We rated Avesbury House Good overall because:

• Following our inspection in August 2015, we rated the service as good for effective and caring. We rated the service as requires improvement for safe, responsive and well led.
• During this inspection, we found the service had made considerable progress since the previous inspection in August 2015 but in some cases the improvements were not yet fully completed or embedded. There were some areas where we have asked the service to do some further work and some new areas for improvement have been identified.
• At the last inspection, in August 2015, there were no systems in place to handle complaints at the service. During this inspection we found there had been improvements. Patients knew how to complain. The service had a formal complaints system in place and staff were investigating complaints appropriately.
• At the last inspection, in August 2015, there were no systems in place to ensure records were complete, accurate and up to date. At the inspection this had improved. The manager could access key performance monitoring information easily in order to understand the performance of the team and make improvements in the service
• At the last inspection, in August 2015, we found that he service had not submitted all required statutory notifications to the CQC. At this inspection, we found that the service was regularly submitting notifications to the CQC when appropriate.
• Patients’ risk assessments were regularly updated, comprehensive and personalised. Staff completed physical health assessments of patients on admission and on-going monitoring was robust. Staff had a good understanding of patient’s individual needs.
• Staff used de-escalation techniques to calm any aggressive behaviour. Staff knew how to report safeguarding concerns and what to report. The service had introduced a new incident reporting tool which staff used with ease.
• Staff operated an effective and well-maintained medicines management system.
• The service had a full range of multi-disciplinary staff available due to the joint working with an NHS trust.

However,

• At the last inspection in August 2015 we found that the service did not have a ligature risk assessment in place and that staff were not aware of ligature risks and how to manage them. During the inspection, although this had improved, we found that ligature risk assessments did not identify all ligature points in the service, which meant that staff were unaware of the risks and how to mitigate them.
• At the last inspection, in August 2015, staff did not have a good understanding of the Mental Capacity Act. During the inspection, we found that this had not improved. Staff had little understanding of the Mental Capacity Act and its principles.
• Safeguarding vulnerable adults training for staff was low at 61%. Staff supervision notes were not always recorded appropriately.
• Staff did not provide all patients with copies of their care plans.