Cygnet Appletree

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

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 as good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. Staff provided a range of care and treatment suitable for patients and in line with best practice and national guidance. Staff had a good understanding of the Mental Health Act, Mental Capacity Act and deprivation of liberty safeguards.

Staff helped patients live healthier lives by supporting them to take part in programmes or giving advice. Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes.

Patients and staff had access to a full range of specialists to meet the needs of the patients on the ward. Staff were appraised and had access to regular supervision. Staff attended regular team meetings. Staff had effective relationships with teams within and outside the organisation.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We looked at 10 care records during our inspection.

Staff completed comprehensive mental health and physical health assessments of the patient in a timely manner at, or soon after admission.

Care plans were personalised, holistic and recovery-oriented.

Overall, staff developed care plans that met the patient’s needs identified during assessment. Only one of the 10 care plans we looked at was incomplete as it did not reference the fact that the patient was immobile.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medication and psychological therapies which included opportunities intended to help patients acquire living skills.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Staff completed food and fluid charts for patients on the wards. However, on Pippin ward, staff were not consistently completing these charts for one patient as we found there were gaps on 4, 5 and 9 June 2025.

On Pippin ward, patients had to ask a staff member to get them a drink of water because the water cooler was in the dining room which was kept locked throughout the day. Staff told us that a water cooler had been ordered but we had concerns that if the ward was busy, patients would need to wait for access to water. The ward was hot due to the sunny weather conditions at the time of our inspection, so the need for patients to stay regularly hydrated was important. However, after our onsite inspection ended, the provider confirmed that a water cooler had been placed in an area of the ward where patients could freely access a drink of water.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. However, audits were not always effective as we found numerous issues in relation to the completion, storage and access to documentation and poor practice in terms of rapid tranquilisation and high dose antipsychotic therapy. There was a quality director within the organisation who carried out internal quality inspections. However, given the significant nature and number of issues we identified, these quality inspections had been ineffective in identifying areas for improvement within the service.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, patients had access to occupational therapists, clinical psychologists, an in-house social worker, speech and language therapists, dieticians, dentists and opticians.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Managers provided new staff and bank and agency staff with an appropriate induction to the service and the ward they worked on.

Managers provided staff with supervision and appraisal of their work performance. The percentage of staff that had had an appraisal in the last 12 months was 97% and the average compliance with supervision during this period was also 97%. Managers used supervision and appraisal sessions to identify the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers ensured that staff had access to regular team meetings.

Managers ensured that staff received the necessary specialist training for their roles. This included advanced practitioner training. Staff members told us that they had been able to work at another Cygnet hospital to learn more about personality disorders.

Managers dealt with poor staff performance promptly and effectively. The provider had a performance management policy which provided advice and guidance for dealing with poor performance in an appropriate, supportive and timely manner.

Staff held regular and effective multidisciplinary meetings.

Staff shared information about patients at effective handover meetings within the team.

The teams had effective working relationships with other relevant teams within the organisation. Staff used a set template for handovers between shifts and teams to ensure all essential information about patients was shared.

The teams had effective working relationships with teams outside the organisation (for example, local authority social services and GPs.

Staff supported patients to live healthier lives. They provided advice in relation to healthy eating and supported patients with addictions.

Ward activities helped promote a healthy lifestyle for patients via learning about healthy food options and activities which allowed patients to take part in exercise such as walking groups and sports activities.

Staff used recognised rating scales to assess and record severity and outcomes. These included the Global Assessment of Functioning scale and the provider’s PARA risk assessment tool which was in-line with recognised tools used in the mental health sector. Outcomes were also measured via 1-to-1 time with the patient’s named nurse and community meetings on the wards.

Staff used technology to support patients. Patients had access to phones and could use video links to maintain contact with family members and friends.

Staff took all practical steps to enable patients to make their own decisions.

Overall, staff assessed and recorded that they had assessed capacity to consent appropriately. They did this on a decision-specific basis regarding significant decisions. However, on Pippin ward, staff had not recorded whether capacity had been assessed for one patient.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.