Welcome House - Nickleby Lodge

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.

The service was in breach of legal regulation in relation to 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.

The provider did not treat people with kindness, empathy and compassion, or respect their privacy and dignity.

We saw some kind and caring interactions during our visit, and people and their relatives spoke positively about the individual staff who worked with them. During the inspection we saw one member of staff patiently support a person with limited mobility, and another member of staff was playing scrabble with a person which we were informed by relatives was an activity they enjoyed. When people came into the office they were spoken to with kindness by management and given an opportunity to discuss their day. One relative told us “Staff are very kind, and know my relative well”. However our observations were that people often went long periods of time without engagement.

The service itself was not consistently caring. One person had been living in extremely undignified conditions for multiple weeks in a room which had an overpowering odour of urine. Only after our inspection was this remedied, and management had not recognised how unacceptable these living conditions were. We found people’s clothing was being stored in a damp and dirty shed due to lack of space in the laundry, which was disrespectful of people’s personal belongings.

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. The provider had failed to recognise the importance of having consistent meaningful and life affirming activity to promote mental wellbeing.

Although we saw some examples of people being enabled to take part in activities that were meaningful to them, there was no structured plan around this, or record of what people wanted to achieve from their own care in the longer term. People had keyworkers who were responsible for coordinating their support, however It was not specifically recorded how they had engaged with people or involved them in their own care. We found people were not empowered to have any documented goals or aspirations, and there was no record of how people had been involved in their own care, what their wishes were and how the provider had accommodated this. This meant we could not see evidence that people’s care plans and key worker records were written about them rather than with them.

The service had developed activity planners with people. Two people had recently attended the cinema together which had been a big achievement, and others attended a local mental health café every week. But there was no formal structure or plan in place to build on this and to promote independence or grow people’s confidence in participating in their wider community.

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.

We saw people treated Nickleby Lodge as their own home, and were able to use the space as they wished including socialising with staff and peers and spending time in their own room or communal areas. People were able to come and go throughout the day. One person came into the office and spoke with management about wanting to go out and get a manicure, and staff supported them to do so at a time of their choosing. This was a positive example of staff supporting somebody to take pride in their appearance. We saw people proactively encouraged to make their own food, and be in control of their own day and how they wished to spend it. There were regular service user meetings which allowed people opportunity to get together to design menus or suggest activities they would like to take part in, as well as be involved in the running of the service.

However we also saw examples where medications were not been managed in the least restrictive way, and that assessments against the Mental Capacity Act were not clearly recorded to demonstrate how they had been conducted. Opportunities had been regularly missed to involve people in their own care

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.

People’s relatives told us they felt staff understood their loved ones and would be able to respond in a sensitive and appropriate way to their support needs. However, there was little robust guidance setting out how specifically staff should respond, for example if a person was in a mental health crisis. We were told and saw from care notes that people suffered regular instances of significant distress or anxiety, but the records of these did not reference what the response of staff to this was or if that had been effective. Additionally we found examples of people placed in undignified situations or at being risk of being placed in these situations, to which staff had not or could not respond. For example, one person being found in a deeply unsanitary room, or the risk of people falling and being unable to call for help due to emergency alarms being tied out of reach.

The provider cared about and promoted the wellbeing of their staff.

Staff were largely positive about the support they had received, and explained when they stared working at Nickleby Lodge they were given the opportunity to get to know people and read their care plans before starting providing care. One staff member stated, “It’s been brilliant. I have learned a lot working here and love my service users. When I started I was given plenty of time for learning. Management are very good, they listen and I can approach with any concerns”. There were arrangements in place where staff could access support from an on-call manager out of hours, and staff felt comfortable in using this and that they could access support at all times.