Cygnet Grange

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked at whether the service met patients’ needs. At the last inspection, this key question was rated as good. At this assessment the rating has remained as good. This meant the service ensured patients were at the centre of their care and treatment decisions. Patients could access accurate, up-to-date, and accessible information and advice, and patients or their families knew how to provide feedback about their experiences of care and support. The service also ensured that patients could access the care, support, and treatment they needed when required. Care, treatment, and support promoted equality, reduced barriers or delays, and protected patients’ rights.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

The evidence showed a good standard. The service made sure patients were at the centre of their care and treatment choices and they decided, in partnership with patients, how to respond to any relevant changes in patients’ needs.

Patients’ care plans clearly reflected their physical, mental, emotional, and social needs. The plans reviewed were personalised to each individual, outlining their support requirements, communication needs, risks, and preferred routines. Staff showed a good understanding of the adjustments required to deliver care in line with these needs.

Patients received appropriate care and treatment, with reasonable adjustments made where necessary. Day-to-day support was monitored through regular multidisciplinary meetings and ongoing communication among staff. Records showed that emerging needs, including physical health concerns, behavioural changes, and environmental factors, were addressed promptly. Staff regularly sought input from external professionals to ensure patients received the right support at the right time. The service continued to make adjustments to maintain a patient-centred and responsive approach.

Patients using the service, as well as carers, were routinely involved in care planning and shared decision-making, ensuring care remained focused on their individual needs. One carer told us they felt actively involved in their loved one’s care.

The evidence showed a good standard. The service understood the diverse health and care needs of patients and their local communities, so care was joined-up, flexible and supported choice and continuity.

Patients’ care and treatment were provided in a way that met their assessed needs through coordinated and responsive services. Although discharges were infrequent, the service had clear processes in place to support transition planning. At the time of inspection, a discharge was being arranged.

The discharge planning demonstrated effective collaboration with external agencies, families, and receiving services. Information was shared promptly, and a phased approach was used to promote continuity of care and reduce anxiety for the individual.

We saw that over the previous 12 months, a number of discharges had been delayed due to a lack of suitable placements, which resulted in extended hospital stays for some patients. Records showed that most individuals affected had since been successfully discharged to appropriate placements, supporting more timely transitions of care.

At the time of inspection, 1 discharge remained delayed. Records showed the individual had been assessed for local placement options; however, these were not progressed as they did not meet the patient’s preferences. Staff told us they were continuing to work with partner agencies to identify a placement that reflected the patient’s needs and wishes, with the aim of achieving a safe, timely, and person-centred discharge.

Quality Statement Score: 3

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Patients were able to access information and advice that was accurate, up to date, and provided in a way they could understand, in line with their communication needs. Staff provided easy-read materials and a monthly newsletter for families and carers, which included details of planned activities such as fundraising events, charity walks, and celebrations. The service also sent monthly updates with photographs showing what individuals had been doing.

Staff communicated with patients in an appropriate, respectful, and personalised way, taking account of their level of understanding. They adapted their communication styles to ensure individuals could engage, feel reassured, and fully understand the support being provided.

Quality Statement Score: 3

The evidence showed a good standard. The service made it easy for patients to share feedback and ideas, or raise complaints about their care, treatment and support. They involved patients in decisions about their care and told them what had changed as a result.

Patients and their families knew how to give feedback about their experiences of care and support including how to raise any concerns or issues. Senior leaders told us they talked to patients in community meetings about what was happening at the service. The service shared records of their Peoples Council ‘You said, We listened to’ process, which we reviewed from September 2025 to April 2026. We saw evidence that staff acted on issues raised by patients in relation to activities and food.

Where improvements were identified, patients were given opportunities to be involved in developing solutions. The provider told us they actively promoted patient involvement and co-production across all areas of care.

Patients were involved in co-designing activities and outings alongside the Occupational Therapist (OT). The service was also working in partnership with patients in areas such as Positive Behaviour Support, Active Support, Culture of Care Standards, and Clinical Governance. This approach showed the service valued patient input and aimed to involve people in decisions about their care and the way the service was delivered.

Between 14 August 2025 and 02 March 2026, the provider reported receiving two complaints. Both concerns were resolved informally. One complaint raised by a patient related to medication information. The patient found the medication list unclear, and the service responded promptly by introducing clearer, more accessible medication lists, including the use of pictures.

Between 13 May 2025 and 21 April 2026, the provider reported receiving 15 compliments. Feedback included praise for the high standard of care, the positive attitude of staff, and the therapeutic interventions provided. Visitors commented on the welcoming and friendly approach of staff. One visitor described the team at the Grange as organised and said they enjoyed visiting the service.

The evidence showed a good standard. The service made sure that patients could access the care, support and treatment they needed when they needed it.

Patients could expect their care and support to be accessible, timely, and in line with best practice, quality standards, and legal requirements, including those related to equality and human rights.

The service made reasonable adjustments for patients with disabilities, including addressing communication needs and ensuring the environment was accessible. For example, specialist chairs were available for patients with Huntington’s disease to support their comfort and safety.

The ward was mostly spacious, with wide corridors that allowed easy movement for patients with mobility needs. There was also access to an adapted bathroom, which helped support patients’ independence and dignity.[HK1] However, we observed a patient in their bedroom who was wheelchair bound and their bedroom was not spacious and they struggled to move around their room.

Patients were supported to overcome barriers to ensure equitable access to the service. The Occupational Therapist (OT) facilitated timely access to appropriate equipment to meet individual needs, including raised toilet seats, grab rails, standing aids, and hoists. This demonstrated that the service took a proactive approach to reducing risks and promoting independence.

Senior leaders told us the service adapted care delivery in response to patients’ individual needs. They explained that additional training was provided to staff, where required, prior to admission to ensure staff had the necessary skills and knowledge to safely meet patient needs. Staff received regular, structured bite-sized training to enhance their knowledge and competence. Records showed that monthly training sessions between January 2026 and May 2026 covered specialist topics such as Huntington’s disease, cognitive communication disorders, reinforcement strategies, and arteriovenous malformations.

The OT contributed to pre-admission assessments, identifying any requirements for specialist equipment or environmental adaptations. This ensured appropriate planning and reduced the risk of delays in care provision.

The Speech and Language Therapist (SaLT) was involved in pre-admission assessments, reviewing patients’ communication needs, social interaction, and eating and drinking abilities. The SaLT utilised the JAYS Observational Assessment of Dysphagia, a specialised clinical assessment tool, to identify risks associated with swallowing difficulties. This enabled the service to plan and deliver care that was responsive to patients’ complex needs.

The evidence showed a good standard. Staff and leaders actively listened to information about patients who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Patients’ care, treatment and support promoted equality, removed barriers to access, and protected their rights.

Patients were able to access their bedrooms freely throughout the day, supporting choice and independence. We saw that patients were encouraged to personalise their rooms; for example, one patient showed us their bedroom, which they had decorated with personal items.

Feedback from families was positive. Relatives reported that the service provided equitable access to care that met patients’ complex and individual needs. They described the environment as suitable, inclusive, and well resourced, with staff making appropriate adjustments to promote wellbeing and engagement.

One carer expressed a high level of confidence in the service, stating that they believed it was the right placement for their relative. They felt reassured by the quality of care provided, commenting that they were extremely pleased with the quality of care provided.

The provider complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of patients with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes. The environment was adapted to promote comfort and accessibility, and staff took steps to ensure patients’ individual preferences were integrated into daily life. Activities and routines were personalised and adapted to each patient’s abilities and interests. Staff accessed translation services when needed to support communication with patients and their families whose first language was not English.

The evidence showed a good standard. Patients were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Patients’ decisions and what mattered to them were reflected in personalised care plans, which were shared appropriately with relevant professionals to ensure continuity of care.

Staff assessments informed detailed and individualised care plans that clearly reflected patients’ needs, preferences, and goals. Care plans demonstrated a proactive and responsive approach to care, with regular review and updates based on ongoing assessment and changes in patients’ presentation.

Patients who were approaching the end of their life were appropriately identified, including those with protected characteristics under the Equality Act and individuals whose circumstances made them more vulnerable. Information was shared in a timely way with relevant services and staff to ensure coordinated and inclusive care.

Where patients expressed a preference for greater independence and fewer care interventions, staff worked collaboratively with multidisciplinary professionals to support them to achieve these goals. Although discharges were infrequent, records relating to the most recent discharge showed that transitions were well planned and managed. This included effective collaboration with external agencies and family members, timely sharing of information, and appropriate preparation to ensure the receiving service had all necessary details to continue care safely and effectively.