Cygnet Paddocks

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 the best available evidence.

This is the first assessment of this registered service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The service team included or had access to the full range of specialists required to meet the needs of patients in the service. Staff from different disciplines worked together as a team to benefit patients.

Staff worked to advocate for patients during the admission process and demonstrated empathy and support during the process.

We have not awarded this service a score for Effective.

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

The evidence showed an exceptional standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients’ health care, wellbeing and communication needs were assessed and reviewed. Care and treatment was delivered to meet patients’ individual preferences and in line with legislation and current evidence-based good practice and standards. Staff worked effectively across the service and were motivated to achieve good outcomes, which were monitored to ensure they met both clinical and patient’s expectations, for example, assessing patients for environmental risk. The service used validated clinical tools such as functional assessments, cognitive screens, risk tools, health of the nation outcome scales (HoNOS), functional independence measures, sensory profiles and behaviour analyses.

Were patients had limited communication the service used a structured pain-assessment tool the disability distress assessment tool (DISDAT) to assess and monitor patient’s level of pain.

Patients said staff worked together to provide the care they needed, which included input from therapy leads such as the occupational therapist, psychiatrist, dietician, speech and language therapist, physiotherapist and psychologist as well as nursing staff. They told us their care and treatment was discussed regularly at the MDT’s held.

Staff described the process of assessment and how each staff team were involved and communicated with each other regarding rehabilitation plans. Risk assessments were developed, and these included physical risks such as personal emergency evacuation plans for staff to follow in the event of an emergency such as a fire. Mobility support needs and use of equipment in a safe way was also recorded. These included promoting the patient’s independence and considering their comfort and preferences.

Staff assessed the physical and mental health of all patients on admission to the hospital. Patients had their health, care, wellbeing and communication needs assessed and evaluated. Records were maintained and updated accordingly. Any risks identified were also assessed and risk management plans implemented.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

During the assessment we saw evidence that people’s needs were met in line with National Institute for Health and Care Excellence (NICE) guidance and offered a range of therapies to support rehabilitation. Staff were experienced, qualified and enthusiastic about the service they provided and developed their knowledge through accessing additional training.

The service ensured that patients had good access to physical healthcare, and clients were registered with a local GP to support access. The clinical lead led the relationship with patients GP’s and coordination of hospital appointments and treatments.

The service completed regular clinical audits, which were structured to ensure that professional, legal and organisational standards were followed. The service was responsive when areas of good practice or improvements were identified, which informed staff’s supervision and training, to ensure staff were supported and developed.

Staff received a comprehensive induction, and bank or agency staff received a concise version of the induction to ensure they had a good understanding of their role and responsibilities in the organisation.

Staff development requirements and opportunities were monitored through appraisal and allowed staff to feedback on how managers could support their personal development goals.

In addition to this, therapies staff attend a monthly clinical supervision, facilitated by an external clinical supervisor, which allowed clinical practice to be reviewed collectively. Individual clinical supervision was also available internally through the clinical lead or specified lead therapist. In addition, psychologist reflective practice sessions were available to staff.

The MDT included clinical, medical and therapists staff. The team consisted of a consultant clinical neuro psychologist, occupational therapist, physiotherapist, speech and language therapist and specialist dietitian, who used the National Institute for Health and Care Excellence (NICE) guidance for patients with an acquired brain injury. For example, we saw in patient care and treatment records, the occupational therapist used the patient categorisation tool (PCAT) used to categorise the complexity of a patient's needs and referral to an appropriate rehabilitation setting. In addition, rating scales and checklists included the rehabilitation complexity scale (RCS) used to assess the level of complexity of a patient's condition. And complex needs checklist, (CNC) used alongside other tools, to flag specific complex needs that require specialist input.

The speech and language therapist used NICE NG236 stroke rehabilitation in adults for screening of communication, onward referral for further assessment, providingindividualised therapy for specific impairments like aphasia (a language disorder caused by damage to the brain) and help patients’ use and enhance their remaining communication abilities.

Other NICE guidance used by clinical, medical and therapist staff included clinical NICE NG211, rehabilitation after traumatic injury, which emphasised starting rehabilitation as soon as possible after the injury. NICE NG252, October 2025, rehabilitation for chronic neurological disorders including acquired brain injury, which setsout recommendations for the design and delivery of neurorehabilitation services. The service was using this guidance to continue to develop the service. And NICE NG211, rehabilitation after traumatic injury, which covered the general principles of rehabilitation following traumatic injury, including the importance of a multidisciplinary team approach

Patients and relatives told us about their goals and aspirations and felt they were being supported to achieve these.

Staff told us they received the training and support required to provide evidence-based care. The multidisciplinary team developed treatment plans for each patient such as positive behaviour support plans to provide long term support. Staff described how weekly interventions based on cognitive behaviour therapy had resulted in significant improvement in the quality of life for a patient who was about to be discharged from the hospital.

Staff had training and professional qualifications relevant to patient’s needs. Regular checks were carried out to ensure they were correctly registered and fit to practice. They were able to describe relevant policies and procedures and evidence-based care and treatment being delivered.

The provider had a policy around the management of behaviour displayed when a patient was distressed. This included potential causes of distress; the roles and responsibilities of staff; ongoing risk assessment and documentation requirements. The provider referenced best practice, including department of health guidance positive and proactive care: reducing the need for restrictive interventions (Department of Health 2014), and NICE ‘the short-term management of violence and aggression in mental health’ 2015.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure concise information was shared through the assessment, review and discharge process when referring, transferring and moving patients between different services.

Patients had positive relationships with staff across the different teams. Staff were supportive of each other and communication was good. Every team and department was patient focused. We observed an MDT and discussions about patients was positive and communication between teams was good. Catering and housekeeping staff told us communication with hospital staff was good and they worked together. Feedback from commissioners was that the MDT improved over the last year and became more cohesive, which impacted positively on patient care. The MDT were described as proactive and flexible in addressing issues of care provision, though this was likely to improve with the appointment of a medical director whose employment would start in early 2026.

Staff from each ward attended the daily safety huddle and communicated any changes related to risk or planned activities for the day. Communication was positive and effective. Each team were motivated to achieve safety and wellbeing for patients and understood their roles and responsibilities.

All staff attended training about safeguarding and restrictive interventions. A range of daily, weekly and monthly meetings took place to support effective communication between teams.

The evidence showed a good standard. 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 saw patients were supported to us the outdoor space at the service, walk to local shops and cafés and into the local town with members of the therapy team, or unescorted. A relative told us the service acted regarding physical health issues and promoted a healthy diet. Another relative told us access to healthcare such as doctors was good. On Sorrel ward was a well-equipped gym, which contained a treadmill, recumbent exercise bike and parallel bars.

Staff knew and understood patients’ individual needs and health aspirations and described how they supported them to achieve these.

Staff promoted and supported patients with healthy eating and smoking cessation and exercise through their GP. Staff encouraged patients to keep hydrated, and patients were also encouraged to go outside for fresh air and / or activities as and when possible. Patients had access to healthcare support and staff contacted emergency services when required to.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service used evidence-based good practice and standards to monitor patients’ progress and identify when referral to other specialist services or additional therapeutic support was needed to support patients. Wellbeing checks were completed using national early warning scores version 2 (NEWS2), a scoring system used by healthcare professionals to assess a monitor patient's health condition and take appropriate action if concerns were identified.

Relatives told us they were involved and updated about care plans, changes or caring interventions.

Staff described how therapy and person-centred care planning had improved patients’ outcomes and increased independence and abilities. We noted that some patients were ready for discharge and had reached their rehabilitation capacity and were experiencing some delays in securing the next placement or community support.

The psychiatrist, therapy leads, and nurses worked with patients to set goals, and these were monitored and evaluated during multidisciplinary team (MDT) meetings held monthly. Patients’ care and treatment was continuously monitored. Outcomes were positive, consistent, and met both clinical expectations and the expectations of patients.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Patients received information about the therapeutic pathway and therapies available in the service. As part of the preadmission assessment the service clarified individual patient’s capacity to care and treatment. This included reviews of legal frameworks, for example the Mental Health Act (MHA) 1983 and Mental Capacity Act (MCA) 2005 to identify legal frameworks to care and treatment to make sure these were up to date and patients understood their rights.

We reviewed 5 care records during the assessment which showed evidence that a patient’s capacity to consent was considered. This was completed as part of the initial assessment.

Staff understood their roles and responsibilities under the MHA and MCA.

We observed staff supported people in the least restrictive way by seeking consent to support then with personal care and medicine administration.

Staff understood the importance of ensuring patients needed to understand what they were consenting to around their care and treatment.

Within clinical notes it was evident that staff had taken the patient’s views and wishes into account, where possible, when planning their care. Staff made every effort to relay information to individual patients in a way they would understand. Where required, the staff team had made decisions in line with the requirements of the MCA. This had included recording discussions with family members or carers, where appropriate.

Staff used the least restrictions where possible when anticipating, de-escalating and managing distressed behaviour or emotional reaction. They used restraint only after attempts at de-escalation had failed. Relatives told us staff used the least restrictive methods when managing risk.