Nelson House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff treated people with kindness, empathy and compassion, and respected their privacy and dignity.

We observed some kind and caring interactions from individual staff. On person told us “The staff here work so hard, they really do care and look after me.” A relative said, “The level of care provided by the staff is excellent. [Person] is always looked after.” When people became upset, we observed staff showed compassion and provided emotional support and reassurance.

Staff protected people’s privacy and dignity. A person told us, “Staff support me to have a wash, they always respect my dignity, giving me a towel to cover up.”

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

There was limited evidence of people being supported or encouraged by staff to engage in meaningful activities of their choosing. We observed people who sat in the lounge watched TV on all 3 days we visited. People who remained in their bedrooms did not receive support to engage in meaningful activities, other than the radio being played in their bedrooms. One person told us, “There isn’t a lot going on here really there isn’t anything to do.” A relative told us, “The care is task focused, there could be more activities.”

People with specific needs did not have these met in relation in relation to the food provided. The menu and food choices did not take into consideration people’s cultural needs, and those who required a modified diet. The provider had not considered people’s needs in respect of the environment. Some people lived with dementia, but best practice guidance for creating a suitable environment for people had not been considered.

However, people and relatives told us staff did their best to meet their individual needs. One person said, “The staff know what I like and my routine, so they support me the way I want them to.” A relative told us, “I cart praise the staff enough they meet [person] needs and know [person] very well.”

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

The provider did not ensure people had choice or control over the way they spent their day, or the food provided. There was limited evidence to support people were consulted about the meals provided and the provision of activities. People did not have control regarding living in an environment that was unsafe and unclean, and which did not promote their independence. People’s choice regarding when to get up from bed was limited due to staffing pressures, and people often had to wait for support.

However, people told us staff did try and encourage them to be independent in aspects of their daily life, such as when providing support with personal care. People who were able to, went out in the community when they wanted to, and people were encouraged to make their own drinks and snacks. People could also access the garden independently and smoke when they wanted to without restriction.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Although staff tried their best, we observed times where people had to wait for support. For example, during busy periods, such as in the mornings and at mealtimes, people often had to wait for support from staff. Staffing pressures and task allocation meant there were times when staff were not present in communal areas to observe or respond promptly to people who required reassurance or assistance.

However, when staff were available, we observed them responding kindly and promptly to people who were distressed, or seeking attention, offering reassurance and support to help them feel safe and settled.

The provider did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.

The provider did not support staff in their roles. The previous manager had left the service in January 2026 and had not yet been replaced. A senior staff member acted up into the manager’s role, but they did not receive support in this role and in relation to completing governance tasks from the provider.

Workforce wellbeing was not proactively considered. For example, some staff worked multiple 12-hour shifts in a row. Staff told us they had limited breaks, due to limited staffing levels. This placed staff at risk of stress and fatigue relatederrors. Some staff described feeling under pressure and frustrated at not being able to meet people’s needs in a timely way due to insufficient staffing levels. Comments included, “People have to wait for support such as pressure relief, as we cannot get to everyone in time.’ and, “We don’t always get chance to provide people with a shower or bath.”

We received feedback from people and relatives with one person stating, “The staff team try their best in difficult circumstances”. A relative said, “The staff do their best and they are all friendly and kind, but they can only do so much.”

However, even where staff sought to provide a good level of care, they were not able to meet people’s individual needs due to systemic provider failures.