explained that staff had supported them to access advocacy services to act on their behalf.

We spoke with one patient who said, “I like it here, staff are helping me to get my life back on track.” Another patient told us “I am developing my daily living skills to help me prepare for moving on from here”. Patients explained their varied activity programmes. They also commented that staff had helped them to develop a better understanding of their illness. One patient said, “I really like having the psycho-education and family therapy sessions.”

Patients told us that they feel safe at Cygnet Lodge. One patient did say “It can get a bit noisy at times.” Patients said that the management are approachable and are confident that any issues of concern would be dealt with properly.

Patients told us that they receive good support from the staff team. One patient said, “Staff have helped me to turn my life around.” Patients described staff as approachable and spoke in glowing terms about a recently appointed charge nurse and ward manager. A patient commented “The Ward Manager and charge nurse are great and very supportive.”

Patients told us that they are involved in decision making about how the home is run.

We rated Cygnet Lodge Brighouse as good because:

• The hospital environment was clean and well maintained. Staff undertook environmental risk assessments to mitigate and manage risks. All patients had a comprehensive risk assessment and the hospital used a range of recognised risk assessment tools. The hospital had robust medication management and regular audits to ensure any gaps were being identified. The hospital were learning from incidents and continuously improving the service in order to drive improvement. Compliance with mandatory training was high, with one module achieving below 75%, and the average compliance rate was 90%.

• All patients had up to date care plans which were detailed and reviewed regularly. Patients had access to a full range of multi-disciplinary staff including a psychologist, doctors, registered mental health nurses, occupational therapist, social worker, art therapist, music therapist and health care assistants. Multi-disciplinary meetings were comprehensive and covered all aspects of the patients care including, risk, medication and discharge plans. Staff had a good working knowledge of the Mental Health Act. They had support from a Mental Health Act administrator who was also responsible for ensuring all documentation was correct and up to date.

• Patients and carers told us about how positive their experiences were at the hospital. They highlighted how staff were caring, knowledgeable and hard working. Patients were able to give feedback on the care and treatment they received.

• The hospital had a strong focus on recovery and rehabilitation; they successfully discharged 11 patients in 12 months. It offered its patients a range of facilities that promoted their recovery such as a shared three bedded shared flat-let. Information was made available to patients appropriate to their needs and they were supported to access other services for additional support where this was required.

• Staff morale was positive and staff felt as though they could approach senior staff regarding issues or concerns. They did not feel at risk of victimisation and felt the hospital would support them wherever possible. The ward manager felt she had enough autonomy in to fulfil her role effectively. There were governance systems in place to ensure the running of the organisation was robust. The ward was accredited and committed to quality and improvement.

However,

• Staff were not always confident about discussing the Mental Capacity Act. Their knowledge varied especially around capacity assessments and how best interest decisions are made.

• Although care plans were detailed and comprehensive, the care plans did not always use the patients’ own words or contain the views of carers and family members.
• The restraint logs were not always completed in sufficient detail to identify the level of holds used.