Cygnet Fountains

Ratings - Long stay or rehabilitation mental health wards for working age adults

• Overall

  Good

• Safe

  Good

• Effective

  Requires improvement

• Caring

  Good

• Responsive

  Good

• Well-led

  Good

Our view of the service

We inspected Cygnet Fountains on 16 and 17 July 2025.

This inspection was carried out using CQC’s approach to inspection; The Single Assessment Framework (SAF). We looked at all quality statements under each key question. This was an unannounced inspection, which means the provider was not told an inspection was going to be starting beforehand.

Cygnet Fountains is a long stay/rehabilitation unit for up to 34 men of working age. It is registered to provide care and treatment to patients detained under the Mental Health Act. The philosophy of the service is to provide rehabilitation to patients prior to being discharged to a community setting. This includes patients with challenging behaviour, forensic histories and substance misuse issues.

The service had a registered manager at the time of our inspection.

Cygnet Fountains was last inspected in September 2019. We rated the service as outstanding overall. It was rated good in safe and responsive, and outstanding in effective, caring and well-led. At this inspection we rated the service as good overall. It was rated requires improvement in effective and good in safe, caring and responsive and well-led key questions.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

• 97% of staff had received training in Mental Health Act, (MHA), Awareness. MHA training was coordinated centrally and monitored by the Hospital Manager; all relevant staff were required to complete this training and compliance was above Cygnets target.
• Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff were able to explain different sections of the Mental Health Act and how this impacted on patients’ rights and liberties.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were. There was a Mental Health Act administrator onsite. Staff confirmed they consulted with them regarding any queries regarding the Mental Health Act.
• The provider had relevant policies and procedures that reflected the most recent guidance. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. There was a corporate Mental Health Act policy dated December 2024 that had been reviewed regularly.
• Patients had easy access to information about independent mental health advocacy. There was a poster in communal areas regarding the advocacy service. Information about the advocacy service was also included in the patient welcome pack.
• Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. Care records confirmed that staff documented when they had explained to patients their rights. This was repeated as necessary if patients appeared to not understand.
• Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Leave was rarely cancelled and always re-arranged as soon as possible if unable to go ahead.
• Staff requested an opinion from a second opinion appointed doctor when necessary.
• Staff stored copies of patients' detention papers and associated records correctly and so these were available to staff. We reviewed 4 sets of detention paperwork and found this to be all in order.
• There were no informal patients during our onsite inspection. Staff understood that informal patients could leave and described how they would manage this situation.
• Care records showed that that patients had access to appropriate after care in accordance with section 117 of the MHA.
• Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. Mental Health Act paperwork was audited monthly. Learning from audits included reminding staff to ensure patients were aware of their rights, ensuring hospital managers hearings had been arranged and that Mental Health Act paperwork had had medical scrutiny.

Mental Capacity Act

• 97% of staff had had training in the Mental Capacity Act (MCA). MCA training was coordinated centrally and monitored by the Hospital Manager; all relevant staff were required to complete this training and compliance was above Cygnets target.
• Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles. Staff were able to give examples of when capacity had been assessed such as in relation to medicine, finances and diet.
• There were no deprivation of liberty safeguards applications made in the last 12 months to protect patients without capacity to make decisions about their own care.
• The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.
• Staff knew where to get advice from regarding the Mental Capacity Act, including deprivation of liberty safeguards. The Mental Health Act administrator was also trained and knowledgeable regarding the Mental Capacity Act.
• Staff took all practical steps to enable patients to make their own decisions. There was evidence in care records that staff had involved patients in decision making and supported them to understand.
• 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.
• When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.
• The service had arrangements to monitor adherence to the Mental Capacity Act. There was a quarterly Mental Capacity Act audit which sampled 5 different patient records per quarter. There were clear actions to be taken following the audit.

People's experience of this service

We spoke with 4 patients who used the service and 1 carer. Most patients told us they felt safe at Cygnet Fountains and the staff were kind to them.

They said the food was of good quality and they were often consulted on food options.

Patients were happy about the spacious environment and said it was kept clean and well-maintained. Patients said they were informed about medicine options and that they understood what their medicines were for. Patients felt their physical health was well looked after due to good access to the local GP and the onsite physical health nurse.

Patients said that there were enough staff who were knowledgeable and knew how to support them. They said their leave from the hospital went ahead and that staff supported them to access the community and visit their family.

Patients told us that they had a care plan and attended their ward rounds with the multidisciplinary team where they felt listened to. They said they were asked for their views about their care and treatment and were given time to respond. They had an advocate who supported them when needed. The advocate was a visible presence on the ward and patients spoke highly of them.

Patients said they were involved in their care planning and that they understood their care plan and next steps.

We observed very positive interactions between staff and patients. Staff demonstrated kind and caring attitudes. Staff clearly knew the patients well and were able to have warm and friendly conversations whilst remaining professional boundaries.

One patient described feeling stuck in the system and that they had exhausted all therapy options.

Most patients told us they felt safe on the ward. However, one patient complained of feeling unsafe due to recent assaults from another patient. We raised this with staff who confirmed they had taken action following this to protect the patient.

One carer said communication was poor outside of ward rounds and that their loved one had been sent on leave with the wrong medicine on number of occasions which was later rectified by staff.