- Independent mental health service
Cygnet Grange
Assessment report published 28 September 2026
Contents
Ratings - Long stay or rehabilitation mental health wards for working age adults
Our view of the service
We assessed Cygnet Grange Hospital from 12 May 2026- 28 May 2026. This assessment included an onsite inspection visit.
We assessed Cygnet Grange Hospital as the rating was aged. Cygnet Grange Hospital was last inspected in April 2019 and rated as good.
Cygnet Grange consisted of 1 ward, a long stay ward for men with 8 beds (6 patients at the time of our site visit)
At this assessment we found breaches of regulations 12 (safe care and treatment) and 17 (good governance) in relation to safety and cleanliness of the environment; not completing accurate observation records and governance. We found the provider addressed breaches of regulation 12 identified at the previous inspection in relation to staff not always effectively monitoring patients’ physical health with the use of tools to assess and respond to clinical changes in patients.
The service was in breach of regulations 12 (safe care and treatment) and 17 (good governance).
We have asked the provider for an action plan in response to the concerns found at this assessment.
Mental Health Act and Mental Capacity Act Compliance Summary
Mental Health Act
Staff were trained in the Mental Health Act, the Code of Practice and the guiding principles. The provider had relevant policies and procedures that reflected the most recent guidance that staff had easy access to. Patients had easy access to information about independent mental health advocacy. Staff explained to patients their rights under the Mental Health Act in a way that they could understand. Staff requested an opinion from a second opinion appointed doctor when necessary. Staff stored copies of patients' detention papers and associated records correctly.
Mental Capacity Act Staff had a good understanding of the Mental Capacity Act, in particular, the 5 statutory principles. The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff took all practical steps to enable patients to make their own decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the patient’s wishes, feelings, culture and history. The service had arrangements to monitor adherence to the Mental Capacity Act.
People's experience of this service
We were able to speak with 4 patients during our site visit. Patients told us that staff were caring and treated them with dignity. One patient said the manager was approachable and friendly and the doctor was the best doctor they had ever had. We spoke with 2 carers during our inspection and assessment of long stay or rehabilitation mental health wards for working age adults. One carer told us that their loved one was safe at the service, they were confident in safeguarding arrangements, risk management and staff responsiveness, particularly given their loved one’s limited capacity to raise concerns themselves. Risks were discussed through ward rounds, reviews and DoLS processes, with carers kept informed of incidents and actions taken. Carers reported staffing levels seemed adequate, and staff were viewed as knowledgeable, attentive and able to respond promptly to their loved ones needs. One carer told us they were involved in discussions about their loved one’s medicines and treatment.
However, 1 carer raised concerns about their loved one being deemed to have capacity and granted unescorted leave despite a history of high-risk behaviours. The same carer raised concerns about poor physical health management, including missed consultant appointments, lack of required health monitoring, and failure to complete necessary blood tests. They also reported concerns about a decline in their loved one’s personal presentation, including poor hygiene and appearance, which is out of character for them.