Welcome House - Nickleby Lodge

We found a culture where regular instances of distress relating to people’s mental health were not appropriately monitored or learned from to improve people’s quality of life. There was no robust plan or strategy of how people would be supported to have maximum wellbeing, or a clear focus on rehabilitation or recovery.

Risks to people posed by their physical or mental health were not always appropriately managed. Risk assessments and care plans were often outdated, missing or did not contain sufficient detail to ensure staff would be able to safely or consistently support people. There was not always clear detail of how staff should work together to protect people from the risk of harm or prevent their health from deteriorating further.

There were sufficient staff employed who had been safely recruited and were knowledgeable about the needs of the people they supported. However, systems to assess their ongoing skills and knowledge needed improvement.

Further steps were needed to ensure people received care that was always person centred, and people were not always involved in their own care. People were supported to have independence and felt at home at Nickleby Lodge, but were not empowered to have any goals or aspirations or supported to plan for the future.

The environment was not always safe or clean, and governance systems had not been effective at identifying shortfalls in care identified at this assessment. There was a lack of robust management and leaders did not understand their responsibilities to provide care to individuals with a mental health condition in line with best practice. The service had a poor learning culture where opportunities were not proactively sought out to continually improve people’s experience or quality of life.

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. There was not clear understanding of this guidance, and it was not reflected in practice.

We identified 6 breaches of legal regulation in relation to person centred care, dignity and respect, safe care and treatment, premises and equipment, good governance and staffing. The breaches around safe care and treatment, good governance staffing had also been identified at the previous inspection but improvement had not been made. In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded