Avesbury House

Updated 9 February 2022

Avesbury House is provided by Partnerships in Care 1 Limited. The provider took responsibility for the service in December 2016.

The service provides a 24-hour low secure service to male patients with severe and enduring mental health needs, often with a forensic history. The service has 24 beds across five units. The units include bedrooms, en-suite / communal bathrooms, communal areas and kitchen facilities. The service provides a step down for patients coming from a medium and high secure unit at a local forensic hospital.

At the time of our inspection there were 24 patients who were all detained under the Mental Health Act.

NHS England contracts the beds at Avesbury House. NHS England commissioned the North London Forensic Service at Barnet, Enfield and Haringey Mental Health NHS Trust to provide the forensic multi-disciplinary team. The North London Forensic Service subcontracts to Avesbury House to provide the building, nursing staff, security staff, domestic staff and support workers.

Avesbury House is registered with the CQC to provide the following regulated activities:

• Treatment of disease, disorder or injury.
• Assessment of medical treatment of persons detained under the Mental Health Act 1983.

At the time of the inspection, there was a registered manager.

At the last inspection in February 2017, we found that the ligature risk assessments did not identify all ligature points in the service which meant staff were unaware of the risks and how to mitigate them. On this inspection we found up to date ligature assessments which included ligatures across the wards. The risk assessments reflected patient risk at an individual level. Staff we spoke to were aware of ligatures and gave examples on how to mitigate them.

What people who use the service say

We spoke with four patients at the service. Patients we spoke with told us they felt safe on the ward. Patients told us staff were approachable and felt able to raise complaints with staff. Patients told us staff respected their privacy and dignity and always knocked before entering their room. All patients we spoke with told us they had received a copy of their care plans.

Patients took part in a patient satisfaction survey in 2021. The results showed 72% of patients said they felt safe on the ward and 92% of patients felt they could raise issues with staff.

Updated 9 February 2022

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.

Updated 9 February 2022

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

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• 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 understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• 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.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

• Medical equipment was not checked daily as per the providers policy.
• Care plans lacked detail specifically around patient’s physical health needs, this was despite the care plan audit saying compliance was 100%.
• Patient’s told us they didn’t have access to a multi-faith room.
• NEWS2 records were not always completed in line with the provider’s policy. National early Warning Scores (NEWS2) which is a system for scoring physiological measurements that are routinely recorded.
• Managers did not have oversight on restrictive interventions and could not provide evidence to suggest these were reviewed regularly.
• Audits completed did not always have action plans on improvements made as a result.
• Managers did not have oversight of bed management including data on delayed discharges.
• The service had no credible strategy to deliver high-quality sustainable care to patients.