- Independent mental health service
Cygnet Lodge Lewisham
Assessment report published 18 July 2025
Contents
Ratings - Long stay or rehabilitation mental health wards for working age adults
Our view of the service
We carried out a comprehensive assessment of Cygnet Lodge Lewisham on 28 and 29 May 2025.
We rated this service as good.
Cygnet Lodge Lewisham is an independent high support rehabilitation hospital for 19 male adult patients. At the time of the assessment, 17 patients were receiving treatment at the service.
This service was last inspected in July 2019 and the service was rated good overall. At that inspection, we found that some legal requirements were not met. We had concerns that the hospital did not provide an environment that was well maintained and clean for patients. We issued one requirement notice for a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. This notice related to a breach of regulation 15 (Premises and equipment).
At this assessment we rated the service as good. We found that improvements had been made to the environment, and they were no longer in breach of this regulation.
We spoke with 18 members of staff, 10 patients and 5 carers. We also reviewed the care and treatment records of 5 patients.
At this assessment we found several areas of good practice. Staff knew what incidents to report, and how to report them. All records had risk assessments that were regularly updated and contained all relevant risk information. Staff told us they avoided using restraint by using de-escalation techniques, and we saw this in practice. All staff completed key mandatory training. All staff had completed monthly supervision. Most staff were up to date with their yearly appraisals. Patients could access a range of interventions and activities in line with national guidance. Ward activities helped promote a healthy lifestyle for patients. Patients told us staff were kind and treated them well. They told us staff were available on the ward to support them when needed. Patients had access to spiritual, religious and cultural support. All staff told us they felt respected, supported and valued by their colleagues and managers.
However, we did find areas of improvement. We saw some examples where intermittent observations were not being carried out in line with hospital policy. There were often no clear action plans when areas for improvements were found following audits or simulation training sessions. Care plans did not always reflect the individual work staff were doing with patients. Most patients told us they were not aware of what a care plan was, and were not involved in creating these documents. Some patients told us they did not have copies of their care plans. Staff told us there was sometimes a duplication of documents on paper and electronic forms, meaning this took staff more time to complete and there was sometimes confusion on where to find up to date information.
People's experience of this service
We spoke with 10 patients and 4 carers.
Patients were very positive about the service. They told us staff were friendly, respectful and helpful. They told us there were enough staff available to meet their needs and they met with their named nurse regularly.
Carers told us staff had positive attitudes, and they had good communication with the ward and managers. All carers told us they felt involved in their relatives’ care, such as through attending ward round meetings or having regular phone calls.
Whilst at the hospital, we saw examples of staff supporting patients in a kind and caring manner.
The hospital collected feedback from patients about their care through surveys and community meetings.
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
All staff had completed training in the Mental Health Act and the Mental Health Act Code of Practice.
Patients had easy access to information about advocacy services. Patients and staff told us advocates visited the ward regularly and attended ward meetings.
The service did not have a contract with a provider for independent mental health advocates, which they should have done. The contract with their advocacy service was for general advocacy.
Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. The hospital’s site resources manager was the Mental Health Act lead for the site.
Records showed staff explained to each patient their rights under the Mental Health Act and repeated this as necessary. Most patients we spoke with were aware of their rights, however 2 patients told us their rights were not explained regularly enough.
Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to.
Staff stored copies of patients' detention papers and associated records correctly and they were available to all staff that needed access to them. Staff understood Section 17 leave and how to manage this. This is permission to leave the hospital agreed with the Responsible Clinician and/or with the Ministry of Justice.
Staff did regular audits to ensure that the Mental Health Act was being applied correctly. The most recent Mental Health Act audit showed that staff were following hospital policy 98.9% of the time.
Mental Capacity Act
All staff had completed training in the Mental Capacity Act and deprivation of liberty safeguards.
For patients who may have had impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. We saw evidence of these assessments in patient’s care records.
Staff took all practical steps to enable patients to make their own decisions
When staff assessed patients as not having capacity, they made decisions in the best interest of patients and considered the patient’s wishes, feelings, culture and history. Staff kept clear, detailed records of this.