Welcome House - Nickleby Lodge

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care.

This service scored 43 (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 always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

There was no evidence of people being involved in their own care, or that it was regularly reviewed with them to ensure it continued to meet their wishes and expectations. It was not clear to what extent people wished to be involved or how this had been explored with them. The guidance in place for staff on how to support people was generic and did not reflect people as individuals with their own needs, strengths and ambitions. Where people had complex health and care conditions there was no clear guidance on what this meant to each person, how they wished to be supported to manage it or how staff could help them stay healthy and well.

One person was autistic and another person had a learning disability. Both of these people had a single line reference within their care plan to this, with no further detail of how this presented, how it affected them in their day to day life and any support they might need to overcome barriers participating in society. The provider failed to demonstrate a knowledge of Right Support, Right Care, Right Culture and put in place any level of structured plan to ensure they were able to live meaningful or empowered lives that allowed them to engage in their own community as equals.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. There was a consistent staff team in place, who generally knew people and their needs well. However, there was no clear plan of how they would receive care that reflected them as an individual. There was no collective understanding of what people’s health and care needs were, how they wished to be support or how this should be achieved in a person centred or consistent way.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was some limited guidance about how staff should communicate with people in a way that they could understand, was compassionate and would support them to make choices about their own care. However, this was brief on detail and did not take account of people’s individual needs. We saw a recent service user meeting record had been designed in Easy Read, but no other documents we saw were and it was not recorded if anybody required information in this format. One person had dementia and the guidance in place simply stated for staff to be understanding and reassure this person. This didn’t explain how staff might effectively provide this reassurance, for instance by highlighting techniques or strategies that had proved effective in the past. There was also no reference to how this person’s mental health diagnosis would interact with their dementia and affect how staff might need to communicate in certain circumstances. This was despite them becoming frequently distressed and needing reassurance.

People’s families told us that they received open and proactive communication from the provider, such as if their health deteriorated. One relative explained, “Management are responsive and always keep me up to date”. However, we found that the provider was not keeping sufficiently accurate or detailed records of people’s care. When people’s needs changed documentation was not always updated, and instances where people’s mental health deteriorated were not consistently recorded.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

There were opportunities for people and their loved ones to share feedback. These included yearly surveys and regular service user meetings. We saw recent meetings had taken place which gave people a chance to raise any concerns and come together to share ideas whilst receiving updates relevant to them such as guidance on the weather or outbreaks of seasonal infections.

However, there was no consistent evidence that people had been actively involved in their own care, and care plans were written about people rather than with them. Although there were some examples of relatives being involved on their behalf. Keyworkers produced a monthly summary of people’s care but these were often identical from month to month. They did not demonstrate they had engaged with people to understand if the care they were receiving was continuing to meet their expectations, or what those expectations were

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. People were supported to regularly access appointments with health and care services, including GP, dentistry and mental health services. They were able to access the wider community when they wished to do so, and we saw people coming and going as they wished through the day. However, it was not always clear what care and treatment people needed, and in some cases we identified people’s health had deteriorated without an appropriate referral being made to access the support they needed for example around the risk of malnutrition or choking. People were living with complex mental health needs but without any clear, written plan of how the service would promote their ongoing wellbeing, rehabilitation or recovery.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. The service was supporting people living with a mental health condition, a learning disability or autistic people and therefore faced significant inequalities in their day to day lives. However, there was no clear evidence the provider had discussed with people the outcomes they wished from their care, or that they had put in place a robust plan to support them in breaking down barriers to participating in society. By failing to record meaningful records of people’s mental health for several years on the basis of people’s distress being normal, they were failing to fully explore contributory factors that could alleviate this and promote improved mental wellbeing.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. There was no evidence the provider had worked with people to actively plan for the future. People did not have any meaningful goals or aspirations recorded setting out what they wanted to achieve from their care. One person had a goal of living independently in the future recorded in their care plan, but management informed us this would be impossible due to their mental health needs. They had not put in place any strategy or plan for how this person’s independence could be maximised. Instead, the goal had remained in their care plan despite us being told it was unachievable, with no evidence it was being reviewed.

We identified people were living with complex physical and mental health conditions, which made the importance of proactively and sensitively discussing end of life care to document and wishes people may have in this regard. However, this was not happening and we could see no evidence that people had been given the opportunity to discuss this