Cygnet Sherwood Lodge

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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 people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At this assessment, we rated this key question Good. This meant people’s outcomes were consistently good and their feedback confirmed this.

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.

Description: We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We scored the service as 3. The evidence showed a good standard of care.

People who used the service and their relatives were actively involved in care and treatment planning. Feedback confirmed they felt included, listened to, and that their needs and preferences were understood. One relative commented, “I am involved in my son’s care and treatment; staff really do include me in decisions, I feel listened to and when I ask for anything the staff are always very quick to get me what I need.”

We reviewed 7 care records, all of which demonstrated that full mental and physical health assessments were completed on admission, or shortly afterwards. Individuals were also supported to access annual physical health checks. Care plans were holistic, person-centred, and focused on meeting identified needs and achieving meaningful outcomes. Staff combined the use of recognised clinical tools with professional judgement to develop a thorough understanding of each person’s needs. Records were regularly updated to reflect changes.

Staff made reasonable adjustments to maximise people's involvement in their care. In situations where a person lacked the capacity to make informed decisions or provide consent, staff followed the relevant legal frameworks to ensure decisions were made appropriately and in their best interests. When people were unable to communicate their needs directly, staff worked closely with families to gather input into care planning and risk assessments.

Families were also provided with relevant information and signposted to appropriate support services, such as carers’ advocacy. All staff completed carer awareness training, enabling them to recognise and respond effectively to the needs of relatives.

Communication needs and preferences were clearly documented, and staff adapted their approaches appropriately, using a range of methods to enhance understanding and support meaningful involvement.

Description: We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 3. The evidence showed a good standard of care.

The psychology team provided a broad range of interventions, including cognitive behavioural therapy, dialectical behaviour therapy, schema therapy, eye movement desensitisation and reprocessing and art psychotherapy. Art psychotherapy enabled people to express themselves through artwork and worked particularly well for people who had difficulty in direct communication and expression. The therapy was person formulated and led and resulted in people progressing from art expression through to open dialogue.

Staff developed and implemented Positive Behavioural Support (PBS) plans, completed behavioural assessments, delivered tailored interventions, and supported individuals to set and work towards personal goals. Staff followed guidance from the National Institute for Health and Care Excellence and had access to regular clinical updates. During our assessment, we observed care and support being delivered in line with current best practice.

The service met individuals’ dietary requirements, with staff providing personalised support where necessary. Nutritional and hydration needs were appropriately assessed and monitored in accordance with national guidance, and this was consistently documented within care records.

Staff were encouraged and supported to explore innovative, evidence-based approaches to improve outcomes for people using the service. They participated in clinical audits, service reviews, benchmarking activities, and quality improvement initiatives. For example, a co-production and risk management project which invited people using the service into training and reflective practice sessions to share their own personal experience and insights. A person leaving the service was supported to engage with and complete training with the community team he was being discharged to.

Description: We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

We scored the service as 3. The evidence showed a good standard of care.

People and their families experienced coordinated care across teams and services. Staff promoted a multidisciplinary approach, involving doctors, nurses, psychologists, occupational therapists, occupational therapy assistants, speech and language therapists, activity coordinators and care support workers.

Staff worked collaboratively across their own teams, the wider organisation and with external partners. Regular multidisciplinary team meetings were held to develop, review and update care and treatment plans where needed. External professionals, such as care coordinators, were invited to care and treatment reviews, supporting continuity and joined-up care for people and their families.

We observed that handovers took place before each shift, were concise and effective, and consistently shared accurate and comprehensive information. Staff promoted effective communication with external services, including the local authority social work team. The processes we reviewed supported co-ordinated care, particularly when people moved between services.

Discharge planning was robust and reflected individual needs, preferences and circumstances. Clinical tasks were appropriately delegated, and referrals were made in a timely way. This supported the delivery of safe and effective care through clear and prompt information sharing.

Description: We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Quality Statement Score: 3. The evidence showed a good standard of care.

Staff supported and empowered people to manage their health and wellbeing, while promoting healthier lifestyle choices. Staff provided guidance on healthy eating and facilitated a range of health-promoting activities, including physical exercise such as walking groups, outdoor pursuits, and sessions in the on-site gymnasium.

People were given the opportunity to attend the forest school. The forest school used a natural, outdoor space to offer small, achievable, and person led tasks. The programme improved people’s personal, social, and emotional life skills, boosted self-esteem and provided a sense of self-worth. Activities included exploring nature, gardening, building, and teamwork exercises tailored to individual capabilities. Forest school gave people the opportunity to work with their peers to manage risks and use their initiative to solve problems and co-operate with others. It also provided exposure to the natural environment and its elements, free open space with sensory impact from sunlight, warmth, wind, cold, rain, sounds and smells.

Meals were freshly prepared on-site, with a variety of healthy options available. Staff encouraged people to make balanced dietary choices while also respecting individual preferences. People using the service told us the food was very good, and healthy options were available. One person told us, “Staff do tell you what’s healthy and good for you, but you can still make your own choices. The food is great and very tasty.” The services physical health nurse also delivered sessions on healthy eating.

People were registered with appropriate local services as part of the admission process, based on their individual needs, and were supported to attend scheduled appointments. Staff maintained effective working relationships with external healthcare providers, including GPs and opticians. Staff referred people to a specialist learning disability and autism provider for dental support, and if the need arose a dental professional attended site to provide care and support. Staff ensured people using the service also had access to a chiropodist.

Regular health assessments were carried out by the speciality doctor and physical health nurse. Staff worked collaboratively with a local GP which ensured people received annual health checks. All interventions were consistently documented in care records. Staff also made referrals to specialist services, such as diabetes clinics to meet individual needs. There was a clear focus on early identification of potential health concerns, enabling timely intervention, promoting overall wellbeing, which reduced the risk of deterioration.

Description: We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

We scored the service as 3. The evidence showed a good standard of care.

Staff consistently monitored people’s care and treatment to ensure positive and sustainable outcomes. Recognised assessment tools, such as the malnutrition universal screening tool (MUST) and physical health monitoring systems including the national early warning score 2 (NEWS2), were used to assess clinical risk, measure progress, and ensured a prompt response to changes in people’s needs. This approach supported delivery of care in line with national guidance and ensured individual needs were effectively met.

The occupational therapy team utilised the model of human occupation screening tool (MOHOST). The tool supported therapists to gain a broad overview of a person’s occupational functioning and assessed how personal factors and the environment affected their daily life participation. They could then plan care to support people individualised needs. Care plans were reviewed regularly to ensure they remained up to date and reflective of people’s changing needs.

The service demonstrated a strong commitment to service development by engaging in collaborative initiatives, including the organisation’s national learning disability and autism steering group and peer review programme. This involved multidisciplinary teams and people using the service visiting other services to review care provision across all areas. The programme aimed to enhance outcomes and experiences for people with learning disabilities and/or autism, as well as their families, through shared learning and reflective practice.

Outcomes from reviews informed service development, including updates to policies, implementation of recommendations, and action planning to strengthen community-based support. There was effective sharing of knowledge and best practice across services, supporting continuous improvement and innovation in care delivery.

Description: We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

We scored the service as 3. The evidence showed a good standard of care.

Staff ensured people were empowered and supported to make their own decisions about their care, treatment and support wherever possible. For people who lacked mental capacity, staff assessed and recorded their capacity on a decision-specific basis, with an emphasis on significant decisions to safeguard the person and protect their interests.

Staff adhered to the Mental Capacity Act guidance and supported people to make decisions for themselves when possible. If people lacked the capacity to make informed decisions, staff followed the appropriate process and involved their families and the relevant professionals, such as advocacy services, in any of the decisions made on their behalf. Staff considered peoples’ wishes, feelings, cultural and religious beliefs, social backgrounds and histories when making decisions.

For people detained under the Mental Health Act, staff adhered to the legal requirements and framework of the Act. Staff respected people’s rights and made sure they were informed of their rights verbally and in writing, in an accessible format, this included their right to appeal. Staff read people their Section 132 rights on admission and regularly thereafter or when their Mental Health Act status, responsible clinician (RC) or treatment plans changed.

Staff consistently recorded the reading and communication of Section 132 rights in people’s care records. Consent to treatment regarding medicines were present and completed appropriately. We found no concerns in the records we reviewed.