We rated Newmarket House as requires improvement because:

• the ward environment was unsafe. Although some ligature points had been identified, and action taken to minimise the risk to patients, other ligature points had not been identified. There were poor lines of sight on wards and the hospital had not mitigated these risks
• arrangements for storing medicines were unsatisfactory. The nurse manager’s office was in the clinic room where medicine was stored. Some medicines were kept inappropriately in a fridge with non- medical items such as food
• some patients’ bedroom carpets were marked and needed to be replenished. Some bedroom walls and woodwork needed repainting, and were faded and worn. Redecoration might help promote recovery and comfort
• the hospital placed blanket restrictions on patients. For example, around the use of mobile phones, the need to keep patients’ personal items tidied away daily, and the use of hair dye
• patients’ risk assessments were not detailed including one in which details of self-harming behaviour and interventions were not recorded
• staff did not do enough to inform patients or engage them in decision-making. Some patients’ care records did not include patients’ or staff comments where patients disagreed with aspects of their care or refused to sign care plans. Care records contained limited evidence that people’s capacity to make decisions about their treatment was assessed. Patients’ information pack were not welcoming or user-friendly. Staff were not aware of advocacy services, although all patients interviewed knew how to access advocacy services
• there was a lack of food and nutrition assessment and monitoring. Nutritional monitoring is vital for this patient group
• the hospital did not manage risk well. Staff and management differed in their understanding of which risks should be reported. Staff told us that they would like to receive more feedback from incidents that had been investigated
• the approach to service delivery and improvement was reactive and focused on short-term issues. Improvements are not always identified or action not always taken
• there was a limited range of rooms for patients to meet their visitors
• complaints procedures were lengthy and complicated
• access was limited to the first floor. There was no lift. 

However:

• there were enough staff and appropriate use of bank staff
• resuscitation equipment was checked regularly and in good order
• staff prepared holistic care plans and reviewed them regularly
• patients were offered a wide range of activities and therapies
• staff received specialist training for their role
• staff and patients interacted positively and staff understood individual patients’ needs and preferences
• patients’ food was of a good quality, healthy and nutritious.
• most staff had worked at the service for several years and knew the patients and hospital well
• most staff said there were good team work, mutual support and visible leadership.