Cygnet Manor

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

Effective - 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 this assessment, we rated this key question Good. This meant people’s outcomes were consistently good and their feedback confirmed this. We found the care and treatment provided by the service was effective. It was evidence based, measurable and monitored for outcomes. Processes and training were in place to support staff to perform their roles and responsibilities effectively. People and their families were encouraged and supported to be involved in their care assessments and treatment planning, which promoted a person-centred approach. Staff demonstrated good knowledge of the importance of capacity to consent. Processes and assessments were in place to safeguard people and their best interests. People were supported if they had communication needs and had access to internal and external resources to help capture their voice, which ensured they were heard.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People using the service and their families were involved in their care and treatment planning and told us they felt included, listened to and their needs and preferences were understood. One relative told us “I am involved in my brother’s care and treatment; staff regularly include me in decision making and I do feel listened to.”

Due to diagnosis and/or presentation, some people were not always able to be fully involved. On these occasions, staff supported involvement as much as possible and adhered to the appropriate legal frameworks when a person lacked the capacity to consent and make informed decisions. Where people were unable to communicate their needs directly, staff supported their families to have input into care planning and assessments of risk.

Staff completed comprehensive and timely assessments of peoples’ physical, mental, emotional and communication needs. The assessments were person-centred and reviewed regularly with the person and their families where possible. Staff used clinical tools alongside professional judgment to build a comprehensive understanding of each person's individual needs. If a person lacked capacity to make decisions, staff adhered to legislation and best practice which ensured decisions were made lawfully and, in the person’s, best interests. People’s families were also supported with appropriate information and resources available to them, for example, carers advocacy services. All staff had also completed carer awareness training which ensured they could identify the needs of relatives and offer the appropriate support.

We reviewed 11 care records. All records evidenced that staff completed a full mental and physical health assessment on admission or shortly afterwards and were supported to attend an annual physical health check. Care plans were holistic, person-centred and focused on meeting people’s needs and achieving meaningful outcomes. Care records were updated regularly. Communication needs and preferences were clearly recorded and where necessary, staff adapted their approach and used various methods to improve the person’s understanding and involvement.

The Psychology team delivered a wide range of care and treatment interventions, for example, Cognitive behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), Compassion Focused Therapy (CFT), Acceptance and Commitment therapy (ACT), and Art Psychotherapy. They also formulated and promoted positive behavioural support planning (PBS), completed behavioural assessments, individualised targeted interventions and personal goal setting.

Staff followed National Institute for Health and Care Excellence (NICE) guidance and accessed regular clinical updates. We observed care and support being provided that aligned with current best practice guidance throughout our visit.

The service met people’s specific dietary requirements with staff providing individualised support when needed. Hydration and nutrition needs were assessed by staff and monitored in line with national guidance and consistently evidenced in people’s care records.

Staff were encouraged and supported to explore new, research-backed approaches to improve outcomes. Staff took part in clinical audits and reviews, benchmarking and quality improvement projects. For example, a ‘Safe wards’ quality improvement project. ‘Safe wards’ was an initiative which was coproduced between staff and people using the service. The project helped to identify and address behaviours that may lead to harm and promoted a culture of safety and respect by reducing conflict and containment through partnership working and enhanced understanding.

People and their families experienced coordinated care across teams and services. The service promoted a multidisciplinary approach, including doctors, nurses, psychologists, occupational therapists (OTs), activity co-ordinators (ACs), speech and language therapy (SALT), an art psychotherapist, a dietician and support workers (SWs). External partners, for example, care coordinators (CCO) were invited to care and treatment reviews, which ensured continuity and effective joined up care for people and their families.

The service had effective collaborative working relationships across their teams, the wider organisation and with external partners. They held monthly multidisciplinary team meetings where care and treatment plans were formulated, reviewed and amended if required. We saw that handovers were concise and effective and took place before the start of every shift, with comprehensive and accurate information shared consistently. Staff told us they had good communication with external services, for example, the local authority social work team. Processes we reviewed ensured care was well coordinated when people transitioned between services. We saw that discharge planning was robust and considered the individual needs, preferences and circumstances of people. We saw that clinical tasks were effectively delegated, and referrals made. This maintained safe and effective care through concise and timely information sharing.

The service and its staff empowered and supported people to manage their health and wellbeing and promoted healthier choices. People were supported to be as independent as possible. Staff provided healthy eating advice and health-promoting activities, for example, physical activity, such as walking with nature groups, outdoor pursuits and sessions in a local gym, The service also provided a personal trainer who attended and completed physical exercise sessions with people who were unable or did not want to travel to the gym. Meals were freshly prepared and cooked on site, with healthy options available. Staff encouraged and supported people to make healthier choices. One person told us “The food is cooked freshly; we have healthy options available. If you want something that isn’t on the menu, they sort it and make you what you want, it’s great.”

The service had positive working relationships with local external partners in care, for example, GP’s, dentists and opticians. People were registered with local services as part of the admission process and according to their needs. People were effectively supported to attend all appointments made.

Health assessments were conducted regularly by the speciality doctor and physical health nurse. All people had annual health checks which were consistently evidenced in people’s care records. The service also provided a monthly well person clinic, which people were encouraged and supported to attend. Staff also referred people to specialist services, such as occupational therapy to meet their individual needs. The service focused on identifying any potential health risks early, ensuring timely interventions, maintained wellbeing and prevented any unnecessary deterioration.

Staff routinely monitored people’s care to achieve positive and consistent outcomes. They used recognised rating scales, such as the Malnutrition Universal Screening Tool (MUST) and physical health screenings to assess severity and track progress. For example, National Early Warning Score 2 (NEWS2). This ensured care aligned with national guidance and clinical expectations and met peoples’ individual needs.

The service had effective systems in place to maintain effective and positive outcomes. Staff actively engaged in monitoring and improving care using technology to support this. Regular reviews of care plans ensured they remained current and aligned with people’s changing needs.

External benchmarking schemes and clinical audits supported continuous quality improvement. The service engaged in and promoted continuous quality improvement initiatives and projects, working collaboratively with other services and teams such as the national organisational learning disability and autism steering group and peer review initiative. This involved care teams and people using services to visit other learning disability and autism services and review all aspects of the service provision. It worked to improve the care, support and lives of people with learning disabilities and, or autism and their families. The process included reviewing policies, implementing recommendations from reviews and planned how to improve support for people living in the community. Knowledge and good practice was shared effectively between services.

The service ensured people were empowered and supported to make their own decisions about their care, treatment and support wherever possible. For people who may have lacked mental capacity, staff assessed and recorded their capacity on a decision-specific basis, with an emphasis on significant decisions to safeguard the person and protect their interests. The process adhered to the Mental Capacity Act guidance and supported people to make decisions for themselves when possible. If people lacked the capacity to make informed decisions, staff followed the appropriate process and involved their families and the relevant professionals, such as advocacy services, in any of the decisions made on their behalf. Staff considered peoples’ wishes, feelings, cultural and religious beliefs, social background and histories when making decisions.

For people detained under the Mental Health Act, staff adhered to the legal requirements and framework of the Act. Staff respected people’s rights and ensured they were informed of their rights verbally and also in writing and in a format which they understood, this included their right to appeal. For example, staff read people their Section 132 rights on admission and regularly thereafter or when their Mental Health Act status, responsible clinician (RC) or treatment plans changed. Staff consistently recorded the reading and communication of Section 132 rights in people’s care records. Consent to treatment regarding medicines were present and completed appropriately. We identified no concerns in the records we reviewed.