The Avalon Centre

The Avalon Centre is a purpose-built neurological centre for men and women over the age of 18 years, who have an acquired brain injury located near the town of Swindon in Wiltshire.

We rated this service as good because:

• The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• Staff assessed and managed risks to patients and themselves well. Staff followed best practice in anticipating, de-escalating and managing challenging behaviour.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through transdisciplinary discussion and updated as needed. They involved patients and gave them access to their care planning.
• Managers ensured they had staff with the range of skills needed to provide high quality care. They supported staff with supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them. Staff helped patients with communication, advocacy and cultural and spiritual support.
• Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
• Staff planned and managed discharges. They liaised well with services that would provide aftercare. Staff did not discharge patients before they were ready and ensured they did not stay longer than they needed to.
• The service treated concerns and complaints seriously, investigated them and learnt lessons from the results, which were shared with the whole team.
• Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the service they managed and were visible and approachable for patients and staff.
• Staff felt respected, supported and valued. They said the service promoted equality and diversity and provided opportunities for development and career progression. They could raise any concerns without fear of retribution.
• Our findings from the other key questions demonstrated that governance processes operated effectively at team level and that performance and risk were managed well. Teams had access to information they needed to manage patients effectively. They had plans to cope with unexpected events.

However:

• While there were systems and processes to safely prescribe, administer, record and store medicines and staff participated in the provider’s restrictive interventions reduction programme they did not follow national guidance for the physical monitoring of patients after the administration of rapid tranquilisation.
• The ward was generally safe and well equipped. However, we found ligature anchor points from the drainpipes and flexible door hooks and wooden pallets which could be used as a climbing aid to abscond. These were addressed during the inspection with all hooks removed and a garden risk assessment completed for the service. The wooden pallets had not yet been removed as staff were waiting for the return of maintenance staff to attend to the concern.
• While the service had measures in place to follow same sex accommodation, the hospital did not have a dedicated female lounge in line with Department of Health guidance on the reduction of same sex accommodation. This was addressed during the inspection.
• Most staff had completed Mental Capacity Act (MCA) training. However, staff spoken with said they were unclear about the principles of the MCA and how this affected their work with patients.
• Patient’s food and fluid intake charts were incomplete. This meant that there was insufficient information to provide a clinical decision in the event of a medical review.
• While outcomes data and quality improvement opportunities and evidence-based policies and procedures were reviewed within the clinical governance framework, we were not assured how this information was shared with staff. All outcome measures were primarily focussed on individual patients and did not provide information on how well the service was performing.
• The service did not have information on display informing those patients who were informal of their rights to leave the ward freely.