Archived: A & A Healthcare Services Limited

Updated 9 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

One inspector carried out this announced inspection on 16 May 2018. We gave the service 48 hours’ notice of the inspection site visit because some of the people using it could not consent to a home visit from an inspector, which meant that we had to allow the service time to arrange for a ‘best interests’ decision about us visiting people.

Before our inspection, we looked at information we held about the service including notifications they had made to us about important events. We also reviewed all other information sent to us from other stakeholders, for example the local authority. We observed how staff supported people when we visited them in their own homes.

We looked at records in relation to three people’s care and spoke with one person who used the service and one person’s relative. We also spoke with the registered manager, the care coordinator and a member of care staff. We later spoke with the office manager and three care staff via email. We looked at records relating to the management of the service, four staff recruitment records, training, and systems for monitoring the quality of the service.

Updated 9 August 2018

A & A Healthcare Services Ltd provides care and support to people living in a supported living setting, so that they can live in their own home as independently as possible. People’s care and housing is provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

This announced inspection was started on 16 May 2018, we gave the service 48 hours’ notice of the inspection site visit because some of the people using it could not consent to a home visit from an inspector, which meant that we had to allow the service time to arrange for a ‘best interests’ decision about us visiting people.

On the day of our inspection three people were using the service, two of whom were receiving 24-hour support.

We last inspected this service on the 22 and 23 August 2017 and rated the service as Inadequate in all key questions except Caring, which we rated as requires Improvement. This meant that the service was rated as Inadequate overall. We found the service was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action to impose conditions on the providers’ registration, which stipulated that no new admissions to the service should be permitted without the written consent of the Commission. We also asked the provider to keep us informed of actions which had or were being taken to mitigate identified risks to the people they are supporting. We decided to impose these conditions on the provider’s registration to help ensure that people were no longer exposed to the risk of harm.

During that inspection, we found that people who used the service were not always safe and well cared for and that risks within people’s environment were not always properly assessed and people were at risk of harm. There was not always sufficient staff on duty to provide care and to support people when needed or as planned. People were not fully protected by the service’s recruitment procedures. Care staff did not always appear to be trained and supported well enough to carry out their roles. People were not helped to make positive choices in eating and drinking to stay fit and avoid food or drinks that affected them adversely. Nor were people always supported to have access to healthcare services or to get their medication as prescribed. Neither were they helped in a caring or respectful way and did not always receive care that was personalised and responsive to their needs. There were no systems in place to record complaints and quality assurance systems were not robust enough and had not identified the concerns we found during that inspection in August 2017.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of care and support people received to at least good.

Due to the inadequate rating and breaches of regulation the service was put into special measures and we imposed conditions on their registration to stop the providers taking on any further contracts and asked them to report to us monthly, detailing the action they were taking to monitor and improve the service they provided the people they supported.

During this inspection on 16 May 2018, we found that significant improvements had been made towards meeting the requirements to help ensure that people received an improved quality of service and there were no longer any breaches of regulation.

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.

The service was well led; the registered manager was knowledgeable about the people being supported and has recruited a care coordinator and an operations manager since our last inspection to improve the running of the service. People, their relatives and staff told us that there had been improvements in the way the service was run since our last inspection in August 2017 and that the registered manager was supportive and had good management skills. Staff told us that they recognised the hard work the registered manager had put into the service to improve the service offered to people. There were systems in place to monitor the quality of service offered to people.

People could express their views and staff listened to what they said, respected their views and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People and their relatives told us that they were confident they were safe in this service. People were protected from bullying, harassment, avoidable harm and abuse by staff that were trained to recognise abusive situations and knew how to report any incidents they witnessed or suspected. Staff understood their responsibilities to raise concerns and there were arrangements in place for reviewing and investigating incidents when things went wrong. Staff told us they would not hesitate to report any suspicions they had about people being abused. Staff had been safely recruited which helped protect people from harm.

Risks were assessed and steps had been put in place to safeguard people from harm without restricting their independence unnecessarily. Risks to individual people had been identified and action had been taken to protect them from harm.

Staffing levels were sufficient to keep people safe and people were supported to manage their medicines in a way that ensured that they received them safely and at the right time. There were also appropriate infection control practices in place to help protect the people the service supported and the staff from the risks involved around contagious diseases.

People’s needs assessments were detailed and they received effective care in line with current legislation from staff who had the knowledge, qualifications, skills and experience they needed to carry out their roles.

The management and staff worked together with outside healthcare professionals to ensure that people received consistent person centred care when they used or were supported by different services. People were asked for their consent by staff before they supported them in line with legislation and guidance.

Staff offered advice to people to help them make healthy decisions around food and supported them to eat and drink enough to maintain a balanced diet. People were also supported to maintain good health and gain access to healthcare services when they were needed.

People received care that was individualised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. They acted to investigate people’s complaints, learnt by their mistakes and made any changes needed to avoid them happening again.