Cygnet Paddocks

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity, and respect.

This is the first assessment of this registered service. This key question has been rated outstanding. This meant people were openly respected and valued as individuals; and encouraged as partners in their care in this service.

Staff respected people’s dignity and showed empathy and compassion in caring for patients and staff demonstrated flexibility in adapting times to support the individual needs of patients. Feedback that we received from patients and relatives was jointly positive. Feedback from commissioners was that the staff group had developed since the service opened and commissioners had observed caring, supportive relationships developing between patients and staff and had observed patients were more confident.

Patients were aware of their rights, whether they were informal or detained under the Mental Health Act. Patients were encouraged to keep in touch with others who were important to them.

We have not awarded this service a score for Caring.

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

The evidence showed an outstanding standard. The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Feedback from commissioners was staff treated colleagues from other organisations with kindness and respect.

The service has a strong, visible person-centred approach, demonstrating empathy in how they communicated with patients and described patient care, for example, the service used ‘about me’ profiles developed with patients and their families and carers. Staff were empathic to the needs of the patients and sensitive to times when people need care and support. Staff involved patients in in everyday choices, for example choosing their clothing, their meals and their activities. The service used communication passports, visual aids and easy-read materials to help patients make decisions.

Commissioners feedback was kindness, compassion and dignity were a strength of the service, which demonstrated a commitment to person-centred care by providing an enriched care environment and how staff responded to patient episodes of distressed behaviour.

We observed examples of staff repeat and simplify information to support patient’s cognitive or communication difficulties. We saw how observation levels were varied for patients based on their personal routines and level of distress to reduce sensory overload. Personal routines were adapted to meet patient’s individual choices, including patient goals of moving toward independence. A patient shared an example of moving back to their local community and potential move to the onsite independent flats and had set goals to achieve this. The patient said, “I know what I need to do and how to do it, but my motivation and memory let me down, so staff take one step at a time with me, and don’t push me too far to soon”.

Managers and staff were able to describe how they developed positive supporting relationships through individualised care through providing support in the way patients preferred.

The service ensured that staff focus on building and maintaining open and honest relationships with people and their families. Housekeeping staff had experience of working as carers in health and social care services and had completed the same training as the care staff at the service, so their experience was utilised in supporting some patients due to the positive relationships they had with individual patients. They shared examples of how they encouraged and supported patients who were distressed by unfamiliar faces during personal care, by supporting the patient and helping with personal care, which was approved by patient’s spouse and relatives. Housekeeping staff shared examples of forming positive relationship with patients’ spouses or relatives, who would approach them share their own experiences, and were encouraged by managers to take time to develop these relationships.

Relatives gave positive feedback about the staff and said they kind and caring. There was a welcoming private and comfortable visitors room areas to visit their family member with or with or supervision if individually assessed as required. The providers visiting policy emphasised maintaining relationships between patients, and their families and carers as people who were important to patients. Patients were also encouraged to spend time outside of the hospital during visits if possible.

The evidence showed an outstanding standard. The service treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The service took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

During a review of care records, we found the patients choices, goals and aspirations were reflected. The initial assessment ensured patients’ views, preferences, wishes and choices were confirmed and communicated regularly in safety huddles, MDT reviews so staff at all levels were aware. Staff looked to provide additional support and treatment for patients were possible and made referrals to other services, for example social care or the patients’ NHS local team. The service had attained a contract with a local GP surgery, because the local integrated care board (ICB) responsible for commissioning services to meet the health needs of local people did not agree a contract due to patients not being from the local area. The local GP contract allowed patients to make individual appointments at the surgery or for patients with more complex needs to attend a local onsite surgery.

The service worked collaboratively with community families, neuro rehabilitation teams, social workers and multiple agencies on discharge planning involving reducing patient’s anxiety and promote continuity of care.

Information about each patient’s equality and diversity needs and unique backgrounds was collected at assessment and used to develop individualised care and treatment plans.

The service created an environment which embraced patients and staff culture and adhered to the Equality Act 2010. Reasonable adjustments were made for patients by providing an accessible entrance to the service and lift to the main floors in the building, and recognising learning difficulties after a brain injury, included aids to support, processing information and trouble with language. For example, providing speech recognition aids or devices to alert staff when patients needed assistance.

Patients said they could be open and honest and were encouraged to share their cultures and backgrounds. Examples of these included patients being able to cook cultural meals and the service celebrating Black history month with a cultural event onsite were staff and patients shared food and wore clothes that reflected their culture. There was an onsite faith facility which included Wudu (ritual) washing facilities and accessible and digital formats of the main world religions.

We saw feedback from a review where a family member relative gave feedback that their family member had started to do more of the things they enjoyed, despite the challenges in engaging them. The patient had started to do more and developed positive relationships with staff who had persevered and got to know the patient’s individual challenges and needs.

Staff understood patients’ individual needs and told us how they promoted person centred care, and this included supporting activities people were interested in such as arranging visits to favourite places, facilitating cooking sessions and music.

Staff spent time with patients interacting and communicating effectively and supporting meaningful activity the patient enjoyed.

The evidence showed an outstanding standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

There was a range of facilities for patients to support their independence, choice and control. Patients could access the onsite facilities and had keys to their bedrooms to lock their bedroom doors. The only blanket restrictions were related to garden access due to the height of the fence and no smoking cigarettes on site. Patients were able to use the ward-based kitchens to make drinks, snacks and meals independently or with staff support, based on their individual needs. Patients had individual treatment, therapy and social activity plans based on their goals. Staff support was available to aid patients with escorted leave or support to access the local communities and visit families or places they were moving to. Staff were able to adapt activities to ensure they were appropriate to patients’ rehabilitation and recognising the potential for distress. Patients were able to access activities as a result, for example, offering more inclusive physical activities like walking, swimming, and accommodating individual choices. Therapists and support workers tailored activities to patients past interests, for example, gardening, cooking and music.

The service offered opportunities to be involved in the provider ‘Music 2 Empower’ initiative launched in October 2019, offering music therapy across the provider services. This offered patients opportunities to develop social relations and connectedness, as well as building confidence and self-esteem. Patients had been involved in creating music through writing lyrics, rapping and digital performance.

A booklet was co-produced with patients explaining on how agency staff should conduct themselves on the specialist a neuro-rehabilitation wards. This was introduced to help agency staff understand patient’s experiences of living in a care setting. In addition, the service linked in with the provider carer’s lead, to establish ‘a carer expert by experience’ role to work to liaise with family members or carers of patients. The service was in the process of starting a carers champion role.

In the summer of 2025 to celebrate the service’s first anniversary, a sports day and awards ceremony for patients, family members, carers took place and from this a visual reminder of the event was created and displayed in the service as well as other activities held at the service. The service also celebrated South Asian heritage month, Black history month, Eid and Diwali.

Patients and relatives told us how independence had been promoted and achieved. Where appropriate, patients could access community leave as soon as they were ready and assessed as ready to do so.

Staff knew how each patient preferred to be supported. An independent advocate visited the hospital two full days per week and then once a month did an extra day in one week. Independent Mental Health and Mental Capacity Act advocates were provided by the local authority through a referral process. The service also had a person with a lived experience who volunteered and visited the service and built relationships with patients and staff, and managers and staff promoted, and were positive about their and the advocate in providing and independent view of the service.

One to one psychology sessions took place with patients, the aim of these sessions was to monitor mood and wellbeing and to move to more independent living.

Staff described how they supported patients to make decisions daily. Where it was difficult to engage patients in therapeutic activities, efforts were made to find areas of interest the patient would respond to.

Staff supported patients to visit shops and facilities in the local town with the aim to increase their independence, choice and control.

Care and treatment plans with a rehabilitation focus were developed and evaluated at multi-disciplinary meetings and innovative ideas included the implementation of a visual discharge plan to be part of care-plan assessments and MDT meeting. Community meetings took place so patients could provide feedback and request changes to hospital routines and activities as required.

The evidence showed an outstanding standard. The service was exceptional in how they listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Patients told us there were enough staff to meet their needs and they did not usually have to wait when they required staff support.

Staff told us they had time to respond to patients’ immediate needs. Housekeepers told how they rescheduled their work tasks to suit the needs of patients. For example, if anyone was distressed or upset, any planned cleaning in that area would be postponed.

During our visit, we observed staff responding to patients’ needs in a timely manner, using calm, supportive de-escalation during a patient’s distress. Staff were trained in positive behaviour support (PBS) and safety intervention.

Staffing requirements were calculated and planned so enough staff with the right skills were available to patients. The service recently employed two new activity coordinators, and this has improved engagement with patients who were not regularly able to participate in community-based activities. Feedback from staff was that ward-based activities helped promote patient’s independence and doing things on the ward to keep patients interested in their care and treatment.

The service regularly gathered feedback from patients through the ‘You said We Did’ process, patient questionnaire boxes were placed around the service and regular community meetings took place. Through this consultation feedback was used to make positive changes. For example, the volunteer completed a monthly coproduced patients’ report about their experiences related to activities, the quality of food, the environment, staff, restrictive practice and safety. The volunteer also gave feedback to the registered manager or clinical lead following their visit, so matters raised by patients could be responded to and resolved quickly.

When concerns were identified staff responded to changing risks to and posed by patients and safety huddles, managers and MDT meetings to assess, discuss and escalate these concerns. When additional individual patient risks were identified, adjustments were put in place, to ensure the safety of all clients. This included additional support, such as increasing observation levels and offering relaxing and reviewing a patients mental and physical health.

The evidence showed an outstanding standard. The service consistently cared about and promoted staff wellbeing. Staff feedback was managers demonstrated exemplary support of their staff and encouraged staff to strive to enable staff deliver person-centred care.

Staff we spoke were very positive about the working environment of the service; they spoke highly of the support available from team leaders and higher management. They felt respected, supported and valued by leaders of the service.

Staff also told us how they had access to support for their physical and emotional health needs. Average sickness in the last 12 months was low at 2% and long-term absence at 0.4%. There was a collaborative approach to ensure that work was covered, and staff could access appropriate support through appraisals.

The service held wellbeing Thursdays when staff who had any health concerns issues or advice could drop in with the practice development nurse, who could check staff’s physical observations do an electrocardiogram (ECG), give advice for minor illness and give advice on management on healthy lifestyle choices. In addition, the practice development nurse and a colleague were mental health first aid trained. The service also offered staff trauma-focused peer support (TRiM) a system designed to help people who have experienced a traumatic, or potentially traumatic events.

Staff were encouraged to access additional training and were supported with career progression. For example, a recently appointed ward manager shared how the registered manager and clinical lead had mentored them over the last 6 months by creating more leadership opportunities for them to gain experience of managing a ward and team of staff. For example, a health care assistant was a registered nurse and had applied for a role at the service so they could gain more experience in mental health, before considering applying for a role in mental health or rehabilitation services. The staff member was positive about the learning and development opportunities they had experienced. The service also had a peer mentor, who was a staff member with lived experience, who had accessed formal training and provide support and role modelling for current patients of the service.

Staff told us morale was high, and staff were aware that patient numbers would increase, and support form leaders was consistent, and leaders had invested more time consolidate the staff team. Staff said the service was supportive with continued professional development. Staff were confident and motivated to improve outcomes for patients, they were clear about their roles and responsibilities.

Staff had access to supervision with their line managers. Staff wellbeing was promoted through training and support.