Avesbury House

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating was requires improvement. This meant the service was not always consistently managed and well-led. Leaders and the culture they created did not consistently promote high-quality, safe, person-centred care.

Prior to the inspection we received anonymous whistleblowing concerns about the hospital with concerns about patient care, medicines administration, restraint, racial bias towards staff, and recruitment practices. We did not find evidence of these concerns, and these were not substantiated by the provider's investigation. The provider had arranged for a closed culture review of the service to take place and recruitment practices and racial bias within the service remained under review. However, we did note that there were gaps in senior oversight of safety measures across the hospital.

There was a breach of regulation 17(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a range of issues during the inspection, which had not been picked up by management checks and audits. These were addressed during or shortly after the inspection, but it was of concerns that the service’s own quality assurance systems had not identified these issues independently. Issues we found included recording action taken if physical health scores were outside of the normal parameters; some patient records lacking clinical detail; storage of medication keys, out of date medicine stock items, and some environment security issues.

Leadership development opportunities were available, including opportunities for staff below ward manager level. Staff spoken with during the inspection felt supported by their colleagues and managers. They knew how to use the whistle blowing process and how to contact the freedom to speak up guardian. Staff appraisals included conversations about career progression where relevant and how they could support staff development. However, some staff raised concerns about insufficient staffing numbers, discrimination towards staff and patients, a divide from the medical and nursing teams, and not being made aware of the results of audits.

We saw evidence that patients views and requests as raised in community meetings and patient council meetings, led to changes within the hospital such as activities provided, and new equipment for the hospital.

There was a clear framework for the discussion of important information such as learning from incidents, complaints, audits and alerts and staff met regularly at business team meeting to discuss this. Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. The service had plans for emergencies. This included contingency arrangements for adverse events.