Welcome House - Nickleby Lodge

Nickleby Lodge is a residential care home providing accommodation and personal care for up to 10 people with a mental health condition. People receive care in one adapted building that had a communal lounge and kitchen facility. At the time of our inspection five people were living at the service.

People’s experience of using this service and what we found

People were at risk because of a lack of staff, particularly at night, available to care for them. People told us there were times they could not go out when they wished due to staff shortages. Although people received the medicines they required, improvements were needed to medicine practices to ensure they were safe. People lived in an environment that was not well maintained or clean and as such could present a potential risk to them. People were cared for by staff who did not always feel supported or have the opportunity to discuss their role with their line manager. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, despite staff following the principles of the Mental Capacity Act 2005, they did not have a good knowledge of the code of conduct with regard to this.

Despite quality monitoring audits taking place, these were not robust and had not led to an improved service for people. The service did not give people the opportunity to achieve goals and aspirations.

People were assisted to remain healthy and access health professional involvement when needed. They told us they were cared for by kind and caring staff and this was evident to us during our inspection. People said they could attend activities outside of the service and they liked living at Nickleby Lodge. People said they felt safe and they knew who to speak to should they have any concerns. People were supported to choose their meals and had input suggestions into the general running of their home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (report published 6 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. We found three breaches of regulation. Please see the Safe, Effective and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nickleby Lodge is registered to provide accommodation and personal care for up to 10 people with mental health needs who do not require nursing care. Accommodation is provided in a semi-detached house in Rochester. The service is situated in a residential area close to the town centre. There is a mainline rail station and bus routes close by. At this inspection, there were six people living in the service.

At the last Care Quality Commission (CQC) inspection in 05 May 2015, the service was rated Good in all domains and overall with Requires Improvement in Responsive domain because we had made a recommendation to the provider about providing diverse meaningful activities.

At this inspection we found the service remained Good.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

People continued to be safe at Welcome House - Nickleby Lodge. People were protected against the risk of abuse. People felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for. Medicines were managed safely and people received them as prescribed.

Staff followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The registered manager ensured the complaints procedure was made available to people to enable them to make a complaint if they needed to. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

People were treated with respect and their privacy and dignity was upheld. People were involved in planning the kind of support they needed.

People received support that was well planned and sensitively delivered.

People received the medicines they needed, when they needed it.

Robust recruitment and selection procedures ensured that people were supported by suitable staff.

Effective quality assurance procedures ensured that people were provided with a good service.

Overall we found that this service was safe, effective, caring, responsive and well-led and had achieved compliance.

We have included some comments that the provider may find useful to note to make sure that the people who live at Nickleby Lodge continue to receive a good service.

The service made sure people were able to make their own decisions about their care and treatment. We found that the care and support that people received was well planned and sensitively delivered. People were supported to eat a balanced and healthy diet, they were given choice and had their preferences taken into account. The home was clean throughout. Staff were given appropriate professional development to enable them to understand people's needs and provide appropriate care and support.