Cognacity

We carried out a focused assessment of Cognacity on 18 and 19 May 2026. We reviewed the provider’s progress against a warning notice for Regulation 17 and additional breaches under Regulations 12 and 13 identified during our previous inspection in October 2025. This assessment focused on governance and the management of risk. We inspected the safe, effective, responsive and well-led key questions. We did not inspect the caring key question and its rating remains unchanged. At the previous inspection, the service was rated requires improvement overall, with safe rated inadequate. As a result of this inspection, our ratings changed. We rated safe good, effective good, responsive as good and well led as good. Overall, our rating for this service changed from requires improvement to good.

Cognacity is an independent consultant-led outpatient mental health service based in London and operated by Cognacity Health Limited. It provides assessments and treatment for adults and children experiencing a range of mental health conditions, including ADHD and autism. Services are available to self-funding patients and those funded through private medical insurance.

During this assessment, we found the provider had made significant improvements and had met the requirements of the warning notice. Governance arrangements had strengthened and leaders had implemented systems to improve oversight of prescribing, incidents, risk management, safeguarding processes and environmental safety. Staff consistently assessed and managed risk, and processes were in place to support safer care and treatment. Records were now maintained for all patients, were contemporaneous and accessible, and were subject to routine audit and oversight.

Improvements had also been made to safeguarding arrangements, incident management, communication with GPs and medicines governance. The service had introduced clearer admission criteria, strengthened prescribing oversight and improved monitoring systems to identify and respond to potential risks.

However, some governance processes were relatively new and were not yet fully embedded. We found examples where learning from incidents was not consistently shared and some risk assessments lacked sufficient details. The service also did not routinely analyse outcome measures to evaluate the effectiveness of treatment, even though staff attempted to collect feedback from patients.

Overall, we found the provider had made progress since the previous inspection and was no longer in breach of the warning notice. Further work was needed to ensure improvements were sustained and fully embedded across the service.

Date of inspection: 16 September to 15 October 2025.

Cognacity is an independent consultant-led service treating adults and children for a range of mental health conditions. It is based in City of Westminster, London and is run by Cognacity Health Limited. The service provides outpatient treatment to people based throughout the UK.

The service team includes directly employed staff and self-employed doctors working for the provider part-time under practising privileges.

The service is for self-funding clients and those funded through private medical insurance. Cognacity offers medical treatments and psychological therapies for mental health disorders, eating disorders, substance misuse, attention deficit hyperactivity disorder (ADHD) and autism assessments. In 6 months leading up to our inspection, 1718 patients accessed psychiatric consultations at the service, both in person and online.

Cognacity registered with the CQC on 30 June 2023 to provide treatment of disease, disorder or injury. At the time of our inspection there was a registered manager in post. Cognacity also provides other services such as therapy, coaching and advisory services, which are not within the scope of CQC registration. Therefore, we did not inspect or report on these services.

This was our initial comprehensive inspection of the service, across all key questions and quality statements. We rated the service as requires improvement.

We took enforcement action as a result of this inspection. We issued a warning notice in relation to Regulation 17 Good governance. We found that the provider had not established effective systems and processes to assess, monitor and improve the quality and safety of the service. This meant that potential risks to people using the service were not identified and mitigated in a timely manner. Audits did not take place consistently. Medicines were not prescribed safely, with appropriate records kept. The provider had not ensured that accurate and complete records in respect of each patient were kept and securely maintained. Not all patients had comprehensive risk assessments, with appropriate support and mitigations in place for any risks. The provider had not ensured that its doctors liaised with patients’ GPs consistently to make sure that care and treatment remained safe. Incidents were not reported, documented, investigated, and mitigated appropriately. Environmental checks were not completed consistently and there was no system to ensure that clinical equipment was regularly checked or maintained. The provider’s system to manage void prescriptions (prescription forms that are not to be used for any reason) was not robust.

The provider was required to become compliant with this warning notice by 7 November 2025.

We found other areas requiring improvement. The service was in breach of Regulation 12 Safe care and treatment and Regulation 13 Safeguarding service users from abuse and improper treatment. Staff did not follow infection control principles by recording when clinical equipment used on patients was cleaned. Outcome measures were not routinely used to monitor the effectiveness of treatment. The provider did not have key policies and procedures in place, and some policies that were in place did not reflect the current guidance. The provider had not ensured that all staff received supervision appropriate to their role. The provider’s policies did not clearly demonstrate the induction and training requirements for different staff groups. Leaders did not document when new staff had completed an induction. Although leaders monitored the completion of mandatory training, its levels or refresher frequency were not documented in the provider’s policies. The duty of candour requirements were not reflected in the provider’s policies, incident records or staff training. The provider had not ensured that staff assessed patients’ capacity to consent on a decision-specific basis. The information governance systems raised concerns over the confidentiality and security of patient data. Monthly prescription reconciliation system relied on staff using their personal smartphones to record, store and send images of patients’ prescriptions. Whilst staff had been trained in safeguarding, robust systems for safeguarding people had not been established.

We have also asked the provider for an action plan in response to the concerns found at this inspection.

We also found areas of good practice. Patients and carers we spoke with said staff treated them with kindness and respect. The service had enough staff with the necessary qualifications and training. Staff enabled patients to have choice and control of their care and treatment. Patients were involved in their care. Staff reported a supportive and open team culture. Managers monitored the completion of staff training, appraisal and appropriate employment checks.