Lilias Gillies House

Lilias Gillies House is a residential service providing accommodation and therapeutic support to people with mental health needs. The service is registered to support up to 20 people in one adapted building. At the time of our inspection there were 13 people living in the service.

People’s experience of using this service and what we found

People felt safe and well supported. The provider assessed and managed people’s risks. Staff were recruited using procedures to ensure they were safe and suitable to provide care and support. The care home environment was clean and safe and the registered manager ensured health and fire safety checks were carried out regularly. Medicines were stored appropriately and recorded accurately. Lessons were learnt and improvements were made when things went wrong.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service was well led. People and staff expressed confidence in the registered manager who had implemented changes leading to improvements. There was an open culture at the service and people felt empowered. People told us staff helped build their confidence and promoted their independence. Quality assurance systems and processes were in place to monitor and drive improvement. The service worked in partnership with others to meet people’s needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 April 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lilias Gillies House is a residential service providing accommodation and therapeutic interventions to 10 people with mental health care needs at the time of the inspection. The service can support up to 20 people in one adapted building.

People’s experience of using this service and what we found

People did not always experience a service that was safe, because the provider was not following national guidance to protect them from the risk of being infected with COVID-19. Although the provider had clear reasons for this, they were not able to provide us with evidence of an ongoing risk assessment process that took into account people’s individual risks and preferences.

Medicines were not always managed safely. Stock counts were not always accurate, meaning there was a risk of medicines going missing or being used unsafely.

There was not always evidence that incidents and action plans from the provider’s quality checks were appropriately followed up and action taken to improve the safety and quality of the service. Although this had improved since our last inspection, checks were still failing to identify some issues around safety and people told us things did not always improve after they raised concerns.

Other aspects of the service were safe. There were enough staff to support people safely. People had detailed and robust individual risk management plans that took into account how to restrict their freedom as little as possible while protecting them from harm. Although people told us they did not always feel safe, the provider had begun taking action to help people feel safer. Staff knew how to manage these risks, protect people from abuse and ensure the premises were safe to use. However, staff did not have training in emergency first aid so there was a risk they would not know how to respond to medical emergencies.

The service had an open, person-centred culture which meant people felt supported and listened to. People and staff had regular opportunities to feed back. The service had visible and flexible leadership and there was evidence of learning from the COVID-19 pandemic. Staff were clear about their roles. The provider shared information where appropriate in an open and transparent way with other agencies such as commissioners.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 19 July 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 and 31 May 2019. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance and safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lilias Gillies House on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lilias Gillies House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, in particular infection control and medicines management, and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what other action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People did not always experience care that was safe, because the service did not manage medicines safely in line with national guidance. Medicine stock levels were not always recorded accurately and the service did not always take appropriate action when people missed their medicines. Medicines were not always stored at the right temperature to keep them safe to use.

The provider did not maintain an appropriate level of cleanliness and food hygiene within the service, meaning people were at increased risk of acquiring infections.

A variety of meaningful activities was available, although there was only one planned activity a day and people did not always have enough to do. This meant there was a risk of people becoming bored and lonely. We have made a recommendation about giving people more encouragement to engage in activities.

Other aspects of the service were safe. People felt safe and knew what to do if they were worried about their safety. Individual risk assessments were in place to protect people from known risks and the provider carried out checks to make sure the environment was safe. There were enough staff to care for people safely and the provider checked they were suitable to care for people. The provider took action when accidents and incidents happened to prevent them from happening again.

The provider had a range of audits to check the quality of the service. However, the audits were not always effective because the provider did not always follow up on issues they identified or did not address them quickly enough. They did not identify or address the problems we found with medicines management and infection control.

People’s care and treatment was effective, because it was based on evidence-based assessments of their need and delivered in part by qualified mental health professionals. Staff were well trained and supported to ensure they had the knowledge and skills they needed. People were able to access the healthcare services they needed and received support to cook nutritious, balanced meals. People received care within a suitably adapted environment that met their needs.

People only received care and treatment they consented to. They planned their care in partnership with staff and received support to make choices about their care and daily routines. Staff got to know people well and developed good relationships with them, recognising their strengths and helping them feel valued. The service promoted people’s privacy, dignity and independence.

Care plans were personalised and took into account people’s personal and medical history, preferences and goals. Each person had a named member of staff to check their care was meeting their needs and help them plan for their future. Staff were receiving training so they would be able to provide end of life care if anyone who used the service became seriously ill.

People were able to make complaints if they wanted to and the manager responded promptly to any concerns. The manager listened to people’s feedback and used it to create a quality improvement plan. People and staff felt the manager was approachable and open.

There was a culture of equality within the service. People and staff were involved in running the service. Staff were clear about what their duties were and the manager was well supported by senior managers.

Rating at last inspection: The last rating for this service was requires improvement (published 25 September 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We have identified breaches in relation to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook an unannounced focused inspection of Lilias Gillies House on 4 September 2018 This inspection was done to check that improvements to meet legal requirements planned by the provider after our April 2018 inspection had been made. The team inspected the service against one of the five questions we ask about services: is the service well led? This is because the service was not meeting the legal requirement related to good governance at our previous inspection. The provider sent us an action plan which stated they planned to make the required improvements by 30 June 2018.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

A manager was in post, however, they were not yet registered with the CQC. An application had been submitted and was being processed. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to the management and leadership of the service. Quality assurance processes had been extended to ensure they monitored and reviewed all areas of service delivery. There was now a regular programme of audits completed and the manager had introduced systems to enable them to have greater oversight of the service and be aware of what improvements were required. Systems had also been strengthened to ensure the provider’s senior management team also had greater oversight of the service to ensure continuous improvements. The introduction of these new systems and processes had identified a number of areas that required improvement. Some action had been taken to address some of these concerns, however, at the time of inspection not all of the improvements had been made and action planning was still in progress. The provider had introduced additional systems to ensure people felt able to have open and honest conversations with the management team, and ensure they had confidence that any concerns raised would be appropriately investigated and dealt with.

Whilst improvements had been made some of these systems were relatively new and therefore we have not improved the rating for this key question as to achieve a rating of ‘good’ requires evidence of sustained and consistent good practice.

At our last inspection on 11 and 12 April 2016 we rated the service Good overall and for each key question. At this inspection on 10 April 2018 we found improvements were required and we rated the service ‘requires improvement’ overall for the key questions ‘safe’ and ‘well-led’.

The service did not have a registered manager in post. A new manager had been in post since September 2017 and their application to become the registered manager was in the process of being assessed. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Robust governance procedures were not in place and there were a lack of audits relating to care records, infection control and medicines management. This meant there was a risk that the provider was not consistently adhering to best practice guidance and there were not robust systems to monitor and improve the quality of all areas of service provision.

Individual risk assessments were undertaken and people were supported to manage and mitigate those risks. However, we found improvements were required to ensure robust health and safety procedures were consistently followed in line with best practice guidance.

The provider and service had been through a period of change since our last inspection including the introduction of a new chief executive officer and a new manager. The focus of the service had also changed to incorporate the principles of psychologically informed environments (PIE) and the introduction of respite and crisis admissions. PIE is an approach to improve the psychologically and emotional well-being of people accessing services.

There were processes in place to record and learn from incidents. Safe medicines management processes were in place and people were protected from the risk and spread of infections.

Staff supported people with their mental health recovery and to regain skills to develop their independence with the aim of moving towards less supported accommodation. People’s care records were in the process of being updated to be structured around the five areas of mental well-being. Care records provided information about people’s needs. Staff supported people with their health needs, including both their mental and physical health. People had free access to the kitchen and there was a rota in place for communal meals.

Caring working relationships had been built between staff and people using the service. People said staff were friendly and they were able to share a joke and have a laugh together. Staff adhered to the Mental Capacity Act 2005 and conditions in place relating to people’s care under the Mental Health Act 1983. People’s views and involvement was integral to service delivery. People were central to their care decisions and how they spent their day.

Staff supported people to build and maintain relationships with friends and family. Staff provided any support required with people’s cultural, religious or sexual preferences. People’s privacy and dignity was maintained.

There were sufficient staff to keep people safe and meet their needs. Safe recruitment procedures continued to be followed. Staff had the knowledge, skills and experience to provide people with the support they required. Staff received regular training and supervision. This included reflective practice sessions to discuss staff’s concerns, thoughts and any difficulties they were experiencing.

There were systems in place to analyse key performance data including incidents and complaints. Staff felt well supported and able to have open and honest conversations with the manager. People were invited to the provider’s head office to meet senior managers and people who use the provider’s other services. A complaints process remained in place and any complaints received were handled in line with the provider’s procedures.

Nevertheless, the provider was in breach of the legal requirement relating to good governance. You can see what action we have asked the provider to take at the back of this report.

At the previous inspection in January 2015, the service was not meeting the Regulations we inspected in the following areas: systems in place to assess and manage risks to people using the service were not effective; care plans at the service did not include clear objectives to show how people were working towards independent living; and the service did not have a registered manager. During this inspection we found the service had made improvements in these areas and were meeting the Regulations inspected.

The service provides residential care for up to 20 people with complex mental health needs. The service is a therapeutic community where people's needs were addressed through a therapeutic programme delivered within and supported by the community of people using the service. The programme was made up of individual and group psychotherapy sessions with practical and rehabilitative sessions.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People at the service generally felt safe. Staff knew how to respond to abuse and had completed safeguarding of vulnerable adults training. They knew how to report safeguarding incidents and escalate concerns if necessary. The service provided a safe and well maintained environment for people, visitors and staff. Risk assessments supported people’s needs and goals. There were sufficient numbers of staff to meet people’s needs. There were procedures and checks in place to ensure only suitable staff were employed. The management of medicines was safe.

Staff were supported with regular supervision and training. The service was working within the principles of the Mental Capacity Act 2005 (MCA). We saw evidence of completed mental capacity assessments, best interests meetings and the use of independent mental capacity advocates in care records. Staff had completed MCA training to support them to deliver appropriate care and support. People were supported to have a healthy diet and to maintain good health.

People’s comments about staff were generally positive. We observed positive and inclusive interactions between people and staff. People and their representatives were supported to express their views and were involved in making decisions about their care and treatment. Keyworkers provided additional support for people. There were regular individual and group therapy sessions for people where they could express their views and opinions and ideas about the day to day running of the home. Staff respected people’s privacy and dignity. People’s preferences for end of life care had been considered with them.

People received personalised care and support that was responsive to their needs. Care records and support plans identified people’s needs, risks and goals. There were regular therapy and keyworker sessions for people using the service to feed back their experiences. People were confident that they could raise concerns with staff and there was a complaints system in place.

Staff spoke positively about the management team and said they were approachable. Staff meetings were held regularly giving staff the opportunity to feedback their thoughts about the service. There was a system of reviews, checks and audits to assess and monitor the quality of service provided and identify any risks to the health safety and welfare of people using the service, staff and visitors. Records relating to the provision of care were fit for purpose.

The summary is based on our observations during the inspection. Nine people were using the service at the time we visited and we met and spoke with all of them over the two days we visited. We talked to staff on duty; they included the manager, deputy manager and five members of the staff team.

We reviewed the care records for four people who use the service. We spoke with four community based mental health professional involved with the placement of people in this home.

If you want to see the evidence that supports our summary please read the full report.

Is the service caring?

People who used the service were inconsistent in their views about the service; people spoken with on day one gave some negative views and were reluctant to engage regularly in the therapeutic groups. Our own observations and the records we looked at did not always match the negative descriptions some people had given us. We saw staff interacted positively with people, written and spoken language used was respectful. On day two of our visit people told us they were more comfortable in the home because a person causing disruption in the community had their placement terminated.

One person said, "It has been a long and slow process for me but staff are kind and have given me encouragement and support, it is up to me now to take the next step." Another person spoke about the efforts made by staff which had helped them with taking responsibility for their actions, they said, "To me it is my home for now and staff are okay."

Is the service responsive to people's needs?

People found staff were responsive to their needs, but we saw staff needed further training to enable them develop further skills and meet the needs of the people using the service.

The activities offered at the service were tailored to meet individuals' needs and to help people to engage in the service.

Staff were effectively supervised and received regular group supervision every week, and in this they reflected on theory, practice and learning. The supervision process helped staff explore their interactions with those in the therapeutic community.

People were aware of how to complain and who to speak to if they had concerns. We saw that complaints made had been responded to quickly, including explaining to people why certain processes were in place. People had the opportunity to discuss the service and identify their concerns or make suggestions through regular meetings.

Is the service well-led?

Processes in place were not effective in monitoring compliance with regulations, audits were not completed in medication management, the complex and specific mental health needs of people using the service were not fully considered in the staff training and development programme.

We saw that the policies and procedures provided clear explanations of rules and conditions of stay, and that these were reflected in the contract and guides for people.

We saw that the home had clear multi-agency procedures in place for protecting vulnerable adults, in accordance with the local authority guidelines. We also saw that staff had received training in safeguarding and that suitable employment checks had been made, including Criminal Records Bureau checks.

There was a comprehensive quality assurance system in place that looked at all aspects of the service provided. There was also evidence that learning from incidents took place and appropriate changes were implemented.