We rated Cygnet Lodge Kenton as good because:

• The premises were clean and well maintained. The provider had assessed risks to patients due to the layout of the service and taken action to mitigate the risks.
• Although there were a number of vacancies in the staff team these were covered by experienced bank staff.
• Staff had completed mandatory training and had the skills to meet patients’ needs.
• The multidisciplinary team ensured each patient had an effective rehabilitation plan which was well coordinated and reviewed regularly.
• The multidisciplinary staff team assessed and reviewed risks to each patient and developed plans to manage identified risks.
• Staff supported patients to express their views and fully participate in planning and reviewing their care and treatment.
• The registered manager and unit manager provided effective leadership and support to the staff team.
• Staff told us they enjoyed their work and felt that the whole staff team was committed to improving the service.
• Cygnet Lodge Kenton has been accredited by the Royal College of Psychiatrists College Centre for Quality Improvement accreditation for inpatient mental health services scheme (AIMS).

We spoke with six people who were detained under the Mental Health Act 1985. No informal patients wished to speak with us during the inspection. People told us that the staff treated them well and respected their privacy and dignity. One person said, “The care is good here. The staff are caring and welcoming.” Another person told us, “There is good personal and individual care here.”

People we spoke with told us that they were involved in planning and monitoring their care and treatment programme. Care plans were based on a recovery star, with domains for change including identity and self-esteem, managing mental health, living skills and relationships. Each person set their own goals and assessed their own progress for each domain. One person said, “My shared care pathway and detailed care plan helps me focus on goals I have to achieve.”

There was a daily programme of therapeutic groups and individual therapy sessions for each person. Groups included self-acceptance, relaxation, well woman, and fitness. There were also groups and individual sessions for behaviour therapy which included analysis and discussion of any incidents that had occurred.

Accurate records were maintained of the care provided for each person, and of how each person set and monitored their own goals. Staff records and other records relevant to the management of the services were accurate and fit for purpose.

We had private conversations with two of the seven people who were currently inpatients at the unit, and we spoke briefly with a group of two people. They told us that they were involved in planning and monitoring their care and treatment programmes. One person said, “It was helpful to think about and write down my own views and plans.” Another person told us that the process of self-analysis meant that they were more able to control their behaviour and their impulses.”

The minutes of daily planning meetings and weekly community meetings showed that people were able to raise any concerns that they had and to express their views about aspects of their treatment and their daily lives.

One person we spoke with, who was an informal patient, told us that on one occasion they were prevented from leaving the premises when they wished to. We checked the daily notes for the day concerned, and found evidence that confirmed this. This meant that restrictions were placed on the person that contravened their human rights, and the requirements of the Mental Health Act 1985 and the Mental Capacity Act 2005.

Two of the five people we spoke with told us that they were happy with their treatment plans, and they felt that they were improving in their health and their abilities to care for themselves. One person told us that they were involved in choosing their treatment plan. They said that they wanted to come to this service because of the specific treatment they provided. They said, “It’s been very helpful for me. The staff are very helpful and caring.”

However some care plans did not contain clear information about the person’s current situation and the care and treatment they needed. One person refused meals and refused to be weighed, but there was no record of any monitoring to ensure that they were not at risk of malnutrition.

People were not supported to express their views and to make decisions about their care and treatment. The five people we spoke with all said that they had not seen an advocate. One person said, “We are not allowed to have advocacy in meetings with us. We never see an advocate and they can do nothing.”

Three of the five people we spoke with said that they were not allowed to go out in the afternoon if they had not attended their planning meeting in the morning. One person said, “I cannot leave this place if they do not give me permission. If I miss the day planning meeting I know I will not be given permission to leave, and I ask to leave many times and I am refused to leave.”