Avesbury House

Our rating of this location stayed the same. We rated it as good because:

• At the last inspection, we found the ligature risk assessment did not identify all ligature anchor points which meant staff were unaware of the risks and how to mitigate them. On this inspection we found that this had improved. The service had a detailed ligature risk assessment which included information on ligature points within each ward. Staff were mitigating the risks through observations and CCTV cameras.
• At the last inspection, we found staff did not have a good understand of the Mental Capacity Act 1983. During this inspection we found this had improved. All staff we spoke with understood the Mental Capacity Act and its principles. Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• The service had improved compliance with safeguarding vulnerable adults training to 94%. Staff were aware and understood their roles and responsibilities around safeguarding.
• At the last inspection we found staff supervision notes were not always recorded appropriately. On this inspection we found appropriate supervision records which were stored securely.
• At the last inspection, staff did not provide all patients with copies of their care plans. On this inspection, all patients we spoke with told us they had access to a copy of their care plans. Patient records we looked at reflected if patients had been given a copy of their care plan.
• Managers did not use agency staff at the service. The service used bank staff who worked regularly on the unit to fill vacancies. This meant the service always had regular staff on the wards.
• Staff did not restrain patients at the service. Staff used de-escalation techniques and completed training for this. Staff told us they felt able to manage aggression without using restraint. The service did not have a seclusion room and patients were not secluded at the service.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

However:

• Although we saw evidence of patients receiving good support with their physical health needs, care plans did not always detail enough information about how staff were meeting each patient’s specific physical health needs. We also found that records of physical health checks were not always complete.
• We found some gaps in the monitoring and oversight of staff completion of safety checks. For example medical equipment was not always checked daily. There were audits completed to check on staff practices, but they did not always specify actions to be taken for improvement.
• Managers did not have oversight of all aspects of bed management within the service. There was no data about the delayed discharges. This information would be helpful in bringing about improvements in patients’ experience. However, no patients had discharge delayed without clinical reasoning.
• The service had a blanket restriction on energy drinks for all patients. This was not individually assessed or reviewed to ensure that this was not overly restrictive. This was not inline with the organisations policy.
• Some patients were not aware of having access to a multi-faith room, although this was available at the service.
• Managers did not have a strategy for the service.