We rated Suttons Manor as good because:

• Wards had sufficient numbers of nurses on all shifts. We reviewed the duty rotas for the previous six weeks. These showed that the provider was meeting staffing establishment numbers. Staff had received up-to-date mandatory training. The current mandatory training compliance rate for the service was 80%. The provider had a mandatory training action plan to improve mandatory training to meet the provider’s target of 95%. Staff received supervision and an annual appraisal in line with the provider’s policy. We reviewed the supervision and appraisal records and found that staff compliance was 100%.
• Staff knew how to use the whistleblowing policy. Staff we spoke to told us that they would feel confident in raising concerns without fear of victimisation. Staff told us they felt that managers would deal with concerns appropriately. Staff are open and transparent and explained to patients when things went wrong. We reviewed the incident reports the saw evidence within care records that staff had discussed with patients when things went wrong.
• Patients received a comprehensive and timely assessment of their needs. Staff used the information gathered during this assessment period to formulate care plans. Patients had good access to physical healthcare. The provider employed a physical health care nurse who worked at the service three times a week. The provider also had a GP who visited the service once a week. Patients’ were involved in the planning of their care. Care plans had a section where patients could comment. Patients attended care review meetings where they could discuss their care plan and any changes they felt needed to be made. Families and carers were involved in patient care. The provider offered family and carers one-to-one sessions and they also invited them to patients’ care reviews.
• Patients knew how to complain. Staff provided patients with information on how to make complaints within the admission pack. Staff knew how to handle complaints appropriately. Staff we spoke to were able to explain what action they would take if a patient made a formal complaint to them.
• The food was of good quality. All the food was prepared on site each day. Patients we spoke to told us that the food was excellent and there was always a choice if patients did not like what was on the daily menu.

However:

• There were ligature points throughout the wards, including the bedrooms and the bathrooms. The provider had completed a ligature audit and risk assessment. However, this did not include all ligature anchor points and the actions staff would take to mitigate each risk.
• Staff did not always update risk assessments following incidents. Staff did not always document all identified risks within the risk assessments such as when patients were subject to multiagency public protection arrangements. Staff did not complete seclusion documentation appropriately. Staff had not documented 15 minute checks on a patient in seclusion.

When we inspected Suttons Manor on 10 January 2014 we found that people were asked for their consent and the provider acted in accordance with their wishes. One person spoke about their medicines and said, "I told them I didn't need them anymore and so they took me off them."

We found that assessments of people's capacity to consent had been carried out and that appropriate certificates had been completed in relation to their capacity. We noted that Second Opinion Appointed Doctors (SOAD) had been used where this was necessary and in accordance with legal requirements.

People had access to an Independent Mental Health Advocate (IMHA) to help them to participate in decisions.

People's care and treatment was planned and delivered in a way that ensured their safety and welfare. We found that risk assessments were comprehensive and resulted in specific measures being put into place to manage those risks.

People told us they were involved in their assessments through meetings and one-to-one sessions. One person said, “Sometimes you get to talk a lot. You get to give your point of view.”

We found that medicines were stored securely and safely. We also found that medicines were subject of a robust and accountable ordering, administration and auditing system.

There were enough suitably qualified staff on duty at all times to meet peoples' needs. Staff numbers and skill mix were managed using an effective rota system.

People's records were accurate and completed in detail. Particular risks were prominently displayed in people's records in order to ensure staff were alerted to those risks.

We spoke with ten people as a group, and we had individual discussions with five people who use the service.

People we spoke with told us that they were able to raise any concerns with staff, or through the mental health advocate for the service. Everyone we spoke with said that they had no complaints about their treatment and their experience of the service. One person said,” This is an excellent hospital.” They also said, “I know my care plan, know why I am here.” Another person showed in discussion that they knew they had a care plan, and they knew a lot about their medication.

Everyone we spoke with said that they felt that they received treatment and support that met their needs, and supported them with the goals of moving into the community. People told us that they were involved in decisions about their treatment, and they understood their care plans, even if they may disagree with the plan. One person said, “They have really helped me since I have been here.” In our discussion this person was very clear on what had happened to them, why they were there and where they were going on discharge. They said that they had been fully involved in the planning meetings with community mental health services.

Everyone told us that there were a lot of activities available. One person said, “Who said that there are no activities in this place? There are loads.” One person told us that they did not attend any groups. However we saw evidence that therapy and other activities were scheduled for this person, but they chose not to attend them. This person then told us that they did attend two therapy groups that they enjoyed.

We spoke with two people who use the service. They said that there is an activity programme in place but the activities did not take place. One person said they did not feel safe and had felt threatened by some staff. The second person said he did not feel comfortable in the ward environment and that there is a bullying culture amongst service users. We were told that staff use their own mobile phones when at work and use social networking websites. One person said that they had made complaints about various matters previously but was given no feedback. The second person said he felt unhappy that he had not been able to attend an Islamic centre and was concerned that he was not fulfilling parts of his faith. They were complimentary about the service user meetings and the registered manager. Both people said that they received their Section 17 leave.

We rated Suttons Manor overall as ‘good’ because:

• Ward environments were clean, safe, and welcoming.
• The use of restraint was low because staff had the skills to support and de-escalate potential aggressive situations. The seclusion room was spacious and well-equipped. There were observation windows that staff closed to support patient’s privacy and dignity.
• The provider staffed the wards appropriately and managers were able to increase staffing numbers based on patient need. 24 hour medical cover was available and the provider employed a physical health care nurse to support and monitor patients with physical health conditions.
• The organisation learnt from incidents. Staff reported incidents and managers investigated thoroughly. Managers communicated lessons learnt to all staff and the wider organisation.
• Patients had access to psychological therapies and treatments in line with NICE guidelines. The provider used National Institute of Clinical Excellence (NICE) guidelines in prescribing and monitoring the use of medications.
• Ranges of staff disciplines were available to work with patients to achieve their mental and physical care outcomes. Staff had regular team meetings to share information about how to support individual patients and discuss any issues that they had found.
• Staff were kind and respectful to patients and always took into account their personal, cultural and religious needs.
• Managers supervised staff regularly to ensure that they were up to date with mandatory training.

• The provider had a ‘ward to board’ initiative in place where staff and patients could feed back any concerns that they had. Staff knew the whistleblowing policy and told us that they felt confident that senior staff would manage their concerns appropriately in a sensitive and robust way without fear of victimisation.

However,

• There were blind spots in the bedroom corridors of the ward. Staff had used mirrors to reduce the risk. However staff would still find it difficult to see all these areas. Staff supervised patients when in the bedroom area to reduce any risks.