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Welcome House - Nickleby Lodge Requires improvement


Inspection carried out on 7 November 2019

During a routine inspection

About the service

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

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.

Inspection carried out on 18 April 2017

During a routine inspection

The inspection was carried out on 18 April 2017, and was an unannounced inspection.

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.

Inspection carried out on 05/05/2015

During a routine inspection

We inspected this service on 5 May 2015. This was an unannounced inspection.

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. At the time of our inspection 7 people were living in the home.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not always motivated, encouraged and supported to be actively engaged in activities inside and outside of the home. For example, people sat down watching TV, or doing nothing in the home throughout our visit. We have made a recommendation about this.

People were protected against the risk of abuse; they felt safe and staff recognised the signs of abuse or neglect and what to look out for. They understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs. There were risk assessments related to people’s mental health and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Staff had been provided with relevant training and they attended regular supervision and team meetings. Staff were aware of their roles and responsibilities and the lines of accountability within the service.

The registered manager followed safe recruitment practices to help ensure staff were suitable for their job role. Staff described the management as very open, supportive and approachable. Staff talked positively about their jobs.

Staff presented themselves as caring and we saw that they treated people with respect during the course of our inspection.

The manager understood the requirements of the Mental Capacity Act and Deprivation of Liberty safeguards and the home complied with these requirements. Medicines were administered safely to people. People had good access to health care professionals when required.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Health care plans were in place and people had their physical and mental health needs regularly monitored. Regular reviews were held and people were supported to attend appointments with various health and social care professionals, to ensure they received treatment and support as required.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive and inclusive atmosphere within the home and people were encouraged to be involved in their care.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the commission.

Inspection carried out on 14 October 2013

During a routine inspection

There were five people living in the home. We spoke with four of the people who lived at Nickleby Lodge. They told us they were happy living there and that staff looked after them well. We saw that they were comfortable with the manager and staff who were supporting them. The atmosphere in the home was calm and relaxed.

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.

Inspection carried out on 30 October 2012

During a routine inspection

There were six people living in the home at the time of our visit. There was 24 hour support provided. People told us they were happy living in the home. They said, "The staff help us, I like it here." "The food is good, there is always a choice." "I choose what I want to do." "I feel safe here."

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.

Inspection carried out on 17 November 2011

During a routine inspection

People told us that the care and support they received was good and they chose to come and go as they liked into the community.