Archived: Cygnet Community Services East Midlands

Updated 10 January 2017

Cambian Community Services East Midlands is part of the Cambian Group. This service provides long stay residential rehabilitation step down services for up to 12 male patients with a mental health diagnosis. A residential rehabilitation stepdown service is the final part of the care pathway for an individual who has successfully achieved a period of inpatient treatment and or rehabilitation. Step down services are a non-clinical environment that supports patients moving from secure hospital settings to the community.

This service is available from two locations: The Sycamores is the step down service for Cambian Storthfield House, an independent mental health hospital based in South Normanton, Derbyshire. The Sycamores houses consist of one house and one bungalow. The Limes Houses is the step down service for Cambian The Limes, an independent mental health hospital based in Nether Langwith, Nottinghamshire. The Limes Houses consists of two, three bedroomed houses. Non-clinical staff operates this service and patients receive their mental health treatment as out patients of Storthfield House and Cambian The Limes.

The Care Quality Commission registered Cambian Community Services East Midlands in 2014 to provide the regulated activity: treatment of disease, disorder or injury.

Cambian Community Services East Midlands specialises in services that includes caring for adults under and over 65 years and mental health conditions. At the time of inspection, Cambian Community Services East Midlands had eight male patients, four patients at The Sycamores and four patients at The Limes Houses.

Patients admitted to The Sycamores and The Limes Houses are not detained in hospital under the Mental Health Act and are free to come and go from the place they reside. Patients may be placed on conditional discharge, guardianship or a community treatment order. Patients on a conditional discharge are discharged from hospital into the community by a tribunal or the Secretary of State for Justice, but have to as part of their discharge, meet certain conditions such as residence. Patients on a community treatment order can be discharged from a Mental Health Act section. A patient on a guardianship order helps a person with a mental illness or disorder to receive care within the community. A Guardian (who could be the local authority) has the right to decide where a patient resides.

Cambian Community Services East Midlands had four patients placed on a conditional discharge, one patient on Guardianship and three patients not detained under the Mental Health Act 1983.

At the time of inspection, a registered manager was in place. The Care Quality Commission had not previously inspected Cambian Community Services East Midlands.

Updated 10 January 2017

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s). Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc). N.B. If there is or should be a registered manager include this statement to describe what a registered manager is: ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.’ Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

Updated 10 January 2017

We rated Cambian Community Services East Midlands as good because:

• Staff provided a safe and caring service for patients in a friendly supportive manner. All areas of the service were maintained and visibly clean and tidy. The service did not use blanket restrictions, restraint or seclusion. Staff used a least restrictive approach to manage challenging behaviours.
• The arrangement for managing medication was safe. Patients had the option of storing prescribed medication in a locked safe in their bedrooms or in a locked cupboard in the staff office. We observed staff following the provider’s self-medication policy as staff did not administer medication.
• Patients followed a therapeutic rehabilitation programme in the community. Staff encouraged patients to complete these activities independently or with support. Support provided by staff encouraged patients to integrate fully into local communities. Staff used a positive risk taking approach in encouraging patients to engage in activities.
• Patient records were up to date and comprehensive. Care plans we saw were holistic and reflected aims and goals set by patients. Risk assessments were current, detailed and clear. Patients attended multi disciplinary team meetings and were involved in discharge planning before and during admission to the houses.
• Staff were trained; knowledgeable and had many years’ experience working in step down services. There were no vacancies in this service as staff had remained in their posts for many years. Staff levels of sickness were low and the service reported no cases of bullying or harassment over the past 12 months.
• Patients said they raised issues with staff and managers without fear of victimisation. Patients raised their concerns at community meetings and received feedback about their concerns from staff. Interactions we saw between staff and patients were very positive.
• All staff received supervision every eight weeks and had an annual appraisal. Staff had access to mandatory and specialist training and had the opportunity to develop leadership and management skills. Staff we spoke to completed qualifications in leadership and management and the care certificate.
• The provider collected weekly data from the locations, which was part of the governance process. The provider used key performance indicators to gauge the team’s performance, which was feedback to the provider’s quality team.

However:

• The multi disciplinary team did not invite support workers to their team meetings. Support workers gave feedback to the multi disciplinary meeting by email and received multi disciplinary team feedback from house managers.
• Staff did not receive feedback of lessons learned that occurred in other hospitals and step down units owned by the provider.