At our last inspection on 29 October 2015 we rated the service good. At this inspection, on 13 and 21 February 2018, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

This inspection took place on 29 October 2015. At our last inspection in December 2014 the service was not meeting the standard in relation to the safety and suitability of the premises. At this inspection we found that the service was now meeting this standard.

The home 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.

The home is registered to provide care and support for 14 people with mental health needs. Shila House is registered for 11 people and 1 Poynter Road is a semi-independent unit for three people. The manager told us that 1 Poynter Road had closed down last year and is no longer in operation. The provider has not informed the Care Quality Commission that there has been a change to the location. The registered manager told us they would be sending in the appropriate notifications as soon as possible. On the day of our inspection there were nine people using the service at Shila House.

People told us that they felt safe within the home and well supported by staff. We saw positive and friendly interactions between staff and people. People were treated with dignity and respect.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported to maintain a healthy lifestyle and had healthcare appointments that met their needs. These were recorded and monitored on a regular basis. Medicines were administered safely and on time. Staff had completed training in medicines and administration.

People were involved in writing their care plans and risk assessments and were able to express their care needs. Care plans were person centred and gave guidance for staff to provide appropriate care. Staff were appropriately trained and skilled to care. Training was updated regularly and monitored by

the manager. Staff had regular supervision and annual appraisals that helped identify training needs and improve the quality of care

The registered manager was accessible and spent time with people. We were saw that there was an open culture within the home and this was reflected by the staff. Staff felt safe and comfortable raising concerns with the manager and felt that they would be listened to.

There were systems in place to identify maintenance issues. Staff were aware of how to report and follow up maintenance.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care. There was a complaints procedure as well as incident and accident reporting. Surveys were completed with people who use the service and their relatives. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

At our previous inspection of the service which took place on 10 February 2014 we found that the provider was not meeting the regulation in relation to safe management of medicines. The provider sent us an action plan to tell us what improvements were going to be made.

This inspection took place on the 9 December 2014. Shila House provides support and accommodation for up to 14 adults with mental health needs.

There were 11 people living at the service when we inspected. 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.

Some areas of the building were hazardous to people, staff and visitors due to inadequate maintenance of the premises.

People told us that they felt safe. Staff knew how to recognise and respond appropriately to incidents or allegations of bullying, harassment, avoidable harm and abuse. Staff were aware of people’s individual risk assessments which included people’s mental health, handling money and falls.

People told us there were enough staff on duty with the right skills. Effective recruitment procedures were in place to ensure that staff employed were suitable and had the necessary skills to work in the service.

Medicines were administered, stored and disposed of correctly and staff had received training in relation to the safe management of medicines.

People told us they were receiving the care they needed and that they knew the staff. People told us and we saw that staff had the skills and knowledge to carry out their roles and responsibilities. Staff were aware of people’s preferences and they had the necessary skills to provide care to people using the service.

Staff were supported and monitored to deliver care and treatment to people to an appropriate standard. Regular supervision sessions, appraisals and training had taken place.

Staff were aware of people’s capacity to make decisions, however most staff had not received recent training in the Mental Capacity Act 2005 (MCA). Staff obtained peoples permission before giving them care and support.

People were supported to maintain good health and have access to healthcare services and receive healthcare support. This included doctors, mental health specialists and occupational therapists. People were supported to receive adequate nutrition.

We saw and people told us staff showed compassion, dignity and respect towards people. People and people significant to them told us people were treated with dignity and respect. People were listened to and were encouraged to make their views known. Regular residents meetings were taking place.

People told us they received personalised care responsive to their needs. Some people participated in the activities available. People had regular one to one sessions. Staff handover meetings provided continuity of care.

People, people significant to them and staff were encouraged to raise concerns about the service. The provider had systems to listen and learn from people’s experiences, concerns and complaints and improvements were made.

People told us that the registered manager and staff were approachable. People and staff were asked for their views about the service.

Accidents and incidents were investigated and lessons learnt were shared with staff. The provider audited the service. Some audits for example the premises audit were not effective whilst others for example medicines management were.

The provider worked with the local authority to implement best practice including staff training and policies.

We carried out this inspection to follow up on concerns from the previous inspection regarding safeguarding and also to respond to concerns that had been bought to our attention regarding medication.

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.

We carried out this inspection to follow up on concerns from the previous inspection and also to respond to concerns that had been bought to our attention.

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.”

We saw that the premises had been refurbished since our last inspection. One person told us “they have done a lot of work and it is much better.” Staff told us that people were much happier.

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.

We saw and were told by people and staff that people gave their consent verbally and in writing. One person told us “I get to chose and I am told by staff why some things I want to do are too risky.”

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 told us they were listened to by staff and involved in decisions about their care.

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.