Welcome House - Nickleby Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 42 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

People’s care was not regularly reviewed when their health or care needs changed or deteriorated. For example, one person’s mental health had declined significantly in recent months, and they had been described as in a state of extreme delirium for multiple months. Their mental health care plan contained no reference to this and had last been updated in October 2025, meaning there was no up to date written plan of how staff should respond to this or help maintain their mental wellbeing. Their physical health had also declined including frequent urinary tract infections which could further exacerbate their delirium. There was no guidance or information on how this person may present, or how their deteriorating physical health may affect their mental health.

Another person had significant unaccounted for weight loss over the last year and had an extremely low appetite. Despite this, there was no information or plan of how staff could work with them to ensure they received the nutrition they needed to avoid losing further weight. Their care plan was instead focused on the risk of obesity and the need for healthy eating, when the risk of malnutrition was far higher.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

It was not always clear what the best practice guidance was for staff to manage people’s complex health and care needs in a way that was safe and personalised to them. In some instances there was a sufficient level of detail and there had been regular involvement with health professionals to ensure this remained up to date. However for other health conditions there was a lack of information on how staff would manage this safely, or the information in place was generic and not up to date. In the majority of cases staff did know people and their needs well, but we could not be assured if this was in line with appropriate guidance because of a lack of sufficient detail in their care plans.

The provider did not consistently comply with statutory guidance for supporting people with a learning disability or autism, such as Right Support, Right Care, Right Culture or STOMP. All people being supported had a complex mental health condition including schizophrenia or bipolar, but there was no plan of how the service would proactively focus on supporting their mental wellbeing and having maximum control over their own lives.

The provider did not always work well across teams and services to support people.

Staff told us they had strong professional bonds with their colleagues and felt safe and empowered working as part of a team. One staff member told us, “I think our strength is how we all work together and the zeal we have for supporting people and growing together as one family”. People and relatives trusted the staff teams who worked with them. A relative told us “No concerns whatsoever. Communication is great and I couldn’t fault them at all”.

Staff told us they were in the main able to explain how they would support people to manage their needs. However, because there was a lack of appropriate guidance in place we could not be assured this was correct or aligned with how each person should be or wished to be supported.

Referrals to wider health and care organisations when people’s needs changed were inconsistent, and the guidance to support when to do so was not robust meaning we could not be assured people’s transition between services would be seamless. For example, we identified hospital passports in people’s care records that were significantly out of date and referenced discontinued medications.

The provider did not always support people to manage their health and wellbeing, so peoplecould not always maximise their independence, choice and control. Staff did not always supportpeople to live healthier lives, or where possible, reduce their future needs for care and support.

We saw some examples of positive action being taken to support people in managing their health needs, and leading healthier lives. The fridge was well stocked with fresh and nutritious ingredients, and people were being supported to manage their own food in a person centred and balanced way. People were supported to regularly access health appointments with physical and mental health services, and in the majority of cases appropriate referrals were being made where people’s health needs deteriorated.

However, there needed to be a stronger focus on preventative strategies to support people’s ongoing health and wellbeing. Care plans were either not in place for complex conditions or they lacked appropriate detail. For example, multiple people were at risk of falling, but guidance focused entirely around what staff would do if a person did fall rather than how to prevent them from falling. One person was at risk of falls and guidance encouraged staff to support them in walking for 10 minutes a day to help them stay mobile. There was no evidence that this was actually happening and staff had not recorded this. Staff were knowledgeable about how to support people and could explain about how they would help people stay healthy, however we could not be assured that reflected best practice guidance for each person.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There was a lack of robust monitoring of people’s complex mental health needs, or a clear plan of how staff should do so. Instances such as people waking up in extreme distress frequently, or people being in a state of delirium for days at a time were not being recorded, analysed or learned from. High risk antipsychotic medications were being given in response but with no monitoring of if these were effective of the least restrictive option. There was no robust plan of how people’s mental wellbeing would be promoted by regularly exploring the things that mattered to them or brought them meaning. One person was described as requiring regular focused 1:1 conversations about their wellbeing each week, but these were not being recorded. This means there wasn’t clear monitoring of their progress or deterioration with their mental wellbeing. Management informed us that conversations happened during tasks such as personal care or meal preparation, rather than setting aside any specific time to talk to people about their emotions or wellbeing. However these were not clearly recorded so we could not confirm they were happening.

The provider did not always tell people about their rights when delivering care and treatment.

Staff had a good understanding of consent, and people had choice in their day to day lives including around how they wished to spend time and choosing to decline care. They had received appropriate training in this area and care records we reviewed always documented where people had chosen not to consent to care and that it was appropriately recorded and respected by staff

However, where the provider had assessed people to lack mental capacity to make decisions for themselves, this were not always recorded in a robust way that demonstrated how they had reached this conclusion. For example, multiple people were assessed as lacking capacity to manage their own personal care. The assessments did not record an actual conversation with the person, or that anybody had been involved to advocate on their behalf. Instead they recorded people as lacking capacity because they may require prompting to perform the task, or that they may choose not to undertake personal care. Neither of which in itself demonstrated that they lacked capacity, or that this had been considered more holistically.