Vital 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 17 October 2018 and we continued the inspection for another day on 18 October, 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 20 people were using the service, some of whom were receiving 24-hour support.

There was a registered manager in post. 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.

We last inspected this service in May 2017 and rated the service as Requires Improvement in all key questions except Caring, which we rated as good. This meant that the service was rated as Requires improvement overall. We found the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During that inspection, we found that people who used the service were not always safe and well cared for. Staff had received medicines training, but medicines were not managed safely as people had not always been given their prescribed medicines and medicine records had not always been completed accurately. Risks assessments were in place, but staff had not always followed the care plan which had put people at risk of unsafe care.

During that previous inspection we also found that staff were not supported well enough to carry out their roles, staff supervision was not consistent and staff had not used their training to de-escalate situations effectively. Staff had acted in a reactive rather than a proactive way and acted in a reactive rather than a proactive way. People did not always have care plans in place when they began to use the service. There was a complaints policy and procedure but the actions taken as a result of complaints had not fully addressed the situation. The quality assurance systems were not robust enough and had not identified the concerns we found during that inspection in May 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.

During this inspection on 17 and 18 October 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 May 2017 and that the registered manager was supportive and had

We inspected the service on 10 and 12 May 2017. Notice was given so that the service staff could arrange for some people using the service to speak with us. This was the first inspection of this service at this location.

The service provides personal care and support for people living in their own homes. At the time of the inspection there were 23 people using the service.

There was a registered manager in post who was present during the days of our inspection. 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.

Many of the people using the service had complex needs requiring one to one staff support at all times. In order to provide the support to people their individuals risk assessment requires monitoring and updating in response to situations and peoples changing needs. Risks to people’s health and wellbeing were not always assessed and documented in people’s care plans. When risks had been identified staff had not always followed the actions as stated in the care plan, such as providing one to one care.

Medicines were not always managed safely. Staff had received training in the administration of medicines. However, they did not always administer medicines as prescribed in the medication administration record. Protocols for when to administer ‘when required’ (PRN) medicines were not in place for every person who used the service.

The staff had received training to safeguard people from harm and some staff were trained to provide therapies. The service is registered to provide nursing care, although the support people require is with their emotional and psychiatric needs. Sufficient numbers of staff were deployed by the service to meet the needs of people. There were recruitment procedures in place. Managers needed to make improvements to ensure that staff received appropriate support when providing 1:1 care.

Some staff informed us they had supervision, spot checks, appraisals and this support was appropriate for them. Whereas other staff said they did not have spot checks and found the group supervision ineffective as they wished to have one to one supervision.

Care plans were developed to guide staff about how best to support people, but were not always personalised and not always in place in sufficient detail when the person commenced using the service. People had access to healthcare services when they needed this and were supported with sufficient food and drinks of their choice.

Staff spoke positively about the care they provided, we saw caring practices of staff empathising and understanding the needs of people using the service with complex needs. We also found some staff to be providing care in a dignified and respectful manner. However, we are also aware of occasions where staff had not supported people as well as they needed at that time.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. The policies and systems in the service were not always clear regarding how to support people.

Best interests meetings had been held in collaboration with professionals involved in people’s care and the service followed the legal requirements in accordance with the Mental Capacity Act (MCA) 2005. However the service had not always worked closely with other professionals and relatives for the full benefit of the people using the service.

Quality assurance systems were not robust enough and had not identified some of the concerns we found regarding medicines management and risk assessments being sufficiently detailed.

We found breaches of regulations in relation to safe care and treatment. You can see what action we asked the provider to