Avesbury House

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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

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 our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff completed a detailed mental health and physical health assessment of patients’ needs at, or soon after, admission. They used the national early warning score (NEWS) tool to monitor and manage patients’ physical health and identify any deterioration.

Staff developed care plans that met the needs of patients identified during their assessments. Care plans were personalised, holistic and recovery oriented. However, there was limited evidence of nurse‑led activities documented in daily entries or regular 1:1 sessions, staff advised that these were sometimes recorded on a different electronic system.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. This included medication, psychological therapies and occupational therapy support. The medical team prescribed medicines to treat patients’ conditions, which were safe, effective, and evidence based. For example, when doctors prescribed anti-psychotic medication, staff regularly monitored the patients’ physical health.

Staff took part in clinical audits and used results from audits to make improvements. Managers had access to quality assurance dashboards including current information about performance with medicines administration, infection control procedures, care plans, risk assessments, and the Mental Health Act 1983. The multidisciplinary team (MDT) employed by the nearby NHS mental health trust worked with the hospital’s nursing team, alongside relevant services outside the organisation.

Staff had access to a reflective practice group for staff. Staff shared information about patients and any changes in their care during handover meetings.

Managers provided staff with supervision and appraisal of their work performance and completed detailed supervision and appraisal records for each member of staff. There were daily MDT meetings that staff from all disciplines attended. There was also a referrals and admission meeting where new referrals were discussed.

Staff supported patients to attend appointments for their physical healthcare and made referrals to other hospitals if they required advice or treatment about their physical health needs.

Staff had access to the provider’s Mental Health Act (MHA) policies and procedures, as well as the Code of Practice. Staff explained to patients their rights under the MHA in a way that they could understand. Staff ensured that patients were able to take escorted Section 17 leave (permission for patients to leave hospital) when this had been granted, and this was evident in their records. Patients had access to an independent mental health advocate (IMHA).

Staff had a good understanding of the Mental Capacity Act (MCA) and the five statutory principles. Records confirmed staff completed patients’ consent to treatment and capacity assessments following their admission.

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.

Staff completed a detailed mental health and physical health assessment of patients’ needs on admission. New patients were initially placed in an anti-ligature room. Patients were allocated to one of two clinical teams, led by a consultant psychiatrist, with ward rounds with all patients every two weeks.

Staff used the national early warning score (NEWS) tool to monitor and manage patients’ physical health and identify any deterioration.

Staff developed care plans that met the needs of patients identified during their assessments. Staff raised concerns that there was sometimes a disconnect in information flow between the multi-disciplinary team employed by the local NHS mental health trust, and the service’s staff, using different electronic record systems. Managers told us that a plan of action was underway, as there had identified the need for improvement in the systems and documentation.

Staff told us that they regularly reviewed patient care plans and involved the patient and their family or carer in this process when appropriate. Care plans were personalised, holistic and recovery oriented. However, 4 of the 5 care plans we reviewed were not fully completed. Staff acknowledged that both verbal and email communication could be better, for example some external appointments needed to be re-scheduled as they had not been logged in the service’s diary. We found that some printed records of patients’ diabetic care plans were not up to date in line with the electronic records. This was addressed on the day of the inspection. Following the inspection, the physical health nurse was tasked with tracking all physical health care plans, and ensuring reminders were recorded in the service diary.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). This included medication, psychological therapies and occupational therapy support.

The medical team prescribed medicines to treat patients’ conditions, which were safe, effective, and evidence based. For example, when doctors prescribed anti-psychotic medication, staff regularly monitored patients’ physical health. There was effective use of the National Early Warning Scores (NEWS).

There was clinical psychologist and occupational therapy input. Staff offered patients the opportunity to see a smoking cessation specialist, and access nicotine replacement therapy.

Staff took part in clinical audits, and managers used results from audits to make improvements. Although some staff said that they did not always receive the results of audits undertaken. Managers had access to quality assurance dashboards including current information about performance with medicines administration, infection control procedures, care plans, risk assessments, and the Mental Health Act 1983.

Staff we spoke with said they used supervision to discuss topics such as patient care, reflect and improve their practice, and for personal support. Staff attended regular training sessions for example simulated patient choking.

Patients had yearly, and as and when required checks-up with opticians, podiatry and dentists, with emergency dental care delivered by a local hospital. Appointments were monitored by administration staff and staff supported patients to attend medical appointments when required. A GP visited the hospital site once a month.

Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure there were no gaps in patient care. The staff team had effective working relationships with other relevant teams within and outside of the organisation.

The multi-disciplinary team (MDT) was provided by the local mental health NHS trust, with 2 consultant psychiatrists leading separate teams including specialist doctors, clinical psychologists, occupational therapists (OT) and assistants, with support from a social worker. A dietitian was employed by the provider. There were daily multidisciplinary team meetings for the service.

Staff had access to a reflective practice group for staff. Staff spoke positively about the team work in the hospital but did note that there were some challenges in preventing a division in communication between the MDT and staff employed by the provider. They advised that they could arrange a GP, dentist, or other relevant health appointments for patients as needed.

Staff made sure they shared clear information about patients and any changes in their care, including during handover meetings. The teams had effective daily handovers between changes in nursing shifts briefing all on-coming staff about each patient on the ward as well as any incidents, which had occurred.

The service provided new staff with a corporate and local induction. The local induction included orientation to the unit and reading various policies and procedures. Staff attended regular team meetings. Managers dealt with poor performance promptly and effectively.

An interim director of clinical services was in place for the service, there was no ward manager position, but 2 charge nurses covered the ward. Staff said that in addition to mandatory training they were provided with relevant specialist training such as training in supporting patients hearing voices, phlebotomy, and diabetes - insulin management training. Staff had undertaken training in supporting autistic patients or those with learning disabilities.

Managers provided staff with supervision and appraisal of their work performance and completed detailed supervision and appraisal records for each member of staff. Supervision compliance was at 100% at the time of the inspection and had remained high throughout the year.

Staff worked together effectively to review each patient and manage their progress as well as their discharge or transfer. Staff liaised with patients’ community care coordinators, local colleges, churches and mosques, social services and other organisations that provided support to the patients.

Staff encouraged patients to live healthier lives. Staff assessed all patients for their weight and height and checked whether they smoked and or misused substances. They supported patients to give up smoking and provided patients with nicotine replacement therapy. The service had a no smoking policy, in line with national guidance.

Staff supported patients to attend appointments for their physical healthcare and made referrals to other hospitals if they required advice or treatment about their physical health needs.

A patient told us that they had received help and advice from a dietitian to help them lost weight and were working with the occupational therapist to cook healthy meals. Another patient noted that their medicines were making them increasingly hungry, and that staff had discussed this with them, and supporting them with what they ate.

Patients had access to a full-time technical instructor who ran group and individual sessions on weekdays including football sessions, a walking group, basketball, and gym access once a week.

Staff we spoke with, noted that they had seen an improvement in the physical health of patients with conditions such as diabetes, through their participation in physical activities.

Staff completed a range of audits to provide assurance on regulatory compliance. For example, there were audits on the completion of risk assessments, care plans, and infection control. Staff took part in clinical audits, and managers used results from audits to make improvements, although some staff said that they were not always aware of the results of audits. Managers told us they monitored team performance through supervision and audits.

Managers had access to quality assurance dashboards including current information about performance with medicines administration, infection control procedures, care plans, risk assessments, and the Mental Health Act 1983. Results of audits were discussed in handover meetings and supervision, with action plans put in place to improve performance.

A pharmacist or pharmacy technician visited the service regularly. The pharmacist carried out a monthly audit of medicines and raised any concerns about the prescribing for individual patients with the doctor concerned and nurse in charge.

Staff had access to the provider’s Mental Health Act (MHA) policies and procedures, as well as the Code of Practice. Staff explained to patients their rights under the MHA in a way that they could understand. Staff ensured that patients were able to take escorted Section 17 leave (permission for patients to leave hospital) when this had been granted, and this was evident in their records.

Staff requested an opinion from a second opinion appointed doctor when necessary. Staff had a good understanding of the Mental Capacity Act (MCA) and the five statutory principles.

Records confirmed staff completed patients’ consent to treatment and capacity assessments following their admission.

Staff could access support on the MCA and Deprivation of Liberty Safeguards (DoLS) from a social worker. The provider ensured that best interest decisions for patients, assessed as lacking consent to treatment, were recorded.

At the time of the inspection 70% of staff had completed training in the MCA and 68% had completed training in the MHA.

Patients had easy access to information about independent mental health advocacy with posters available in the communal areas. Staff said that they made referrals for advocacy as needed, and there was also a project in place to have experts by experience within the provider organisation.

We met with the MHA administrator for the hospital who explained the systems in place to audit paperwork, train and support staff, including out of hours