Cygnet Acer Clinic

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive- this means we looked for evidence that the service met people's needs. At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant people's needs were not always met. People's individual needs, preferences and circumstances were not always responded to consistently. Patients told us there was not enough meaningful activity available to them, activities were sometimes cancelled and opportunities for therapeutic engagement were limited. Our observations during the inspection supported this feedback, as we saw patients spending extended periods in communal areas with limited meaningful interaction or activity. The service did not always meet patients' cultural, religious and social needs.

Staff could access interpreters, translate information and spiritual support when require, but staff knowledge of patients' individual cultural and religious needs was not always consistent.

However, staff supported patients to maintain contact with family members and carers, access advocacy services and receive information in formats that met their communication needs. Staff provided dietary options and healthcare interventions designed to meet the needs of the patient group. Staff worked collaboratively with external agencies and community services to support discharge planning and continuity of care.

We have not awarded this service a score for Responsive.

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

The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices, and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Patients did not consistently feel listened to, and several described a service that felt task-focused rather than centred around their individual needs and preferences. This reduced assurance that people felt at the heart of how their care and treatment was delivered.

Care plans did not consistently demonstrate that patients' needs, preferences and aspirations were reflected in care planning. We found examples where care plans contained generic interventions and lacked sufficient individualisation. Some care plans contained limited evidence of patient voice and did not clearly demonstrate how patients had been involved in planning their care or how care would be adapted if their needs changed. This meant staff could not always demonstrate that care delivery reflected patients' individual preferences, strengths and long-term goals.

Care plans did not consistently reflect patients' physical, emotional, social and psychological needs. For example, we found limited evidence of personalised coping strategies, trauma-informed interventions and meaningful therapeutic guidance within crisis plans. This reduced assurance that care planning fully reflected patients' individual circumstances and supported them to make informed choices about their care and treatment.

Patients did not always feel empowered to influence aspects of their care and treatment. Feedback from patients indicated they did not consistently experience care that felt collaborative or personalised, despite systems being in place to support patient involvement.

However, staff involved patients in multidisciplinary reviews, ward rounds and discharge planning processes. We observed and reviewed evidence that patients were encouraged to participate in discussions regarding their care and treatment and staff sought patients' views regarding decisions that affected them.

Staff made reasonable adjustments to support patient involvement where required.

The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff worked collaboratively with a range of internal and external professionals to support continuity of care. We found evidence of effective multidisciplinary working and observed positive collaboration between nursing staff, medical staff, psychology, occupational therapy and other professionals involved in patients' care and treatment.

Staff shared information effectively through handovers, multidisciplinary meetings and ward rounds. Records demonstrated that relevant information was communicated between teams to support safe and coordinated care.

Staff supported patients to maintain contact with family members, carers 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 arrangements where appropriate and with patient consent.

The service worked with care managers, community mental health teams and other agencies to support discharge planning and continuity of care. Staff were proactive in working with external services to support patients’ needs. However, the service did not have dedicated social work provision. Staff reported that some patients had complex social care needs, and progress with discharge planning was sometimes affected by challenges accessing external community and social care support. The absence of dedicated social work provision meant the service had less internal capacity to provide additional support with some patients’ wider social care needs and discharge planning.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff provided patients with appropriate information in ways that met their individual needs and supported them to understand their care, treatment and rights.

Staff identified and responded to patients' communication needs appropriately. The service complied with the Accessible Information Standard and staff demonstrated an understanding of the need to adapt communication to meet individual requirements.

Staff made reasonable adjustments to ensure patients could access information in a format they could understand. For example, interpreter services and translation technology were available and used to support patients whose first language was not English. We reviewed evidence that interpreter support had been arranged for ward rounds and discussions regarding care and treatment to enable patients to participate fully in decisions affecting them.

Staff ensured patients received information regarding their rights under the Mental Health Act and records demonstrated that rights were explained and revisited when required. Patients had access to independent advocacy services.

Staff understood patients' communication needs and demonstrated a commitment to removing barriers to communication. Information could be provided in different formats, and staff were able to access additional support when required to ensure patients could understand information relating to their care, treatment and rights.

Whilst information regarding advocacy services was not prominently displayed on the ward at the time of inspection, staff and patients were aware of how advocacy support could be accessed.

The evidence showed some shortfalls.

The service had processes in place to support patients to provide feedback, raise concerns and make complaints. Patients had access to advocacy services, and staff understood how to support patients to access independent support. However, some patients did not always feel fully involved in decisions about their care or understand what changes had been made as a result of their feedback.

People did not always feel their views, concerns, and experiences influenced the care and treatment they received. Patients knew how to raise concerns and complaints. Information about complaints processes was available, and patients could raise concerns through staff, ward rounds, advocacy services, community meetings, and formal complaints procedures.

However, feedback from patients during the inspection and themes identified through complaints records indicated that people did not consistently feel listened to when they raised concerns. Several patients told us they had raised concerns regarding therapeutic engagement, activities, staffing, and aspects of their care but did not feel meaningful changes had followed.

Complaint records demonstrated recurring themes relating to communication, staff attitudes, therapeutic engagement, family involvement, management of risk and patient safety. Several complaints described patients and relatives feeling that concerns raised had not been fully addressed or responded to in a way that improved people's experiences of care.

However, staff understood how to support patients to raise concerns and could explain the complaints process. Staff received feedback following complaints investigations and leaders discussed learning through governance processes and team meetings. Patients had access to independent advocacy services, and staff understood how to support patients to access independent support when raising concerns or complaints.

The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff ensured that patients could access the care, support, and treatment when they needed it. Staff made reasonable adjustments to support individual needs who required it, for example when patients did not speak English as their first language. Medical cover was available day and night, and a doctor could attend the ward promptly in an emergency. The hospital was within a reasonable distance of the local acute hospital.

Staff planned for discharge effectively, liaising with care managers and community mental health services to support continuity of care. Leaders and staff were alert to discrimination and inequality and took steps to ensure that no patient was disadvantaged due to wider societal, organisational, or individual factors. Patients had equal access to care, treatment, and support, with legal equality and human rights requirements upheld, including consideration of protected characteristics and the provision of reasonable adjustments.

The evidence showed some shortfalls. Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Patients did not consistently feel that their views were heard or fully reflected in service development. Some patients with protected characteristics under the Equality Act reported that their needs were not always fully considered or consistently met. As a result, these patients did not always feel confident that the service acted on their feedback or fully understood their individual needs.

The service did not fully identify or respond to barriers that may affect equality of experience or outcomes for all patient groups. For example, the service did not have a multi-faith room available, which limited the ability to fully support the spiritual and religious needs of all patients on site.

Despite this, staff were trained in equality, diversity, inclusion, and human rights, which supported their understanding of how to recognise and respond to inequality and discrimination. Staff promoted opportunities for patients to share their views and raised concerns.

Patients had access to advocacy services, which they valued and used to support them in expressing concerns, including issues related to discrimination or inequality.

Staff did take some steps to support equity in care and reduce barriers to access. For example, staff made reasonable adjustments for patients who did not speak English as a first language and supported dietary and cultural requirements where possible.

The evidence showed some shortfalls. People were not always supported to plan important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Planning for the future was not always clearly evidenced in care records because care plans did not consistently reflect how patients’ wishes, feelings, and longer-term goals were considered when planning ongoing care and discharge. In some cases, it was difficult to see how discharge planning linked to broader future planning or how patient outcomes informed forward planning.

However, staff supported patients to make decisions about their care and treatment and future planning, including discussions around advance decisions such as do not attempt cardiopulmonary resuscitation (DNACPR) where appropriate. Staff involved relevant healthcare professionals and partner agencies in planning care and treatment for patients with complex needs.