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 remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. 

Staff assessed patients’ physical and mental health, developed and reviewed care plans, and provided treatment in line with best practice. Multidisciplinary teams worked together to meet patients’ needs, and staff understood and fulfilled their responsibilities under the Mental Health Act and Code of Practice. 

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.

Although staff assessed people’s needs, assessment findings were not always translated into sufficiently detailed plans to support the effective management of identified health needs. 

We reviewed 5 care records during the assessment. Although staff completed comprehensive mental health and physical health assessments and regularly reviewed patients' needs, assessment information was not always translated into clear, up-to-date care planning documentation. Some care plans were repetitive and did not always clearly demonstrate progress towards recovery goals. We found examples where goals were repeatedly recorded as achieved but carried forward without clear evaluation of progress or identification of next steps. Some physical health care plans including those relating to asthma management and catheter care, lacked sufficient detail to guide staff's responses to identified risks. 

However, staff reviewed patients' needs regularly through multidisciplinary team meetings, ward rounds and ongoing clinical review. Leaders described how staff used information from incidents, observations, positive behaviour support plans, handovers and daily safety processes to identify changes in patients' presentation and adapt care accordingly. Staff demonstrated a good understanding of patients' individual needs and risks and were able to explain how support was adjusted in response to changes in presentation. 

Staff used assessment and review processes to understand patients' needs and support their recovery and rehabilitation journey. Care records showed that patients had individual goals relating to their recovery and future discharge, and staff worked collaboratively with patients to identify the support and interventions required to achieve these goals. For example, one patient's plan identified their wish to move towards independent living and discharge from hospital, with specific actions including occupational therapy input, progression of community leave, development of self-management skills and liaison with external agencies to support future placement planning. 

Staff 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. 

Staff delivered care using a multidisciplinary rehabilitation model which focused on supporting patients to develop skills, increase independence and work towards discharge.  

Staff provided a range of therapeutic interventions appropriate to the patient group. Patients had access to medication, psychological therapies, occupational therapy interventions, and rehabilitation activities that promoted independence and social inclusion. Occupational therapists used recognised evidence-based models, including the model of human occupation and the Vona du Toit Odel of creative ability, to assess patients' needs and inform treatment planning.  

Staff used sensory modulation approaches to support emotional regulation and wellbeing. Patients accessed a range of therapeutic and community-based activities, including sensory activities, cooking, baking, community skills groups, physical activities, and opportunities to engage in projects within the local community. Staff adapted interventions to meet patients' individual needs, abilities, and levels of motivation. 

Patients had access to physical healthcare and specialist services when required. The multidisciplinary team included nurses, doctors, psychologists, occupational therapists, pharmacists, and social work input, enabling the service to meet patients' diverse mental health, physical health, and rehabilitation needs. Leaders described strong multidisciplinary working, with clinicians regularly involved in patients' day-to-day care, treatment reviews, and discharge planning. 

The service was also moving towards a formulation-based approach to risk management, focusing on patients' strengths, protective factors, and individual circumstances in line with current best practice guidance. 

Mental Health Act 

Staff compliance with Mental Health Act training was at 93.9% Staff demonstrated a good understanding of the Mental Health Act 1983, the Mental Health Act Code of Practice, and the guiding principles. Staff had access to Mental Health Act policies, procedures and administrative support and knew who to contact for advice when required. 

Records showed that staff explained patients' rights under the Mental Health Act in a way they could understand, repeated this when required and documented these discussions appropriately. 

Section 17 leave formed an important part of patients' rehabilitation and recovery plans. Some patients told us they did not always feel able to access leave as they would have liked. However, staff and leaders reported that leave was not routinely cancelled due to staffing pressures, and we did not identify evidence to suggest that authorised leave was being restricted inappropriately. 

Staff stored detention papers, Section 17 leave documentation, and associated records appropriately and these were accessible to staff when required. Where applicable, care records referred to Section 117 aftercare arrangements as part of discharge planning. 

The service completed regular Mental Health Act audits to monitor compliance with legal requirements and identify opportunities for improvement. Overall, staff discharged their responsibilities under the Mental Health Act and Code of Practice well.

Staff worked well across their teams and services to support people. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services. 

Staff worked with a range of external agencies and professionals involved in patients' care. Leaders described collaborative working to support discharge planning, access to community opportunities and the development of rehabilitation pathways. Relationships with partner agencies were positive, although there were opportunities to strengthen collaborative discharge planning and further improve progression towards discharge for some patients. 

Feedback from stakeholders was mixed. Safeguarding partners described effective communication regarding safeguarding concerns and reported that staff regularly sought advice in relation to safety planning. They also reported that the provider worked collaboratively with external agencies and involved patients appropriately in safeguarding processes. Advocacy services described the multidisciplinary team as responsive and reported that staff were receptive to feedback and patient requests. 

However, some stakeholders raised concerns regarding discharge planning and progression. One commissioning stakeholder reported challenges in achieving a shared understanding of realistic discharge options and described occasions where progress towards discharge had stalled. However, stakeholders confirmed that the service proactively invited them to meetings and shared information promptly when requested. 

The service supported patients to manage their health and wellbeing to maximise their independence, choice, and control. The service supported patients to live healthier lives and, where possible, reduce their future needs for care and support. 

Staff supported patients to improve and maintain both their physical and mental health. Patients had access to routine physical healthcare monitoring, health screening programmes, and health promotion initiatives. The service promoted a different health topic each month and provided information and education to patients on subjects including oral and dental health, breast screening, healthy eating, physical activity, cervical screening, and smoking cessation. Staff also discussed health promotion topics through wellbeing sessions and individual support. 

Patients were encouraged and supported to make healthier lifestyle choices. Staff promoted healthy eating and provided opportunities for patients to develop skills relating to food preparation and nutrition. Staff supported patients to attend physical activities and participate in therapeutic groups designed to improve both physical and mental wellbeing. 

Patients were supported to increase their independence through graded community access, engagement, and development of daily living skills. The rehabilitation programme focused on helping patients develop the skills required for greater independence. Patients had access to occupational therapy interventions, community skills groups, and opportunities to participate in activities within and outside the service.  

Staff used sensory modulation approaches to help patients understand and manage their emotional wellbeing. Patients had access to a range of sensory and therapeutic activities, including physical exercise, community activities, cooking, baking, creative activities, and opportunities to engage with local community initiatives. These interventions supported patients to develop coping strategies, improve self-management skills, and increase their confidence. 

Leaders described rehabilitation as being centred on individual goals and supporting patients to achieve the greatest level of independence possible. Staff reviewed progress regularly and adapted interventions to reflect patients' changing needs, abilities, and aspirations. 

The service routinely monitored people’s care and treatment to support ongoing review and improvement. 

Staff used a range of outcome measures to monitor patients' progress throughout their admission. For example, occupational therapists completed the Activity Participation Outcome Measure (APOM) following a period of assessment and repeated this during Care Programme Approach reviews to monitor progress in areas including use of free time, work ability, social ability and personal management. Staff also used occupational therapy assessments, sensory assessments, and multidisciplinary outcome measures to monitor progress and inform care delivery. Staff completed assessments on admission and discharge which measured changes in areas including mental state, medication concordance, use of leave and levels of risk. Staff used this information to review patients' progress throughout their admission. 

Some external stakeholders expressed concerns regarding patient outcomes and progression towards discharge. However, the service had systems in place to monitor patients' progress and review care and treatment on an ongoing basis. 

The service told patients about their rights around consent and their rights under the Mental Health Act and supported them to understand and exercise those rights. Staff took practical steps to support patients to make their own decisions wherever possible. Care records showed that patients were involved in decisions about their care, treatment, and rehabilitation goals. Staff sought consent before providing care and treatment and respected patients' views, wishes, and preferences. 

Where there were concerns about a patient's ability to make a particular decision, staff completed and recorded mental capacity assessments. These assessments were decision-specific and reflected the principles of the Mental Capacity Act 2005. Records demonstrated that staff considered patients' ability to understand, retain, weigh-up and communicate relevant information when assessing capacity. 

When patients lacked capacity to make a specific decision, staff made decisions in their best interests. Records showed that staff considered the person's wishes, feelings, values, and circumstances when making best interest decisions and involved relevant professionals and others where appropriate.