Newmarket House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm. All wards were safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.

We have not awarded this service a score for Safe.

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

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service self-reported 40 accidents, incidents and near misses in the last 12 months, which were discussed at team and clinical governance meetings. All staff knew what incidents to report and how to report them.

Staff demonstrated a strong understanding of duty of candour by maintaining an open and transparent culture. They provided patients and families with comprehensive explanations and sincere apologies when incidents occurred. Managers evidenced this commitment through specific case examples, and staff confirmed they received structured debriefs and emotional support following any safety incidents.

Staff were able to give examples of learning from incidents. For example, several patients were admitted with a diagnosis of Emotionally Unstable Personality Disorder (EUPD). The service saw an increase in self-harm incidents, which was noted through reviewing trends, and identified learning needs. EUPD learning was shared with staff, training was delivered to staff and the service started implementing traffic light emotion regulation plans and distress management support. The provider noted that incidents of self-harm had reduced because of this.

As a result of lessons learned from previous incidents, staff accompanied any patient home after discharge when family transport could not be arranged.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had robust referral and admission processes to ensure all necessary information was gathered to ensure patient safety. Staff utilised clinical meetings and detailed handovers to communicate any identified risks and ensure a safe transition into the service.

The service had an exclusion criteria, which included patients who were actively suicidal or self-harmed to an extent that it may not be possible to maintain their safety, patients detained under The Mental Health Act 1983 and significant ongoing alcohol or substance misuse.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge.

3. We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew who the safeguarding lead within the service was and how to contact them.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies.

In the 6-month period leading up to inspection, there were no incidents of restraint.

Staff followed safe procedures for children visiting the service.

The service had blanket restrictions in place to aid therapeutic recovery. As all patients had a prescribed meal plan, all food and drink consumed at Newmarket House was provided by the service. Patients were not allowed to supply their own food or drink and low-calorie drinks, foods, substitutes, or chewing gum were not allowed at the service. All patients signed a service user agreement at the start of treatment to confirm they understood and would follow the services restrictions.

Mental Capacity Act

Staff supported patients in making informed decisions about their care. They demonstrated a thorough understanding of the Mental Capacity Act (MCA) 2005, including its five core principles, and followed the providers policy for assessing and recording capacity. Records evidenced that patients were given comprehensive explanations and adequate time to process information before consenting to treatment. The service maintained 100% staff training compliance for the MCA.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint and seclusion only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We looked at 5 risk assessments and risk management plans during the assessment. Risk assessments included physical and mental health, risks around patients eating disorder, collaboration with services, risk of absconding, safeguarding and capacity.

There were no incidences of restraint or use of seclusion in the last 6 months.

Staff involved patients in care planning and risk assessment, evidenced in care plans and participation in multidisciplinary team reviews. Staff developed specialist care plans, using occupational therapy support. For example, relaxation care plans. All patients care plans were signed and patients had access to a copy of their care plan.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties.

Staff enabled patients to give feedback on the service they received through regular community meetings; we reviewed minutes from these meetings. The provider was proactive in addressing concerns or queries that were raised by patients.

Staff ensured that patients could access advocacy.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff carried out regular risk assessments of the care environment. Staff had mitigated the risks of ligature points adequately. All patients who entered the service had a thorough risk assessment completed prior to admission and had no current or recent ligature risks.

The service complied with guidance on eliminating mixed-sex accommodation and male patients had separate bedroom and bathroom facilities. However, some patients continued to share bedroom space, which does not meet current best practice for dignity and privacy. This was mitigated by a robust pre-admission process that ensured patients were fully informed of any room-sharing requirements prior to admission.

Staff had easy access to alarms and patients had easy access to nurse call systems, alarms were present in all rooms.

Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

At the time of inspection, there were no vacancies at Newmarket House. The service employed their own bank nurse and support worker for use when needed. Bank staff completed the provider’s induction programme and had priority choice of all available shifts. Agency staff were used to fill 17 out of 910 shifts in the 3-month period prior to inspection. When agency staff were used, they used staff who were familiar with the service.

Staff sickness in the three months prior to inspection was 3.4%, and in the same timescale, no staff had left the service.

Newmarket House also offered placements for third year students studying BSc (Hons) Mental Health Nursing degrees, occupational therapy placements for students at both undergraduate and master’s levels and placements for Psychology students from the local university.

Staff had received and were up to date with appropriate mandatory training and the training was appropriate for the patient group using the service. At the time of inspection, mandatory training compliance was 100%.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. Any ‘clean’ stickers were visible and in date. All areas were clean, had good furnishings and were well-maintained. The service was decorated to a high standard and had a homely feel. Patient artwork was displayed throughout the building.

Cleaning records were up to date and demonstrated that the ward areas were cleaned regularly.

Staff adhered to infection control principles, including hand washing.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed good practice in medicines management, including transport, storage, dispensing, administration, medicines reconciliation, recording and disposal, and did it in line with national guidance. The service did not store controlled drugs on site.

Staff involved patients in the prescribing and reviewing of their medicines. They helped them understand how to manage their medicines safely. Patients told their medicines were explained to them before treatment started, including any side effects. We saw examples of this in patient’s records.

The service had policies related to medicines in place. For example, medicines management and prescribing.