Shila House

Shila House provides care and support for 11 people who have mental health needs. There were 11 people using the service when we visited. Shila House is a detached house located in Enfield, North London. Each person had their own bedroom with a large communal area on the ground floor. There was a small courtyard where people have access to outside space.

People had detailed risk assessments that provided staff with information on how to minimise risks. People, where possible, were involved in creating their risk assessments.

Medicines were well managed and people received their medicines safely and on time.

There were sufficient staff deployed to meet people’s needs and ensure person centred care.

Staff received regular supervision and appraisal that ensured that they were supported in their role.

There was a focus on people’s mental health and wellbeing and people were encouraged to be part of the conversation around keeping themselves well.

We observed warm and friendly interactions between staff and people throughout the inspection. Staff knew people well.

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

People had access to a varied diet and were able to make snacks and drinks whenever they wished to.

Care plans were detailed, person centred and tailored to each person. People and relatives had input into planning care.

People had access to a wide range of activities both within the home and in the local community.

The home had an emphasis on promoting independence where possible and people were actively encouraged to be independent.

There were regular reviews of people’s mental health. Staff knew how to refer people for both physical and mental health issues. People were involved in planning their own healthcare needs.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity.

The management was open and transparent and people and staff were encouraged to voice their opinions on how the service was run. People told us they felt listened to.

The registered manager promoted a culture of learning for the staff and staff told us that they felt supported.

There were systems and processes in place to ensure good governance and oversight of the service by the registered manager.

At the last inspection on 1 November 2013 we had concerns because we found that the provider was not responding appropriately to allegations of abuse. At this inspection we saw that the manager and staff were taking the appropriate action in response to incidents and allegations of abuse. One person who used the service told us 'I can talk with any staff.'

We found that medicines in the home were not managed in accordance with the provider's policy or with guidance from the Royal Pharmaceutical Society of Great Britain 'The handling of medicines in Social Care.' People we spoke with were unable to tell us the possible side effects of the medication they were taking.

The planning and delivery of care was designed to meet the person's individual needs and ensure their welfare and safety. One person told us 'the new manager is very good and I go to the market with staff to do some shopping.'

Prior to our visit we had received concerns regarding people's safeguarding which included the provider not responding appropriately to allegations of abuse. We found that the provider was not responding appropriately to allegations of abuse.

At the last inspection of the service on 12 July 2013 we had concerns because the provider had not made appropriate steps to ensure, at all times there were sufficient numbers of suitably qualified, skilled and experienced persons employed. At this inspection we found that there had been problems with staffing but there were now sufficient numbers of staff. One person told us 'There are enough staff and you get used to the regulars.'

Staff told us that a cleaner had been employed and that they had more time to provide care and attention to people. Staff told us that there had been a few times when there were not the required numbers of staff on duty but that cover was usually arranged by the person managing. Records showed that there were some shortfalls of staff during the day and mostly at night.

The provider had a system in place for identifying, receiving, handling and responding to complaints and comments made by people using the service and those acting on their behalf.

Records showed that care plans were regularly reviewed and updated. People told us they had a keyworker to help them with care. Some relatives told us they were involved in discussions about people's care.

Staff were aware of safeguarding policies and procedures and knew to report any allegations of abuse to the manager but not to the local authority safeguarding team or police as necessary.

We saw that there were items outstanding regarding the safety and suitability of the premises from the previous CQC report in December 2012. We saw additional items that affected the fire safety of the building, dampness, poor decoration, trip hazards, poor maintenance and cleaning.

Staff told us that cleaning duties impinged on their caring duties and this meant that sufficient staff were not available on some days to meet people's needs. Staffing numbers did not reflect the provider’s statement of purpose.

We saw records and were told by the manager and staff that some staff had received training and had regular supervision sessions but had not received annual appraisals.

The provider did not have a system in place for identifying, receiving, handling and responding to complaints and comments made by people using the service and those acting on their behalf.

People said they felt safe and they were happy with the staff that supported them.

The paintwork in the lounge, hallways and a bedroom was dirty and chipped. There were areas of damp in a vacant bedroom and lounge. The stair carpet was worn which could become a trip hazard.

Staff told us they received regular supervision meetings but these were not all recorded. Training records did not evidence that staff had up to date appropriate training to enable them to deliver the care to people that they needed. The provider and manager said they would ensure that staff training was updated.

There was a system in place to monitor the quality of the service. Quality assurance surveys were in the process of being sent to people that use the service to obtain their feedback.