Cygnet Elowen Hospital

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• 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 patients’ care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of patients’ care, treatment and support did not always achieve good outcomes or was inconsistent.

Gaps in specialist eating disorder support, including limited psychology input and inconsistent therapeutic engagement during the early period after the service opened, reduced the effectiveness of care for some existing patients. Patients’ rights around consent were not consistently respected, Mental Health Act administration had previously been problematic.

However, patients’ needs were assessed well, and comprehensive assessments were used to inform care planning. Staff supported people to manage their health and wellbeing and encouraged them to live healthier lives by promoting independence, skill development and engagement in meaningful activities. Staff used recognised outcome measures and national guidance to monitor progress and inform care, and there was evidence that patients were supported to make improvements in their health, skills and quality of life.

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.

Staff carried out comprehensive assessments of patients’ needs, considering their physical health, mental health, sensory, social, and communication needs. These assessments informed the development of care plans and were completed by staff with the appropriate skills and experience. Staff took a strengths-based and trauma-informed approach to understanding patients’ needs.

Staff involved patients as much as possible in their assessments. Where needed, staff provided additional support to enable involvement, including adapting communication or involving advocates.

Staff involved families, carers, and other professionals in assessments and reviews where appropriate. Relatives told us they felt included throughout the process. Staff regularly reviewed and updated assessments to ensure they remained current and reflected patients’ needs and progress. They maintained clear and comprehensive care records, which supported ongoing review and demonstrated appropriate action in response to any changes.

Staff did not always provide consistent specialist support for disordered eating, and this affected some patients’ experience of care. Some patients told us that earlier in their admission staff lacked confidence and experience in supporting eating disorder care, which had an impact on their treatment. Patients also described periods where dietary support did not fully meet their needs, and while staff said they had enough time to support patients during mealtimes, feedback about post‑meal support was mixed, which is an important part of eating disorder care. Most of these gaps had been addressed by the time of the inspection, but improvements were still being embedded.

At the time of our inspection all staff completed MHA training, and staff demonstrated a good understanding of the Act, the Code of Practice and guiding principles. Staff had access to MHA administrative support and legal advice, knew who their MHA administrators were, and could access up‑to‑date local policies and the Code of Practice. Patients had access to independent mental health advocacy, and staff explained patients’ rights clearly, repeated this as required and recorded discussions appropriately. Section 17 leave was facilitated when authorised, second‑opinion appointed doctor input was sought when required, detention paperwork was stored correctly and accessible, informal patients were informed of their right to leave, and care plans referred to Section 117 aftercare where applicable. Section 17 leave allows patients who are detained under the Mental Health Act to leave the hospital for a specified period, for example to attend appointments or activities, subject to conditions agreed by the clinical team to maintain safety.

Staff and leaders understood current legislation, national standards and evidence‑based guidance relevant to the service and applied these in practice. Staff delivered care in line with this guidance and involved patients in planning how it was reflected in their care. Staff supported patients to meet their nutritional and hydration needs, with access to specialist dietetic input and care plans designed to support recovery from disordered eating.

When the hospital first opened, the multidisciplinary team (MDT), which should include nurses, support workers, psychologists, doctors, dietitians and other specialists, was not fully established. As a result, some patients did not have timely access to the full range of specialist support, particularly psychological and eating disorder expertise. This led to inconsistent therapeutic input and disrupted continuity of care, which, for some patients, negatively affected their confidence and trust in the service.

Leaders recognised these shortfalls and took action shortly before our inspection by recruiting additional MDT members and introducing structures to support multidisciplinary working. However, these improvements were relatively recent and had not been embedded for a sustained period at the time of our inspection.

By the time of our visit, staff, teams and services were working more collaboratively. Staff held regular MDT meetings and ward rounds, shared information through structured handovers, and ensured relevant professionals could access the information needed to assess, plan and deliver care. Staff also worked with external partners, including community services, to support transitions, referrals and discharge planning.

Staff considered patients’ individual needs, circumstances and ongoing care arrangements when planning transitions and shared information clearly between teams. They escalated concerns appropriately and involved additional services when patients’ needs could not be met by the hospital.

While leaders and staff had taken appropriate action to address earlier gaps in MDT provision, the initial lack of specialist input had impacted some patients’ experiences, and the improvements seen were still in the early stages of embedding at the time of the inspection.

Staff supported patients to live healthier lives by addressing their day-to-day health and wellbeing needs. Staff worked with patients to set achievable health goals, celebrate improvements, and respond promptly when health outcomes were not met.

Staff encouraged patients to take an active role in managing their own health and wellbeing wherever possible. They involved patients in monitoring their progress through regular ward rounds, meetings where patients and staff review care, discuss concerns, and plan ongoing support and through one-to-one sessions and group activities with psychologists, occupational therapists, and dietitians. Staff guided patients to make healthier lifestyle choices, including improved diet, and supported them to understand the impact of these choices on their recovery.

Staff identified risks to patients’ health and wellbeing and prioritised support to prevent deterioration. For example, they supported patient whose fine motor skills had deteriorated due to illness, using targeted exercises and therapies to help maintain independence and promote overall wellbeing.

Patients, relatives and partner agencies reported ongoing concerns about aspects of care in the months following the hospital’s opening. These included limited therapeutic activities, inconsistent specialist support and dissatisfaction with nutritional provision. These issues negatively affected patients’ experiences of care and their confidence in the effectiveness of treatment. Although staff took action to address these concerns in the months leading up to our inspection, the impact of earlier shortfalls continued to affect some patients.

Staff supported patients to understand their care and treatment options and worked with them to agree goals, explaining what good outcomes would look like and how these could be achieved. Staff encouraged patients to maintain and improve their quality of life, including promoting independence and developing skills through activities such as baking and craft.

Staff used recognised assessment tools to support this process, including the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) to measure psychological distress, the DIALOG scale to assess quality of life and treatment satisfaction, the Eating Disorder Examination Questionnaire (EDE-Q) to assess eating disorder behaviours, the Model of Human Occupation Screening Tool (MOHOST) to evaluate occupational functioning, and the National Early Warning Score 2 (NEWS2) to monitor physical health. Information from these tools was used to inform care planning, decision‑making and the tailoring of interventions. Care records captured patients’ health and wellbeing, documented expected outcomes and reflected actions taken to support progress.

However, because the service was newly established and had experienced early challenges, including inconsistent specialist input and limited therapeutic provision, improvements were not yet consistently reflected in patient outcomes. At the time of inspection, outcomes were variable and not always fully optimised, indicating that further work was required to embed improvements and ensure consistently effective care.

Leaders told us that, following findings identified by the CQC during an inspection of another ward within the hospital, they discovered errors in some Mental Health Act (MHA) paperwork on this ward. One patient’s Section 3 documentation contained errors that could have made their detention unlawful. This demonstrated that systems for assuring the correct application of the MHA were not consistently effective. The provider audited all MHA paperwork before our visit, corrected the errors and applied the duty of candour, informing the patient of the issue and the actions taken.

At the time of our inspection, all patients on the ward were detained under the MHA, and staff demonstrated an understanding of patients’ rights within this context. Staff explained patients’ rights in ways they could understand, repeated this as needed and involved patients in decisions about their care where possible. For example, when patients requested Section 17 leave, which allows detained patients temporary leave from hospital under specific conditions, staff discussed requests with the responsible clinical team and included patients in decision‑making.

Staff sought consent in line with relevant legislation and guidance, including the Mental Capacity Act 2005. They identified when patients lacked capacity and made best‑interest decisions appropriately, involving families, carers or advocates as required. Care plans documented patients’ capacity, decision‑making ability and the support needed, and staff sought consent before providing care and treatment. DNACPR decisions were clearly recorded, securely stored and communicated effectively through care plans and handovers. During our inspection, we observed staff seeking patients’ consent in practice. However, because the errors in MHA documentation were identified only after external inspection findings and the corrective actions were recent, further embedding of robust oversight and assurance arrangements was required to ensure sustained compliance.