Avesbury House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

The average length of stay at the hospital was 861 days. The hospital held regular meetings to discuss referrals, transfers and discharges.

Staff said that they involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided.

The service could support and make some adjustments for disabled people and those with communication or other specific needs. Some of the bedrooms had ensuite toilet or bathroom facilities. The service provided a variety of food to meet the dietary and cultural needs of individual patients, for example halal and vegetarian options. Patients had access to spiritual and religious support and staff were clear about the need to be sensitive in respecting the needs of transgender patients.

Staff supported patients with activities outside the service, such as education, employment and family relationships. The wards offered weekly programmes of activities provided by occupational therapists and other staff. These included arts and crafts groups, exercise, and access to computers. Patients said they would like to have more activities available to them at weekends. Staff supported patients to stay in contact with family members, including visits to the service, and involvement in relevant meetings about their care.

Most patients and carers were aware of how to make a complaint about the service or how to find out about this. Information on how to complain was displayed in communal spaces and included in welcome packs. Staff received training in addressing complaints and concerns. Few complaints had been received over the last 12 months. Staff gave examples of learning from complaints including improving communication with patients and carers.

Staff said that they had received some training in working with autistic people and people who had a learning disability.

Staff sought feedback from patients on the ward through questionnaires and regular meetings and attended training in diversity and inclusion.

Discharge planning was clear for patients nearing transition. External professionals were involved where needed, helping maintain continuity of care.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

Staff developed individual care plans with patients which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected patients’ assessed needs, were personalised, holistic and recovery oriented.

Staff said that they involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. On some care records it was clear that patients’ views were included in their care plans using. However, this was not always the case.

The service could support and make some adjustments for disabled people and those with communication or other specific needs. Managers made sure staff and patients could get help from interpreters or signers when needed.

The service provided a variety of food to meet the dietary and cultural needs of individual patients, for example halal and vegetarian options. Patients had access to spiritual and religious support, including support to observe festivals such as Ramadan.

Staff were clear about the need to be sensitive in respecting the needs of transgender patients.

Staff told us patient stay was controlled by the Ministry of Justice, but length of stay was discussed and monitored in ward rounds and care planning approach (CPA) meetings. Patients we spoke with, felt supported and included in ward rounds and CPA meetings and spoke of their personal goals for example, working towards unescorted leave, employment, and discharge. Staff told us families or carers could attend/ be involved in CPA meetings with patients’ consent in person or by a video call.

The average length of stay at the hospital was 861 days at the time of the inspection. The targeted length of stay usually depended on how a patient responded to treatment and other clinical related factors and the Ministry of Justice. Managers indicated that there were no delayed discharges at the time of the inspection.

Staff supported patients with activities outside the service. When appropriate, staff ensured that patients had access to education and work opportunities. Patients told us, they were supported by staff and external services to attend college courses either online or in person, and supported introductions at the job centre. Three patients were attending college courses at the time of the inspection.

The hospital provided weekly programmes of activities provided by occupational therapists and other staff. These included football and basketball sessions, a social club, walking group, coffee group, cooking group, and gym access once a week. However, patients said there were far fewer activities available to them in the evenings and at weekends.

Staff encouraged patients to undertake jobs within the hospital including preparing the dining table, garden maintenance, purchasing newspapers, and cooking breakfast for breakfast club.

Staff and patients said that activities were supported by management. For example a van was purchase after a request from patients. The van was used to transport patients to various activities such as football matches within the community, and trips to places of interest.

Staff supported patients to stay in contact with family members, including visits to the service, and involvement in relevant meetings about their care. Staff also supported patients to access their chosen place of worship within the community including a local mosque and church.

Discharge planning was clear for patients nearing transition. External professionals were involved where needed, helping maintain continuity of care. At the time of the inspection 5 patients were on the discharge pathway.

Staff provided patients and relatives/carers with relevant information about the wards. Staff were able to provide easy read care plans and documents, and translations into other languages, for those who needed this.

Staff made information leaflets available in languages spoken by patients.

There were notices with relevant information for patients posted in communal areas within the hospital. Staff made sure patients could access information on treatment, local services, their rights and how to complain.

Most patients and carers told us that they would be able to make a complaint about the service or find out how to do so. Information on how to complain was displayed in communal spaces and included in welcome packs.

Staff received training in addressing complaints and concerns, 98% of staff had completed this training at the time of the inspection.

Few complaints had been received over the last 12 months. Staff gave examples of learning from complaints including improving communication with patients, family members.

Staff held weekly community meetings where patients were able to express their thoughts, feelings, and suggestions for improvements that could be made. Patients were also able to raise concerns through the patients’ council. Recent topics discussed included maintenance issues, organised trips in the community, and gym equipment.

The service could support and make adjustments for disabled people and those with communication needs or other specific needs. Some of the rooms within the hospital were on the ground floor and had wet rooms which meant reasonable adjustments could be made if necessary to meet patients’ needs. Patients were moved between rooms/flats only when there were clear clinical reasons, or it was in the best interest of the patient. Staff did not move or discharge patients at night or very early in the morning. Patient transfers were planned and took place at times that were appropriate for the patient and team.

Patients said that they were satisfied with the choice and quality of food to meet their dietary and cultural needs.

Staff said that they had received some training in working with autistic people and people who had a learning disability.

Managers advised that there were no patients’ discharges delayed at the time of the inspection but noted that they would monitor any patients whose discharge was delayed. Patients generally did not have to stay in hospital when they were well enough to leave unless this was due to Ministry of Justice restrictions, or awaiting appropriate supported accommodation or residential placements.

Staff sought feedback from patients on the ward through questionnaires and regular meetings. Some staff acknowledged that they could do more to involve patients in the running of the service, to ensure that people most likely to experience inequality, had the best outcomes possible.

Staff undertook training in diversity and inclusion across the wards. Ward teams had effective working relationships with external teams and organisations for example local colleges, community teams, and a local church and mosque.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. These included the model of human occupation screening tool.

Staff support patients to make decisions about their care and treatment and their future. Staff carefully planned patients’ discharge and worked with care managers and coordinators to make sure this went well. Community care coordinators were invited to ward rounds, either in person, or via video conferencing facilities.

Discharge was discussed at multidisciplinary team meetings involving community mental health teams and local authorities to ensure that there were no barriers for when the patient was ready to be discharged.

Relatives were invited to ward rounds when patients consented. Some relatives/carers were frustrated at the amount of time taken for particular patients to be ready for discharge.