Cygnet Lodge Lewisham

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We looked at 5 care and treatment records at the hospital.

Staff completed a comprehensive mental health assessment of patients in a timely manner at, or soon after, admission. Care plans and risk assessments matched the needs identified in a patient’s assessment.

Patients had a number of care plans in place and these were updated regularly. We saw examples of staff providing individualised care to patients. However, care plan documents were not always personalised and sometimes had generic plans in place for patients. For example, we saw 2 patients with the same generic action plans for religious needs. This was despite staff having worked closely with the patients and supported them to attend different local churches.

Staff involved patients in discussions about their care and treatment. We saw examples of patient led discussions about treatment occurring in ward rounds. Some care plans had patient views recorded on them. Patients told us they met regularly with their named nurses. However, most of the patients we spoke with told us they were not aware of what a care plan was, and were not involved in creating these documents. Six patients told us they did not have copies of their care plans. Following the assessment, managers told us they had added a new tick box to show if a care plan had been signed and a copy given to patients. They were also planning to use visual aids and simplified summaries of care plans to enhance understanding of care planning sessions.

Staff assessed patients’ physical health needs in a timely manner after admission. Staff used the national early warning score (NEWS) system to detect and respond to clinical deterioration of physical health. We saw regular reviews of physical health in patient records. We saw examples of staff creating individual care plans to meet patient’s physical health needs, such as, management of epilepsy or diabetes.

Patient’s physical health observations were seen to be occurring in communal areas. Staff told us this was due to the lack of space in the clinic room. More invasive treatment, such as injections, would occur in the clinic room. Although this could have negative impacts on patient privacy and dignity, patients did not raise this as a concern.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies, as well as supporting daily living skills. The psychological therapies offered were tailored to the individual’s needs, and patients were offered both group and 1:1 sessions.

The hospital supported patients to integrate with their local community. Patients were supported to attend voluntary work places, attend educational courses and access community activity groups. One patient had a voluntary job in a charity shop, and others had completed courses in maths, English and bike maintenance. Patients were also able to attend community football sessions with a local football club.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. For example, we saw patients being supported to attend the dentist and to register with a GP.

Ward teams included a range of specialists to meet the needs of patients. This included nurses, healthcare assistants, doctors, psychologists, occupational therapists, a fitness instructor, a social worker and a physical health nurse. A music therapist and an art therapist also provided sessions for patients each week.

Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group.

Patient’s had access to a range of activities throughout the day. The timetable changed every 3 months. At the time of assessment, the planned activities included, swimming, psychology chuckle therapy, newspaper group, a healthy eating group, a substance misuse group and a garden volunteer session. There were also sessions focusing on activities of daily living, such as cooking and food shopping. There were a number of community trips, such as to museums, the cinema, football matches and beach trips.

We saw activities taking place as planned, as well as pool tournaments with staff each day. An occupational therapy assistant worked on Saturdays to provide group sessions and activities at the weekend. However, a number of patients told us they would like more TV channels and access to online streaming services to be able to watch more movies and sports events.

Where the hospital had identified specific areas of learning needed, they had arranged for this training to be delivered to staff. For example, staff were able to access training on learning disabilities and personality disorders prior to new patients being admitted. Staff also told us they were given training on specific areas following incidents, such as training on how to administer medicines for a patient having a seizure.

Managers provided new staff with appropriate induction. Staff told us they had received an induction, which included time to shadow staff on the ward before starting their role.

Staff received monthly clinical supervision. In these meetings they were able to discuss clinical cases, safeguarding, audits and learning. Every 3 months staff received managerial supervision. This included topics such as staff wellbeing and the hospital’s values. All staff had monthly logged supervision.

In May 2025, 94% of staff had completed their appraisal. This included discussions around staff’s achievements and strengths as well as a development plan.

Staff had access to monthly reflective practice, led by the hospital’s psychologist. Staff told us they found these sessions useful and supportive.

Managers ensured that staff had access to regular team meetings. Team meetings were held monthly, and staff could attend in person, or remotely. Minutes from the meeting were saved on the hospital’s shared drive, which all staff accessed, and was also emailed to the team.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff told us they had been able to access nursing apprenticeships, and the psychologist had recently completed training in Eye Movement Desensitisation and Reprocessing (EMDR) therapy. The manager told us he was completing a hospital manager development programme.

Managers dealt with poor staff performance promptly and effectively. Managers told us they worked closely with the staff team and picked up any concerns as they happened. They had not needed to performance manage any staff member.

Staff participated in clinical audit and quality improvement initiatives. Staff completed audits in a range of areas, such as, documentation, physical health and medicines. Staff shared the findings of audits in team meetings and via email. In most cases audits led to improvements in care. Such as implementing a second named nurse for each patient to follow up on outstanding documentation and actions when the primary named nurse was not at work. However, in the documentation audit we saw the same outstanding documents in consecutive audits, meaning there was not always an effective action plan put in place following these findings. For example, a violence and aggression care plan was missing for one patient for 3 weekly audits, and a patient was missing a care plan on self-neglect for 2 weekly audits.

The hospital was completing a quality improvement project looking into patient constipation, as this was a common side effect of frequently prescribed medicines. The project aimed to increase conversation around bowel movements, and ensure staff spoke with patients daily about this topic. The hospital was also in the process of starting a formal project looking into patient’s physical health.

Staff shared key information to keep patients safe when handing over their care to others. Handover meetings occurred at the beginning of nursing shifts, as well as on weekday mornings for the multidisciplinary team. Staff told us handover meetings were effective in sharing key risks and plans for the next shift. We observed a multidisciplinary handover meeting and patient’s ward rounds. These meetings contained detailed patient-led discussions. All staff were seen to contribute their views in these meetings.

The wards had effective working relationships with teams outside the organisation. For example, we saw community teams attending ward rounds and the hospital’s social worker spoke with the local authority on safeguarding matters. Staff told us they also communicated with supported accommodation to support patient discharges.

Staff supported patients to live healthier lives. For example, through participation in smoking cessation schemes, healthy eating advice and supporting issues relating to substance misuse. A carer told us their relative had been referred to a dietitian to support him with healthy eating.

Ward activities helped promote a healthy lifestyle for patients, for example, a healthy eating group, walking groups and sports activities. The hospital had a fitness instructor come into the service 2 days per week. They supported patients in activities on the ward, as well as in the local community. The hospital was opposite a park and near to a gym and swimming pool where patients received free memberships. The hospital also took part in events, such as, ‘marathon in a month’ where patients walked the distance of a marathon in a month, patients were supported to make t-shirts for this event. They also celebrated national fitness day where patients and staff took part in activities in the local park and had certificates for participation.

Patients had access to a kitchen where they were able to make their own food, with support from staff. The hospital’s occupational therapy team supported patients in being able to cook for themselves. The hospital recently bought an air fryer and they helped their patients learn to cook, using an air fryer cookbook they had developed with patients, to increase their confidence. Staff were able to print out this cookbook for patients upon their discharge, increasing their independence when in the community. There was also another cookbook, created by the patients, filled with recipes they had chosen and cooked themselves. This was also available for patients to have and use once in the community.

Staff used recognised rating scales to assess and record severity and outcomes. For example, to measure side effects of medication. Doctors also used the Global Assessment of Progress (GAP) to measure patients progress and outcomes

Staff had access to technology to support patients effectively. For example, patients were able to video call their families using the ward’s computers.

Staff took all practical steps to enable patients to make their own decisions.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. For example, we saw doctors documenting capacity in ward round meetings, stating if patients had the capacity to consent to their medication.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.