Cognacity

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 people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is our first inspection of the service. This key question has been rated requires improvement.

The service was in breach of Regulation 12 Safe care and treatment. The provider did not have systems to monitor that the interventions were effective and evidence-based. Comprehensive assessments, evidence-based treatment plans and risk assessments were not consistently in place when prescribing medicines and treatments.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most of the time, the service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 10 care and treatment records. Most contained assessments that were completed in a timely manner and detailed. Staff developed care plans that were personalised and met the needs identified during assessment. Staff involved patients in the completion of their risk assessments and care plans. The records reflected conversations with patients. We spoke with 8 patients and 5 carers of patients using the service. Most said they felt involved in reviewing their care and treatment, although 6 people said they or their relative did not have a care plan.

However, the provider did not have policies and protocols that outlined what assessments and screening patients needed before and during treatments and any exclusion criteria.

The prescribers did not consistently liaise with patients GPs and other healthcare professionals when commencing treatment. The service did not always have patients’ medical history available and instead relied on information reported by patients or carers.

Although the service offered treatment for substance misuse, there were no drug testing kits available to carry our relevant screening. Leaders told us this would be carried out at other locations, however there was no protocol in place for this.

The service did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

The service offered a range of care and treatment interventions suitable for the patient group. These included medication and psychological therapies. However, the provider did not have systems to monitor that the interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). We did not see that comprehensive assessments, evidence-based treatment plans and risk assessments were consistently in place when prescribing medicines and treatments.

The service did not participate in regular clinical audit, benchmarking or quality improvement activity. This meant the provider did not measure the effectiveness of treatments provided and did not learn from the results. However, some clinicians undertook audits in their specialist area. An audit of referrals to therapy following autism assessments was completed in May 2025.

The provider did not always ensure that patients had access to physical healthcare. Prescribers did not always review the effects of medicines on patients’ physical health in line with the national guidance. One patient was prescribed a dose of methadone that can cause heart problems, however we did not see that the prescriber had discussed or requested an electrocardiogram (ECG). At the same time, we saw that 4 patients receiving treatment for attention deficit hyperactivity disorder (ADHD) had received appropriate physical health monitoring and were offered both medical and psychological treatment. Some patients and carers we spoke with said staff referred them for blood tests and physical health checks to their GPs or independent providers.

The multidisciplinary team (MDT) included a range of roles that met the needs of the patient group, such as psychiatrists, psychologists and therapists. Staff were experienced and qualified and had the necessary skills and knowledge to meet the needs of the patient group.

The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The provider did not have effective systems for staff to share information about patients. Some staff we spoke with said the team worked closely together, however others shared concerns about the lack of available forums for multidisciplinary team (MDT) discussions of issues related to patient care. Although we heard that discussions about patient care took place informally between staff and doctors, this created the risk of inconsistency in information sharing and decision-making.

The service did not always have effective working relationships with teams outside the organisation. The prescribers did not communicate with patients’ GPs and other healthcare professionals consistently when providing treatment. We saw limited evidence of partnership working following the 2 safeguarding referrals made.

However, the provider had developed more effective working relationships with a number of independent providers and established shared care arrangements for attention deficit hyperactivity disorder (ADHD) with primary care. Some patients we spoke with told us the service had supported them with providing letters for their studies or work.

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

We spoke with 8 patients and 5 carers. Some shared examples of the service helping them or their relative to live a healthier life, where appropriate. For some, this included regular discussions about their lifestyle, and for others, encouraging them to exercise more, or discussing sleep hygiene and meditation. One patient had been offered a referral to a dietitian.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider had not ensured that staff routinely used recognised tools and rating scales to assess and record outcomes. Some staff we spoke with shared examples of using Beck’s scale and PHQ-9 for assessing depression symptoms, however others confirmed that they did not use outcome measures, tools or questionnaires when providing treatment.

We did not see evidence of outcomes being measured in most care records we viewed. This meant the provider had limited data on treatment outcomes and effectiveness. However, in 3 records we saw PHQ-9, GAD-7 (questionnaire for anxiety symptoms) and DIVA-5 (questionnaire for assessing ADHD symptoms).

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider did not have policies on the Mental Capacity Act (MCA) 2005 or consent relevant to the service provided. Because most patients approached the service for treatment voluntarily, they were presumed to have capacity. However, we viewed the record of a young patient and saw no documentation of Gillick competence (used to determine whether young people under 16 years of age can consent for their own treatment) or consent from their carer who accompanied them.

Staff completed mandatory training on the MCA and 93% were up-to-date with it. However, according to the training records, the frequency of MCA training refresher was every 10 years and therefore it may not provide sufficient guidance for staff.

Most patients and carers we spoke with said that staff had explained consent at the start of the treatment, including how they shared their information.