Lilias Gillies House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided. Lilias Gillies House does not provide nursing care. Lilias Gillies House accommodates up to 20 people with mental health needs. At the time of our inspection ten people were using the service.

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.

Lilias Gillies House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Lilias Gillies House does not provide nursing care. Lilias Gillies House accommodates up to 20 people in one adapted building. At the time of our inspection 12 people were using the service.

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 supervi

We visited Lilias Gillies House on 11 and 12 April 2016. The inspection was unannounced.

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.

People we spoke with told us that they were involved with their therapy sessions and were finding their time at Lilias Gillies House to be a positive and supportive experience. One person said “the therapy meetings are interesting.” Another person said “I really like it here the staff are nice.”

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.

The inspection took place on 8 and 9 January 2015. The visit on 8 January was unannounced and we told the provider we would return on 9 January to complete the inspection. When we last inspected the service in June and July 2014, we found the provider was not ensuring the safety of people using the service, staff did not manage medicines safely and staff did not receive the training they needed to support people. During this inspection, we found the provider had taken action and addressed the concerns we identified.

Community Housing and Therapy is a registered charity providing care and accommodation for people with severe and enduring mental ill health. The provider described Lilias Gilles House as, “a safe, containing therapeutic community” that offered a “structured, recovery orientated programme.”

Lilias Gillies House is a residential home for up to 20 adults with mental health problems and associated complex needs. At the time of this inspection, seven people were living in the home. Community Housing and Therapy provides the service. The service is run as a therapeutic community providing support in the form of therapeutic groups and meetings aimed at preparing people to move on to more independent accommodation. The estimated length of stay is 18 months to three years for their programme of rehabilitation.

The service has been without a registered manager since July 2013 and there was no registered manager at the time of this inspection. 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.

Staff supported people in a caring and professional way, respecting their privacy and dignity.

The provider had arranged for additional staff training since our last inspection. Staff had the training they needed and they were able to tell us about people’s individual needs and how they met these in the home.

The provider did not have effective systems for assessing and managing risks to people using the service.

The provider had worked with the local authority safeguarding adults team to improve safeguarding procedures in the home. Staff understood the provider’s safeguarding procedures and they understood the importance of reporting any concerns about the welfare and safety of people using the service.

The provider had improved medicines management in the home. People consistently received their medicines safely and as prescribed.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). The Deprivation of Liberty Safeguards provide legal protection for vulnerable people who are, or may become, deprived of their liberty in a hospital or care home.

The acting manager and staff communicated effectively to make sure all staff were up to date with each person’s care and support needs. Care records reflected people’s health and social care needs and staff regularly reviewed each person’s care and support. However, the plans we looked at did not always include the views and aspirations of the person and we did not see any clear objectives to show how people were working towards a move on to more independent accommodation.