Cygnet Acer Clinic

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 our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

People did not always receive care and treatment that was supported by clear, personalised care planning. Care plans, risk assessments and crisis plans did not consistently provide staff with sufficient guidance to manage risks, support patients during periods of crisis or demonstrate how outcomes were being monitored and reviewed.

However, staff completed mental and physical health assessments following admission and patients had access to a range of evidence-based interventions, including psychological therapies, occupational therapy and physical healthcare services. Staff used recognised clinical outcome measures to assess needs, monitor progress and evaluate treatment outcomes. The multidisciplinary team included a range of professionals with the skills and experience required to meet patients' needs. Staff worked collaboratively to review care and treatment, and patients were generally involved in multidisciplinary reviews and discharge planning. Staff demonstrated a good understanding of the Mental Health Act and Mental Capacity Act and supported patients to access advocacy services when required.

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 some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing, and communication needs with them.

We reviewed four care records, including care plans, risk assessments and crisis plans. Staff did not consistently ensure that care plans, risk assessments and crisis planning documentation provided sufficient guidance to support safe and effective care.

Staff did not ensure risk assessments were sufficiently individualised. For example, care plans contained generic interventions such as "engage in 1:1", "offer PRN" and "use coping strategies" without specifying which coping strategies should be used, when patient’s experienced distress or how staff should respond to changes in presentation. This meant staff did not have clear guidance to manage identified risks.

Staff did not ensure crisis plans provided meaningful guidance to support patients during periods of deterioration. This meant staff did not have clear guidance to manage risks during periods of crisis.

Staff did not consistently assess and plan for physical healthcare risks. For example, one patient had a catheter in situ without a detailed catheter care plan or risk assessment outlining monitoring requirements, signs of deterioration, escalation arrangements or staff responsibilities. This increased the risk of physical health deterioration and avoidable harm.

However, staff had completed mental health and physical health assessments following admission and some records demonstrated patient involvement in care planning.

The evidence showed some shortfalls. The service did not always plan and delivered people’s care and treatment with them, including what was important and mattered to them. However, staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Care planning and risk management arrangements supported the delivery of care; however, improvements were needed to ensure they were consistently personalised and effective. We reviewed four care records and found examples where risk management interventions were generic, crisis planning was incomplete, and records did not always demonstrate how the effectiveness of interventions was reviewed and updated.

The service had effective multidisciplinary processes in place, with staff regularly reviewing patients’ progress, risks and treatment needs through MDT meetings and ward rounds. However, individual care records did not always clearly reflect patients’ specific risks, needs, preferences and support requirements. This meant that staff did not always have clear, personalised guidance on how to respond to individual patient risks and changing needs

The multidisciplinary team included a range of professionals with the skills and expertise required to meet patients' needs, including psychiatrists, nurses, psychologists, occupational therapists, pharmacists, dietitians and peer support workers. The service did not have dedicated social work provision. Staff reported that some patients had complex social care needs and that discharge planning had been delayed on occasions due to difficulties accessing appropriate social work support and community-based services. The delays were related to challenges in accessing external community provision and were not solely within the control of the service. However, the absence of dedicated social work input meant the service had limited internal social care support available to help coordinate complex social care needs and support timely discharge planning.

Staff ensured patients had access to physical healthcare services and specialist advice when required.

Mental Health Act

Staff understood their responsibilities under the Mental Health Act (MHA) and generally applied the Act in accordance with the Code of Practice.

More than 90% of staff had completed Mental Health Act training. Staff demonstrated a good understanding of the Mental Health Act, the Code of Practice and its guiding principles. Staff had access to Mental Health Act administrators, administrative support and legal advice when required. Leaders maintained policies and procedures that reflected current legislation and guidance allowing staff to access local Mental Health Act policies and the Code of Practice when needed.

Staff explained patients' rights under the Mental Health Act and records demonstrated these discussions were repeated and reviewed as required. Staff stored detention paperwork and associated documentation appropriately and staff requested Second Opinion Appointed Doctor (SOAD) reviews when required. The service displayed notices informing informal patients of their right to leave the ward freely. Care records referred to Section 117 aftercare arrangements where appropriate.

Patients had access to Independent Mental Health Advocacy (IMHA) services, and staff and patients told us they understood how to access advocacy support. However, feedback received from the advocacy service indicated they had received no referrals from the ward. In addition, there was limited information regarding advocacy services displayed on the ward at the time of our inspection. Leaders told us information boards had recently been removed following incidents of aggression and had not yet been reinstated.

Staff generally supported patients to access Section 17 leave when authorised. During the inspection, some patients told us that there had been occasions when their leave was delayed due to staff being required to respond to incidents or support other patients on the ward.

Leaders completed regular Mental Health Act audits and demonstrated oversight of Mental Health Act processes.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked effectively with colleagues, partner organisations and other services to support continuity of care and treatment.

Staff held regular multidisciplinary team meetings and ward rounds to review patients' progress, risks and treatment needs. Staff shared information about patients’ needs effectively during handovers and team meetings.

Staff worked collaboratively with professionals across the service, including medical staff, nursing staff, psychologists, occupational therapists and pharmacy staff. Staff described positive multidisciplinary working, and we observed effective multidisciplinary discussions during ward rounds and patient reviews.

Staff maintained effective working relationships with teams across the wider organisation and worked collaboratively with external professionals and agencies involved in patients' care. This included care coordinators, community mental health teams, commissioners, local authorities, GPs and other healthcare providers where required.

The evidence showed some shortfalls. The service did now always effectively support people to manage their health and wellbeing to maximise their independence, choice, and control.

Staff did not consistently support patients to live healthier lives, promote wellbeing or maximise opportunities for recovery and independence.

Many patients told us they did not feel supported to live healthier lives whilst in hospital. Patients described limited meaningful activity, long periods with little to do on the ward and insufficient therapeutic engagement from staff. Patients told us this negatively affected their wellbeing, recovery and motivation.

Our observations were consistent with this feedback. We observed patients spending prolonged periods congregating in communal areas with limited evidence of meaningful activity, stimulation or therapeutic engagement. Staff often missed opportunities to engage patients in supportive conversations or recovery-focused interventions. Interactions were frequently task-focused rather than therapeutic. This meant patients did not always receive support to maximise their health, wellbeing and independence.

The service had an activity timetable that included a range of opportunities intended to support wellbeing and recovery, including physical activities, mindfulness sessions, sensory groups, arts and crafts and beautician appointments. However, whilst the programme appeared comprehensive, patients' experiences and our observations did not consistently demonstrate that patients benefited from meaningful engagement and therapeutic activity in practice.

Staff told us patient engagement varied depending on acuity levels, incidents occurring on the ward and the needs of the patient group. Whilst activities were available, staff did not consistently ensure patients were meaningfully engaged in activities that promoted recovery, wellbeing and healthier lifestyles.

The evidence showed some shortfalls. 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.

Care records did not consistently demonstrate how outcomes were evaluated or how the effectiveness of interventions were measured over time. In most of the records we reviewed, care plans lacked clear outcome measures, evaluation, or evidence of review. This meant staff could not always demonstrate whether interventions were effective in reducing risk, improving wellbeing, or supporting recovery. The absence of meaningful evaluation reduced assurance that care and treatment plans remained responsive to patients' changing needs and circumstances.

Patient feedback regarding whether staff supported them to achieve positive outcomes was mixed. Whilst some patients described improvements in independence and daily living skills, others told us they did not always feel supported to achieve their recovery goals or maximise their quality of life.

However, staff used a range of recognised clinical assessment and outcome measures to assess needs, monitor progress, and evaluate treatment outcomes. These included the Model of Human Occupation Screening Tool (MOHOST), Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Clinical Outcomes in Routine Evaluation-10 (CORE-10), DIALOG and Activities of Daily Living (ADL) assessments.

Staff used the Global Assessment of Functioning (GAP) assessment tool on admission and discharge to measure changes in patients' mental state, medication concordance, use of leave, and levels of risk. Staff also used DIALOG to assess patients' satisfaction with treatment and quality of life outcomes. The DIALOG assessment tool is a standardized tool used in mental health care to assess a patient’s satisfaction with various aspects of their life and treatment. These tools supported staff to monitor patient progress and evaluate the effectiveness of care and treatment provided during admission. Staff routinely monitored patients' health, wellbeing, and recovery through multidisciplinary review processes.

Staff understood their responsibilities under the Mental Capacity Act 2005 and supported patients to make decisions wherever possible.

Staff took practical steps to enable patients to make their own decisions and involved patients in decisions about their care and treatment. Where patients may have had impaired mental capacity, staff completed and recorded capacity assessments appropriately. Staff assessed capacity on a decision-specific basis and records demonstrated that staff considered capacity in relation to significant decisions.

Where patients lacked capacity to make a specific decision, staff made decisions in patients' best interests. Records demonstrated that staff considered patients' wishes, feelings, values, culture and personal history when making best interest decisions.

Staff demonstrated a good understanding of the Mental Capacity Act and its principles. Mandatory training compliance for the Mental Capacity Act exceeded 90%, providing assurance that staff had received appropriate training to support the application of the Act in practice.