We rated Nelson Trust as good because:

• Staff were proactive at identifying and managing risk. There were effective systems in place to ensure the management of clients’ risks. Risk assessments and recovery plans were personalised, thorough, and understood by all staff. All staff understood how to report incidents and near misses. Managers reviewed incidents in governance meetings and involved staff in discussing the learning from incidents and implementing change. Incidents were also reviewed by the risk and assurance team.

• The premises were safe for the clients. The managers had completed ligature and environmental risk assessments on the premises in 2018. These were reviewed every six months.
• Care plans and crisis plans were up to date or comprehensive to assist the teams to deliver safe care and treatment to clients. They were holistic, personalised and promoted recovery and met the individual needs of each client. They included physical health care checks from clients’ GPs.

• Clients and their families were encouraged to work together. Families were offered weekend workshops to assist and understand their relative’s recovery. Family members spoken with were very positive about this.
• The service ensured clients were integrated into the local social networks, employment and education opportunities. Many clients remained in the local area after completing their treatment and became part of the community.
• The service ensured there was a wide choice of treatments and clients’ individual needs and preferences were central to the planning and delivery of tailored services. There was an education academy where clients completed educational courses in conjunction with the local college. There was also a maintenance team in the service where clients could learn new skills.

• Senior managers in the service demonstrated clear, effective and inclusive leadership with a strong sense of direction and objectives. All staff spoken with were aware of the developments and direction of the service.
• The board of trustees, the senior management team and the Chief Executive Officer were visible across all sites. They visited the houses and attended community meetings. Clients and staff were confident they could raise concerns with any of the senior management team and they would be acted upon.

However:

• Staff members did not ensure clients had access to advocacy services.

People told us “I feel I get respect from the staff”, and, “I feel respected and that the staff care”. They said they were involved in developing their care plan which was tailored to their individual needs. People were positive about their experiences at Nelson House and told us that the program was working for them.

People's needs were assessed and care was planned in relation to this. Comments from people about their care included, “This is a safe place. There is a lot of love and care here”, “It is good here, it feels positive”, “I get a lot out of the groups. The support is really good”. People were able to attend groups and therapeutic one to one sessions which addressed their specific needs. Where a need for specific domestic abuse work was identified the provider arranged training to meet this need.

Medicines were managed safely. We identified a safety issue with medicines and the provider took immediate action to rectify this.

There was a suitable mix of experienced and qualified staff who were able to access additional training and supervision as required.

The provider had an effective system in place to monitor the quality of the service.

We carried out this inspection to ensure improvements had been made. We found that the environment was clean and hygienic and appropriate guidance was available to support this.

We spoke with three people engaged in treatment at Nelson House and two members of staff. We looked at three people’s care records.

People felt respected and treated considerately. They understood the conditions of their treatment and any sanctions if the therapeutic contract was broken. They were able to make choices about their treatment.

People were active participants in planning their care and their goals were discussed and reviewed every three weeks. There was a range of activities and educational services which people could undertake.

The home was clean and tidy but we had some concerns about the lack of appropriate guidance to people on minimising the risk of infection or spread of infection.

People were supported by staff who were trained, supported and committed.

The provider had a system in place to monitor the quality of the service.