Welcome House - Nickleby Lodge

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

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

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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

We found there was a lack of any clear vision for the service. People living at Nickleby Lodge had done so for many years, and there had not been full consideration to how people could be supported to have the best possible quality of life that supported them to achieve the things that mattered to them. People did not have any recorded goals or aspirations from their care, and there was a complacency that their being in poor mental health was routine and therefore did not need to be monitored or learned from to support their wellbeing. When asked about how the service were supporting people’s mental wellbeing, management responded that they were helping them access appointments with mental health services. There was a lack of acknowledgement that supporting people’s mental wellbeing was also the responsibility of the provider, and there was a need to have a robust and person-centred plan in place of how this would be achieved.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

There was a lack of robust management at the service. Prior to our inspection a new manager had started, who had previously worked at the service as a senior carer. This person was going through the registration process with the Care Quality Commission at the time of the inspection and were still being supported by the previous registered manager. Management lacked clear knowledge about their responsibilities for ensuring robust and person centred care planning arrangements were in place, and for monitoring and learning where people where people experienced poor mental health or placed themselves at risk of harm. They had failed to proactively identify concerns or areas for improvement at the service, and audit and governance systems they had put in place were not effective.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff were confident that their voice was heard, and if they had any concerns they would be listened to and addressed. There was a whistleblowing policy in place guiding staff on how to raise concerns to external bodies such as CQC if they wished to do so. One staff member told us “The management give us room and space to share our opinions and concerns, and I believe they would be listened to and acted upon”. Another staff member added “Management are supportive and accessible. I am very happy at Nickleby Lodge”.

The provider valued diversity in their workforce. They did work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

All staff had received training around equality and diversity and told the inspection team they felt supported working at Nickleby Lodge. They felt listened to and involved in the running of the service, such as through regular team meetings to share information. Staff stated they were treated with respect at all time.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance systems in place were not robust and had consistently failed to identify concerns found in the standards of practice and support . Regular audits of people’s care had not identified that care plans were insufficiently detailed or outdated, not person centred and placed people at greater risk of psychological or physical harm. They had not identified areas where the environment was unsafe or unsanitary. They had not ensured staff received appropriate supervision, or that their competency and knowledge was monitored consistently or robustly.

There had been significant failings in the monitoring of people’s care. Regular instances of anxiety and distress had not been recorded for several years in some cases, meaning there was no ability to analyse, learn or improve people’s outcomes.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people.

We found examples of the provider working collaboratively with partner organisations, however this was not always consistent. The provider had built a positive relationship with a local voluntary organisation, and several people attended regular events focused on wellbeing hosted by this group. They also engaged as part of the local Skills for Care Registered Managers to share learning with other providers. There were also some good examples of referrals being made proactively, for instance for one person who had recently deteriorated in health significantly and had involvement from multiple organisations involved in their care. However, other referrals to manage people’s complex health and care needs in the safest way had been missed. There was insufficient guidance around at what point referrals should be made to wider health and care professionals to ensure people’s needs were being safely managed. For example, one person had diabetes but there was no guidance on their safe blood sugar levels and when staff might be concerned that it was not being well managed. Other people had a risk of constipation but no guidance on at what point this would be unsafe and require medical advice, risking leaving people in profound discomfort and potential harm.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people.

Opportunities were consistently missed for learning. Where incidents were reported, there was no detailed analysis to determine any opportunities to learn from these or improve people’s care. People were routinely in distress, but this was not appropriately recorded or monitored. This meant it was not possible to analyse these to identify if these reflected an unmet support need, or situation in their life where staff needed to provide additional support to promote their mental wellbeing.

The provider had failed to sustain improvements since the last inspection. Breaches of regulation identified had not been met, and we identified further breaches of regulation demonstrating a significant impact on the lives of people at Nickleby Lodge.