Cygnet Acer Clinic

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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

Caring- this means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity, and respect. At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement.

This meant people did not always feel well-supported, cared for or treated with dignity and respect. People did not always experience compassionate, person-centred care. People were not always treated with dignity and respect. Some patients told us their individual preferences were not always respected, and one patient reported that their cultural and religious needs were not consistently recognised or accommodated.

However, staff involved patients in multidisciplinary reviews and care planning to varying degrees, and patients had access to advocacy services to support them in expressing their views. Family members were generally positive about communication from the service and told us they were appropriately involved in discussions about care and discharge planning when consent had been provided.

We found a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to dignity and respect.

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 some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Thefive patients we spoke with provided negative feedback regarding their experiences of care and treatment. Patients felt staff were not always caring, compassionate or responsive to their needs and did not always provide the emotional support they required.

Our observations during the inspection did not consistently demonstrate a culture that promoted dignity, respect, and compassionate care. We observed limited therapeutic engagement between staff and patients throughout the inspection. During observations of communal areas at various times throughout the day, staff interactions primarily focused on completing tasks, such as observations, rather than providing emotional support or therapeutic intervention.

Staff did not always respect patients' preferences regarding who delivered their care and treatment. Two patients told us requests for staff of a particular gender were not consistently accommodated, and this increased their distress. Staff confirmed that patients' preferences regarding the gender of staff delivering care were not always accommodated. This meant staff did not consistently provide care in a way that respected patients' preferences and dignity.

The environment did not consistently promote patients' dignity. We observed unclean bedrooms and ensuite facilities, including blood contamination on bedroom walls and floors following self-harm incidents that had not been cleaned promptly. This did not support patients receiving care in a clean, dignified, and respectful environment.

However, staff maintained the confidentiality of patient information and there was culture of kindness and respect between colleagues from other organisations.

The evidence showed some shortfalls. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff did not consistently demonstrate an understanding of patients' individual cultural and religious needs. One patient told us staff did not always recognise or respect their cultural and religious needs. In addition, during the inspection, a ward manager told us that there were no patients on the ward with protected characteristics or specific cultural, spiritual or reasonable adjustment needs. Given the responsibilities of this role, this indicated that further assurance was needed to ensure staff had a consistent understanding of patients’ individual needs and how these should be identified and supported

This demonstrated that staff did not always have sufficient awareness of, or respond appropriately to, patients' individual beliefs, preferences, and values.

Whilst some care plans documented patients' cultural and religious needs, patients did not always experience these needs being fully understood or accommodated in practice. One patient told us they felt aspects of their religious needs were compromised due to difficulties accommodating their preferences regarding the gender of staff involved in their care. The service did not have a dedicated multi-faith room available for patients. Whilst prayer equipment and religious resources were available on request, the absence of a dedicated space reduced opportunities for patients to practice their faith in a private and supportive environment.

Staff did not always demonstrate that patients' strengths, aspirations, and personal goals were clearly reflected within care planning documentation. We found some care plans lacked sufficient individualisation and did not consistently identify patients' personal goals, strengths, or aspirations.

However, staff generally meet patients' communication needs. Information was available in accessible formats, and staff could access interpreting and translation services when required. For example, the service purchased translation equipment and arranged interpreter support to enable a patient whose first language was not English. This helped the patient participate fully in ward rounds and understand complex information relating to their care and treatment.

Staff considered patients' dietary requirements and preferences. Patients had access to food that met religious, cultural, and dietary needs, including halal options and arrangements to accommodate allergies and intolerances.

The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Patients told us that planned activities, escorted leave, and opportunities for meaningful engagement were not always available when they wanted or needed them. Some patients reported that escorted leave was delayed or rearranged due to staffing pressures. Patients also told us that activities were sometimes cancelled or did not take place as planned, which reduced opportunities for choice, independence, and recovery-focused engagement.

Patients did not always feel involved in decisions about their care to the extent they wished. Whilst some care plans demonstrated good patient involvement and reflected patients' preferences, we found examples where patient voice was limited and care plans lacked sufficient evidence of co-production. This reduced assurance that care and treatment consistently reflected what mattered most to individual patients.

Patients told us they did not always feel listened to when raising concerns or expressing preferences about their care. For example, some patients reported that preferences regarding the gender of staff involved in their care were not always accommodated, which increased their distress and reduced their sense of control over how care was delivered.

Staff supported patients to understand their rights under the Mental Health Act, and patients generally confirmed they were aware of their leave arrangements and rights whilst detained. Patients had access to advocacy services, and staff could explain how patients could obtain independent support if required.

Staff supported patients to maintain relationships with family members and those important to them. We observed family involvement within multidisciplinary reviews, and leaders demonstrated a commitment to involving families and carers in care planning and discharge discussions where appropriate.

Staff provided a programme of activities intended to promote independence, wellbeing, and recovery. These included physical activities, mindfulness sessions, sensory groups, arts and crafts, and access to community leave. However, patients consistently told us there was insufficient meaningful activity on the ward, and our observations reflected this feedback. During the inspection we observed patients spending prolonged periods in communal areas with limited meaningful occupation or therapeutic engagement. This meant opportunities to support independence, skill development, and recovery were not always fully realised in practice.

The evidence showed some shortfalls. The service had processes in place to seek and consider patients’ views, including through patient meetings, assessments and reviews. However, patients did not always feel their individual needs, concerns and preferences were fully understood or responded to in a timely way.

Staff did not always identify, assess, or respond to changing risks in a timely and effective way. We saw evidence of repeated self-harm, ligature incidents, cutting, and head banging. Despite the high frequency and recurrence of these incidents, we found limited evidence that effective action had been taken to reduce recurrence or strengthen risk management arrangements. For example, care plans and risk assessments did not consistently provide clear escalation guidance, post-incident management arrangements, or specific interventions to respond to increasing levels of risk.

Staff did not consistently respond to known risks through robust care planning. We found examples where risk management plans relied on generic interventions without clearly identifying what actions staff should take in response to deterioration, self-harm, refusal of food and fluids, ligature use or significant changes in mental state. This meant staff did not always have sufficient guidance to respond consistently to patients' immediate needs.

Staff did not always maintain environments that supported safe and responsive care. During the inspection we observed cluttered bedrooms, unclean bedroom and bathroom facilities and blood contamination following self-harm incidents that had not been cleaned promptly. Patients told us staff did not always respond quickly enough to concerns about their environment or provide sufficient support to maintain safe bedroom spaces. This increased the risk of harm and reduced assurance that emerging risks were identified and addressed effectively.

Patients and staff provided examples where staffing pressures affected the service's ability to respond promptly to patients' needs. Patients told us to escort leave, and planned activities were sometimes delayed or rearranged. During the inspection we also observed one occasion where a patient was unable to locate a qualified nurse for a prolonged period as both nurses were attending meetings.

The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Staff generally felt supported and valued by leaders and described positive working relationships within their teams. Staff spoke positively about the support available from colleagues and immediate managers, particularly during periods of increased patient acuity and following challenging incidents.

Staff were proud of the care they provided and remained committed to supporting patients despite the challenges associated with working in a high-acuity environment. Staff described a strong team ethos and demonstrated commitment to improving outcomes for patients.

Leaders recognised the impact that working in mental health services could have on staff wellbeing and provided access to occupational health and wellbeing support services. Staff confirmed they could access support for their physical and emotional wellbeing when required.

Managers provided staff with regular supervision and appraisal. Staff told us supervision provided opportunities to discuss clinical practice, wellbeing, professional development and career progression. Leaders also supported staff to access additional training and development opportunities relevant to their roles.

Staff sickness absence had been higher than usual in recent months; however, leaders told us absence levels remained below the wider organisational average. Leaders had implemented contingency arrangements to maintain staffing levels, including access to regional staffing support, bank staff, agency staff and on-call management systems.

Staff described opportunities for their achievements and contributions to be recognised through organisational recognition schemes and local initiatives.

However, some staff told us increasing patient acuity and changes to referral and admission processes had created additional pressures on the ward environment. Leaders were aware of these concerns and described measures implemented to support staff, including reflective practice, supervision and additional management oversight.