We rated Cygnet Brunel as good because:

• Staff completed thorough assessments of patients. Assessments were holistic and staff used these to inform individualised care plans for patients. Staff ensure that all assessments, including risk assessments and care plans were updated regularly.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
• The service provided treatment and care for patients that followed a recovery focused model. Staff supported patients with their physical health and encouraged them to live healthier lives. They ensured that patients were offered a minimum of 25 hours of therapeutic activity each week.
• Staff had appropriate training that enables them to meet the needs of patients and keep them safe.
• The team included or had access to the full range of specialists required to meet the needs of the patients on the ward.
• Staff understood their roles and responsibilities under the Mental Health Act 1983, the Mental Health Act Code of Practice and the Mental Capacity Act.
• Staff treated patients with compassion, kindness and supported their individual needs. Staff involved patients and those close to them in decisions about their care, treatment and changes to the service.
• The service was accessible to all who needed it and took account of patients’ individual needs. Staff helped patients with communication, advocacy and cultural support. Patients had their own bedrooms where they could keep personal belongings safely.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
• The culture at the hospital was developing. Most staff felt supported and respected by managers. Staff worked well together as a team despite experiencing lots of staffing changes since the unit opened in October 2017.

However:

• The physical environment of the wards was not suitable for the patient group. It did not support the needs of the patients or the model of care. There were blind spots and a lack of space for patients to freely walk around in. We observed several near misses where patients almost walked into each other. Some communal rooms could not be observed from outside the room and doors did not have observation panels meaning a door could be opened onto another patient.
• The process for making best interests decisions for patients was not well documented. When patients lacked capacity to make their own decisions, staff made and recorded decisions in the patients’ best interests. However, there was no evidence that staff were involving family and carers in this process.