Cygnet Sherwood House and Cygnet Hospital Sherwood

On this page

• 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 patients 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 patients outcomes were consistently good, and patients feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service did not always make sure patients’ care and treatment were effective because they did not always check and discuss patients’ health, care, wellbeing and communication needs with them.

We looked at 8 care records during our inspection. Staff gathered information about the patient as part of the pre-admission assessment and carried out a comprehensive assessment with the patient and the wider MDT of their mental, physical and social care needs when they were admitted to the service.

Staff did not always complete care plans that were personalised, holistic, or recovery-oriented. Patient views often lacked detail, and some were repeated from month to month. This limited the personalisation of care plans and reduced their effectiveness. Staff provided limited evidence of family involvement and did not update all plans when necessary. For example, we found evidence that staff discussed changes in a patient’s physical health needs during morning handover but did not record these changes in the patient’s notes and NEWS2 (The National Early Warning Score 2) assessments were not always completed in line with the providers policy and patients care plan.NEWS2 is a standardised tool used to quickly identify adult patients (aged 16+) at risk of clinical deterioration)

We were not assured that staff assessed and met all patients communication needs to maximise the effectiveness of their care and treatment. For example, we found evidence that staff had not completed an appropriate communication care plan for a patient with communication difficulties. There was a lack of provision locally for dental care, which had remained on the risk register for some time. We did not find evidence that this had affected patient care.

However, most patients records documented a robust approach to physical health monitoring with an onsite phlebotomist (a healthcare professional trained to draw blood from patients for tests, transfusions, research, or donations) and good links to the local GP. The service recently introduced a portable Electroencephalogram (ECG) machine to the ward as part of the management of patients receiving High-Dose Antipsychotic Treatment (HDAT), which required regular monitoring of patients’ physical health, due to increased risk of side effects.

We plan and deliver patients care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the patient group. They delivered these interventions in line with guidance from the National Institute for Health and Care Excellence (NICE) and the Royal College of Psychiatrists (RCP).

The service had a psychology team that offered therapy to patients. All patients had opportunities to attend individual (formal and informal) psychology sessions and group interventions. These included drop-in sessions for low-level social engagement and coping skills groups, as well as training and work opportunities designed to help patients develop independent living skills.

Staff delivered mindfulness workshops to help patients access community activities during leave, such as shopping. Patients also attended sessions on emotional regulation and substance misuse.

The hospital promoted sexual safety and online awareness. The local police force delivered a session on sexual safety and online risks, and occupational therapy staff provided follow-up sessions to reinforce learning.

Patients had access to the full range of specialists required to meet their needs. In addition to doctors, nurses, and clinical support staff, the service employed occupational therapists, clinical psychologists, and peer support workers.

Staff ensured that patients had good access to physical healthcare, including offsite specialists when needed. Managers told us that although the hospital did not employ a speech and language therapist, staff arranged support from a sister hospital when a patient required this service.

Staff participated in clinical audits which were discussed at the monthly clinical governance meeting. The service was in the process of information gathering and auditing, with a view to meeting the standards required to become a member of the AIMS Quality Network for Mental Health Rehabilitation Services, which is run by the Royal College of Psychiatrists (RCP) .

However, staff applied these interventions inconsistently and did not always record outcomes effectively. Care plans did not consistently reflect a holistic or recovery-oriented approach, and some care plans lacked detail about how evidence-based interventions were tailored to individual needs.

Most staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. However, some staff told us they lacked confidence to challenge patients about illicit drug use on the ward.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act 1983 (MHA) and the Mental Health Act Code of Practice.

Staff had easy access to administrative support and legal advice on implementation of the MHA and its Code of Practice. Staff knew who their MHA administrators were.

The provider had relevant policies and procedures that reflected the most recent guidance.

Patients had easy access to information about independent mental health advocacy services, and the provider employed a peer support worker.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted.

Throughout our assessment we saw how patients were able to access the section 17 leave from the hospital. Staff managed this by signing patients out and completing safety measures on their return, including searches, bag checks, and urine tests when required

We reviewed the section 17 paperwork and saw that they were fully completed. Staff stored copies of the patients detention papers and associated records (for example, Section 17 leave forms) correctly, these were available to all staff that needed access to them.

The service displayed a notice to tell informal patients that they could leave the ward freely. These were found in reception and on the ward.

Staff knew and understood that patients could request an Second Opinion Appointed Doctor (SOAD) when necessary for detained patients who refuse treatment or lack capacity to consent .

Staff completed regular audits to ensure that the MHA was being applied correctly and there was evidence of learning from those audits.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings every day. These meetings were comprehensive and covered all aspects of patients’ care.

Staff used a set template for handovers between shifts and teams to ensure all essential information about patients was shared.

Teams maintained effective working relationships with external partners such as local authorities and GPs. They supported patients in accessing relevant local services and collaborated effectively with the other services run by the provider at the same location.

The service supported patients to manage their health and wellbeing to maximise their independence, choice, and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

Staff completed an initial physical health check for patients on admission to the unit and completed an annual physical health check. Patients were registered with a local GP and had access to onsite physical health checks and screening. There was also a phlebotomist onsite to enable compliance with HDAT.

Staff supported patients to live healthier lives by providing healthy eating advice, managing cardiovascular risks, introducing a sleep hygiene clinic, and addressing issues related to substance misuse. Although recent incidents of drugs being brought into the hospital posed a challenge, staff and managers recognised this and worked proactively to manage it.

Staff promoted healthy lifestyles through ward activities, including walking groups, sports sessions, and cooking healthy meals. Patients had opportunities to complete therapy jobs that helped them develop domestic skills, manage finances, and maintain daily routines.

Managers explained that local policy currently allowed patients to smoke in a designated outdoor area. However, they were planning to make the service smoke-free during 2026 and were developing enhanced smoking cessation support for patients.

The service routinely monitored patients’ care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of patients.

Staff used recognised rating scales to assess and record severity and outcomes. These included the Global Assessment of Functioning Scale (GAF) and National Early Warning Score (NEWS 2). The data from this was used to inform care planning and to adjust where needed.

Clinical data, such as blood tests and physical health checks, were recorded and stored by nursing staff. The specialty doctor would be sighted on these results, and they would be discussed in daily meetings and ward rounds with the patient.

The service told patients about their rights around consent and respected these when delivering person-centered care and treatment.

Staff took practical steps to enable patients to make their own decisions. We observed staff engaging patients in conversations about their wishes for the day and what activities they wanted to do. The service followed a care model that emphasised positive decision-making. We saw enough staff were available for patients to check in and ask questions when needed.

The catering team explained how they co-produced a new meal structure with patients. Patients decided to adopt a ‘café-style’ approach to their food choices, giving them greater control and variety.

During a medication round, we observed a qualified nurse giving a patient time to discuss whether they needed any “as and when required” medication. This approach allowed the patient to reflect and make their own decision, which they told us was helping them prepare for life beyond the service.

Staff demonstrated a clear understanding of how consent interacts with the Mental Health Act. When patients were detained under the Act, staff continued to involve them in decisions wherever possible and applied least restrictive principles, including for medication and restrictive interventions.