Archived: A & A Healthcare Services Limited

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.

We carried out this announced inspection on 22 and 23 August 2017 and this was their first inspection since being registered in January 2016. Notice was given so that the service staff could arrange for some people using the service to speak with us.

There was a registered manager at the service. 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 people who used the service were not always safe and well cared for. People’s care records included detailed risk assessments and guidance for staff on the actions necessary to keep people safe. However, risk assessments and the resulting guidance on how to help people to manage distressed behaviours was not followed by staff consistently.

Risks within people’s environment were not always properly assessed. To protect people from leaving their home without staff support and putting themselves in danger, some of the people who use the service were locked in at their home and the key was removed from the lock and kept by the staff supporting that person. There were no risk assessments in place around people not having free access to leave the building in the event of a fire or other emergency situations. Nor did people have an individual personal emergency evacuation plan (PEEP) in place so that staff and emergency workers knew what support they needed in times of emergency.

People did not always have sufficient staff on duty to provide care and support to people when needed and as planned. Staff told us and care records stated that there were occasions when they were unable to start their shift on time.

People were not fully protected by the service’s recruitment procedures, not all staff members were checked to ensure that they were of good character and were able to care for the people who used the service.

The provider had medicines policies and procedures in place which guided staff on how people were supported with their medicines, where required, safely. People’s care records included guidance on the type of support that they required with their medicines. However, there had been occasions when people did not get their medication on time and when it had not been available to them.

Staff were provided with training in safeguarding and they understood their roles and responsibilities in this subject, including how to report concerns. There had been a high number of safeguarding referrals that were being investigated by the local authority safeguarding team at the time of our inspection.

People did not always receive an effective service. Care staff felt that they received the training they needed to meet people’s needs, however, we have been told by the local authority safeguarding team and other healthcare professionals that the staff did not always appear to be trained and supported well enough to support this group of people who had complex support needs.

Care records showed that for those people less than 18 years old appropriate consent had been sought for the provision of care and treatment. However, one person had recently reached 18 years and was being restricted from leaving their home alone because they would be at risk of being hurt or hurting others. The registered manager had not taken sufficient action to ensure that they were being restricted within legislative guidelines under the Mental Capacity Act.

People were not always supported to eat a healthy diet. Staff did not support people to make positive choices in eating and drinking to stay fit and not to eat or drink things that affected them adversely.

People were not always supported to have access to healthcare services. Healthcare appointments were missed.

People were not always supported in a caring way. People’s relatives and professionals involved with people who used the service believed that some staff did not take sufficient action to build up a trusting and caring relationship between them and the people they worked with, saying that the staff were not consistent with their approach with people. Staff did not always show respect towards the people they supported.

People did not always receive care that was personalised and responsive to their needs. People’s care plans were personalised to include detailed information about them, but care plans sometimes took a long time to be put in place. Staff were not always proactive in supporting people and sometimes did not follow the care plans to avoid confrontation.

The service listened to people’s experiences, concerns and complaints, but the registered manager had no systems in place to record them, which would to allow us to see the complaints made or evidenced what action was taken.

Quality assurance systems were not robust enough and had not identified the concerns we found. The registered manager was also one of the directors of the organisation. The staff they managed told us that the registered manager was supportive. However, relatives and social care and healthcare professionals felt that the service was not well led.

The overall rating for this service is 'Inadequate' and the service has therefore gone into 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.