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 knowledgea

A & A Healthcare Services is a domiciliary care service offering personal care and supported living to people in their own home. All of the people who used this service had multiple diagnosed conditions including Attention Deficit Hyperactivity Disorder (ADHD), autism, mental health disorders, a learning disability and epilepsy. The people who were supported by this service displayed multiple behaviours that challenge. At the time of our inspection six people were using the service, the majority of whom were receiving 24 hour support.

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