Cygnet Elms

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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

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 Outstanding. At this assessment the rating has changed to good.

This meant people were supported and treated with dignity and respect; and involved as partners in their care.

Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff informed and involved families and carers appropriately.

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 a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

The provider monitored whether people were receiving and offered at least 25 hours of meaningful activities a week. In the six months prior to our inspection this target was met in March (96%) and April (98%), with slightly lower compliance in January (94%), February (85%), May (93%) and June (92%).

Throughout our assessment, we observed staff treating patients with kindness, compassion, dignity and respect. Staff built therapeutic relationships based on trust and demonstrated a good understanding of patients’ individual needs.

Staff responded promptly to patients’ needs, listened actively to them and communicated in a way the patient could understand. Staff provided patients with reassurance, encouragement and emotional support when required, supporting patients to understand and manage their care and treatment.

Patients told us staff treated them well and supported them. Throughout our assessment we observed staff and patient interactions. Staff were respectful and person-centred and consistently promoted patients’ privacy, dignity and choice.

Staff told us they felt able to raise any concerns about disrespectful, discriminatory or abusive behaviour without fear of negative consequences.

We spoke with 2 patient relatives. Both relatives spoke positively about the service, describing staff as kind, polite, helpful and supportive. Both relatives expressed feeling more than satisfied with the care provided by the service and raised no concerns.

One staff member told us patients were supported with personal care and wellbeing activities, including attending to their hair and nails.

We saw examples of positive feedback from patients and their relatives displayed throughout the service. This included a ‘Butterfly Wall’ in the communal area, where patients could leave comments about their experiences when discharged, and a display of thank you cards from patients and their families in the MDT room.

The evidence showed an exceptional standard. The service treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The service took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff treated patients as individuals and adapted care and support to meet their individual needs. Patients told us they felt listened to and involved in their care. We observed staff providing personalised care, adapting their approach to meet patients individual communication, sensory and emotional needs.

Care plans reflected patients’ personal, cultural, religious and social needs. Staff considered people’s backgrounds, beliefs and protected characteristics when delivering care and support. The service co-produced transition and discharge plans to ensure patients’ individual needs and preferences were reflected throughout.

Staff adapted communication to meet patients’ individual needs, using a range of accessible resources including easy-read information and Talking Tiles, developed by the Speech and Language Therapy team. These resources supported patients to understand complex health and legal information and to express their views and preferences about their care and treatment. Patients were supported to complete pre-multidisciplinary team meeting (MDT) forms to share their views and preferences prior to their MDT. Patients then received easy-read summaries of the outcomes following their MDT meetings.

The service made reasonable adjustments to promote patients’ independence and meet their individual needs. For example, patients requiring lift access were individually risk assessed and supported to use the lift safely or provided with independent access where appropriate.

The service had a sensory room that had recently been refurbished following feedback from patients. There was also a multi-faith room on site, to support patients’ religious and spiritual needs.

Staff supported patients to celebrate different cultures and promote inclusion through activities such as World Culture Day. During this event, patients and staff explored different cultures together through food, themed activities and a passport-themed experience, encouraging participation, learning and cultural awareness in an engaging and meaningful way.

The service recognised and celebrated patients’ achievements through its newsletter. For example, one patient was supported to visit London for the first time and later celebrated their birthday with a trip to Blackpool. This demonstrated the service’s commitment to supporting patients to achieve personal goals and participate in meaningful experiences.

Care records demonstrated highly personalised care planning, reflecting people communication needs and preferences. During our assessment, we observed examples of information being adapted into accessible formats, such as easy-reads and Talking Tiles, which enabled patients to better understand complex information and participate actively in decisions around their care and treatment.

The evidence showed an exceptional standard. The service was exceptional at promoting people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Staff encouraged and supported patients to have as much choice and control over their care, treatment and wellbeing as possible. Staff involved patients in decisions, taking into account their capacity and legal status, using appropriate communication methods to help patients understand their rights and make informed choices.

Staff promoted independence by supporting patients to achieve their personal goals and maintain important relationships. Patients were supported to remain connected to their families and local communities through flexible visiting arrangements, community leave and meaningful activities. Patients had been supported by the service to achieve significant personal goals, such as; starting a PhD, getting married and participating in a local theatre group.

The service offered a wide range of group activities based on patients’ individual interests, preferences and abilities. Patients also had a personalised activity timetable. Activities included; community outings, shopping, board games, arts and crafts, baking and cooking. We observed patients engaging with activities on offer during our assessment. We also saw examples of patients shaping activities to reflect their own interests, including personalisation of popular board games that reflected the service, including staff and patients.

Staff supported patients’ physical health alongside their mental health and encouraged patients to participate in activities that promoted their wellbeing and independence.

The service promoted community inclusion by providing accessible information about local places and activities, helping patients understand and access opportunities within the local community.

Patients were supported to prepare for their discharge by developing daily living skills including cooking, budgeting and travelling independently where appropriate.

The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff responded promptly to patients’ immediate needs and used a range of de-escalation techniques to manage distress safely and effectively, with physical interventions used as a last resort. No restraint was used during the assessment period. Throughout our assessment, we observed staff responding quickly and compassionately to patients, providing reassurance and adapting their approach to meet individual needs.

Patients’ individual risk assessments were clearly documented, with proactive strategies in place to reduce risk of harm or distress. Staff reviewed patients’ daily risks daily, during morning risk meetings, where they discussed changes in presentation, behaviour, incidents and section 17 leave. Comprehensive risk assessments were also reviewed and updated regularly to ensure they reflected patients’ current needs.

Patients had personalised Positive Behaviour Support plans (PBS) that followed least restrictive principles and identified individual triggers, early warning signs, proactive strategies and reactive support to reduce distress and minimise the need for restrictive interventions. PBS plans were informed by psychological assessment and formulation and were supported by regular psychological outcome measures. We identified an opportunity for the provider to strengthen PBS documentation by consistently recording how patients had been involved in developing their plans and ensuring guidance relating to physical interventions were individualised where appropriate. The assistant psychologist told us work was underway to improve the PBS plan template to better capture each patient’s view.

Patients were involved in discussion around their needs and preferences, and staff adapted their communication to promote understanding and engagement. The service used a range of accessible communication methods, including Talking Tiles and easy-read information, to help patients understand their care and seek support where required. Talking Tiles provided accessible information on topics including; advocacy, safeguarding, the MHA, the MCA and the patients care pathway.

Patients and their relatives told us they felt staff were responsive, compassionate and acted promptly when support was needed. We observed a staff member providing a patient with compassionate support during our assessment, when they became distressed following the loss of a beloved pet.

The service maintained strong links with advocacy services, with an advocate visiting the service twice a week to support patients and their relatives to express their views and communicate their needs.

Seven of the nine patients were on enhanced observation levels during our assessment. Staff told us the enhanced observation levels were individually assessed and implemented to support patient safety and prepare them for successful transitions to community settings. We observed staff maintaining therapeutic engagement with patient whilst carrying out enhanced observations, during our assessment.

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 told us they felt respected, supported and valued by their colleagues and leaders. They spoke positively about working for the provider and expressed pride in the care they delivered.

The provider supported staff wellbeing through access to an occupational health service and made reasonable adjustments for staff with family and caring responsibilities where possible, supporting a healthy work-life balance. We reviewed staff sickness levels over the past 12 months, which were noted to remain low.

Staff were supported to develop professionally through regular supervision, appraisal and career development discussions. Leaders told us opportunities for further education and professional development were available to staff. The provider also recognised and celebrated staff achievements through their Stars of Elms awards. For example, in December 2025, a Senior Staff Nurse from Cygnet Elms was highly commended at the Stars of Learning Disabilities and Autism Awards in the Brilliant Learning Disability Nurse category.