• The manager and head of care were visible on the ward, were accessible to staff and were proactive in providing support.
• The culture on the wards was open and encouraged staff to bring forward ideas for improving care.
• Staff carried out a risk assessment of every patient before and on admission. Staff updated the assessments daily and reviewed them after an incident.
• Observation of the ward and patients was good.
• Staff were caring and treated patients with dignity.
• All staff had completed mandatory training and had access to further specialised training.
• Staff updated patient care plans regularly. Patient care plans showed staff engaged with patients.
• Staff understood the safeguarding process and took appropriate action when necessary.
• The manager completed a ligature risk assessment yearly which outlined plans and actions to reduce the ligature points. However, the ligature points had not been clearly identified.

We rated Cygnet Acer Clinic as good as because:

• Staff completed and updated risk assessments for each patient and used these to understand and manage risks individually. Staff supported patients to make their own decisions about their care and staff assessed and recorded capacity clearly. Care plans were personalised, holistic, recovery orientated and up to date. Patients had been involved with writing them.
• Staff understood their roles and responsibilities under the Mental Health Act (1983) and the Mental Capacity Act. The completion rates for training were 100%. Staff used restraint as a last resort and had positive behavioural plans in place to help patients develop strategies to manage their challenging behaviour.
• The hospital was visibly clean, and furniture was in good order. Domestic staff cleaned all areas of the ward regularly and both clinic rooms were clean. Staff stored medication correctly and they carried out daily checks on equipment.
• Staff understood what abuse was and how to report it. Safeguarding training was 95%.
• Patients accessed independent advocacy services and staff supported and encouraged them to access services in line with the Mental Health Act Code of Practice.
• The team included a good range of specialists to help meet the needs of the patients.
• Patients had rooms with ensuite facilities which they were able to personalise.
• Staff worked with individual patients to maximise the amount of time they could spend in the community accessing various groups including educational facilities, animal help groups, personal support groups and charities.

However:

• Staff had not updated the current ligature risk assessment since access to two areas had changed, and staff had not changed the risk assessment to reflect the change.
• There was a raised level of complaints and concerns about staffing levels and staff attitudes towards patients.
• We observed in two out of 10 patient notes staff had identified concerns but no care plans written to action or support the concerns..

• No all appropriate information was displayed in patient areas to inform patients of the complaints procedure, how to contact the CQC, provide information on mental health. Nor information for informal patients about their right to leave,the manager rectified this once informed

• The provider should improve the engagement of staff in knowing the vison and values of the organisation.
• The provider should ensure there is sufficient staff on the wards to facilitate patient activities including one to one sessions and planned leaves.
• The provider should ensure that SOAD is requested when required in order to ensure the correct authorisation for treatment is in place.