Wilberforce Healthcare UK Limited

Wilberforce Healthcare UK Ltd is a domiciliary care service providing care and support to older people and younger adults, as well as people who may be living with a learning disabilities or autistic spectrum disorder, dementia, mental health need, or a physical disability.

Not everyone using the service receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection 16 people were being supported with personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People's experience of using this service and what we found

People were safe from harm. Systems and appropriately recruited staff supported this. People's risks were safely managed. Sufficient numbers of staff were employed to support people with their needs. People were safely supported with handling medicines and keeping their homes clean.

Staff were trained, skilled and well supported by the provider. People had good relationships with the staff who protected their rights to lead a normal life. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us staff were kind and caring. People were respected, staff championed their privacy and dignity and encouraged their independence in all aspects of life.

Staff were motivated to provide person-centred care based on people's choices and preferences. They were dedicated to their roles. People were supported to do the things they wanted to. Any dissatisfaction in receiving the service was addressed and resolved. Staff understood about he support people needed with end of life care.

People had the benefit of a service that was positive, inclusive and forward-looking. There was a registered manager and a management team who maintained checks on how well the service was provided. Documents held in the office were secure to ensure confidentiality of people's information. Staff respected people’s confidentiality when the supported them.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC's website at www.cqc.org.uk.

Rating at last inspection and update.

The last rating for this service was requires improvement (report published 19 July 2018) and there was one breach of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of any regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults and younger disabled adults.

At the time of our inspection 24 people were receiving a service. However, only 15 people were receiving a regulated activity. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager at the service. A registered manager is a person who has registered with the CQC 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.

At our last inspection, we rated the service as ‘Requires Improvement’. During this inspection, we found the service continued to be ‘Requires Improvement’.

At this comprehensive inspection, we saw people who used the service were protected from abuse and avoidable harm, by staff who knew how to keep people safe. However, risks were not always identified and recorded clearly in people’s care plans. This meant staff did not always have access to guidance about risks and ways these could be minimised. Risks in people’s environments were identified and responded to and infection and prevention control practices were in place to keep people safe from the spread of infection.

Care plans were not always person-centred and reviews of people’s care were not always recorded. Although staff were aware of changes to people’s needs and how to support them in line with their preferences, care plans and risk assessments were not always updated in a timely manner to reflect these changes. We made a recommendation about ensuring care plans were more person-centred.

Systems and process were not effective in identifying shortfalls and had not been successful in improving the quality and safety of the service. We saw that the potential to identify shortfalls was missed. The registered manager did not have oversight of accidents and incidents, so patterns and trends could not be identified.

People received support with their medicines if needed. However, the medication was not always recorded and administered safely. One person’s medication administration records (MAR’s) were missing, therefore there was no evidence to show staff had recorded or administered this person’s medicines, as prescribed. Staff were not provided with protocols for administering ‘as and when needed’ (PRN) medication. In addition, there was no guidance available to staff to administer one person’s medication covertly. This meant there was potential for these medications to be administered incorrectly, possibly putting people at risk of harm.

You can see what action we told the provider to take regarding the above areas at the back of this full version report.

Staff were recruited safely and deployed in sufficient numbers to meet people’s needs. People told us they were supported by regular staff, which provided continuity of care. Staff were knowledgeable about people’s needs and supported them in line with their preferences.

Staff received effective levels of supervision and support. Staff had completed an induction and a range of training to equip them with the skills and abilities to meet people’s needs. People were supported to access healthcare and attend appointments. For those that required support with their nutritional needs, support was provided to maintain a diet of their choosing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to make their own decisions where possible and consent was gained before care or support was provided. For those that lacked capacity to make particular decisions, staff followed the principles of the Mental Capacity Act 2005 and acted in people’s best interests.

Staff were caring and understood the importance of confidentiality and respected people’s privacy. People were supported to be independent and were treated with dignity and respect.

A complaints policy was in place and people told us they knew how to make a complaint if needed. There was an open culture and communication was good between staff and management, as well as people using the service. Ongoing feedback was gained from people and staff, to improve the running of the service. The registered manager was aware of their responsibility to inform the CQC of notifiable incidents.

Further information is in the detailed findings below.

This inspection took place on 16 and 17 May 2017 and was carried out by an adult social care inspector. This inspection was announced because we needed to ensure the registered provider would be available to talk with us.

At our focused inspection of the service on 19 January 2017 the registered provider was not delivering a regulated activity. This was due to the level of risk we identified at our comprehensive inspection of the service on 10 and 13 October 2016. The registered provider had failed to ensure compliance with regulations 8, 9, 12, 13, 16, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We followed our enforcement policy and used our enforcement powers to urgently suspend the registered provider’s registration. This meant they could not deliver the regulated activity of personal care for a three month period.

At our focused inspection of the service on 19 January 2017 we spoke with the registered provider who described the changes and improvements at the service. Due to the suspension of their registration we could not check that the methods described by the registered provider were being operated as described. We reviewed policies and procedures as well as supporting documents that had been developed to ensure the service could be managed effectively. We assessed the actions of the registered provider and followed our enforcement policy which led to the suspension of this service being removed.

At this comprehensive inspection we saw people who used the service were protected from abuse and avoidable harm by staff who knew how to keep people safe. Known risks were managed to ensure people were supported safely and potential risks were mitigated. Staff were recruited safely and could be deployed in suitable numbers to meet people’s assessed needs. Staff had been trained to administer medicines safely and the medicines administration records we saw were completed without omission.

Staff received effective levels of supervision and mentorship. Staff had completed a range of training to equip them with the skills and abilities to meet people’s assessed needs. People received care from a range of healthcare professionals and were supported to attend healthcare appointments when required. People who used the service were encouraged to eat a healthy, balanced diet of their choosing.

People told us they were supported by caring staff who understood their needs and knew their preferences. People received care from small teams of staff to ensure there was consistency and continuity in their care. People told us staff treated them with dignity and respect. Staff understood the importance of treating private and sensitive information confidentially. The registered provider ensured information was stored securely and was not accessible to unauthorised people.

People or their appointed representatives were involved in the initial planning and on-going delivery of their care. Care plans and risk assessments were updated as people’s needs changed or developed. A complaints policy was in place which was provided to people at the commencement of their service. People who used the service told us they knew how to raise concerns and make complaints.

The service was led by a registered manager who was aware of their responsibilities to report notifiable events to the Care Quality Commission. Quality assurance systems and processes had been developed to ensure shortfalls were identified and action was taken to improve the service when required. People who used the service and their relatives were asked to provide regular feedback on the service and their opinions were used to improve the service when possible.

This inspection took place on 19 January 2017 and was carried out by an adult social care inspector. This inspection was announced because the service was suspended at the time of the inspection and we needed to ensure the registered provider would be available to talk with us.

At the last inspection of the service on 10 and 13 October 2016, the service was noncompliant with regulations pertaining to person centred care, safe care and treatment, safeguarding vulnerable adults, staffing, complaints, good governance and submitting notifications. Due to the level of risk we identified we followed our enforcement policy and used our enforcement powers to urgently suspend the provider’s registration. This meant they could deliver the regulated activity of personal care for a three month period.

The service had a registered manager which is a requirement if their registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this focused inspection we spoke with the registered provider who described the changes and improvements at the service. Due to the suspension of their registration at the time of this focused inspection so we could not check that the methods described by the registered provider were being operated as described. We did review policies, procedures, and supporting documents that had been developed to ensure the service could be managed effectively.

We have assessed the actions of the registered provider and have followed our enforcement policy which has led to the suspension of this service being removed.

The office is based in Hull city centre and is accessible to people with physical or mobility difficulties.

This unannounced inspection took place on 10 and 13 October 2016. The inspection team consisted of two adult social care inspectors. At the last inspection of the service in December 2015, the service was complaint with all of the regulations we inspected at that time.

The service had a registered manager which is a requirement if their registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this comprehensive inspection we found multiple breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 and a breach of the Health and Social Care Act 2008 [Registration] Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any Representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered 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 registered 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.

The service could not deploy sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people who used the service. The registered provider could not deliver commissioned care to 17 people totalling 102 care calls between 8 and 9 October 2016. The registered provider had to permanently hand back care packages for 21 people to the local authority commissioners, Kingston upon Hull City Council as they did not have enough staff meet their needs.

People who used the service were exposed to the risk of abuse by way of neglect because the registered provider failed to ensure the service could deploy sufficient numbers of staff to meet their assessed needs.

People did not receive safe care and treatment. The call monitoring records we reviewed provided clear evidence that staff consistently failed to stay for the full duration of the care call. People who had been assessed as requiring the support of staff for 30 minutes had their care delivered in less than four minutes. Staff failed to support people at agreed times, arriving up to 179 minutes late and up to 177 minutes early to care calls. Vulnerable people who required time specific medicines, repositioning to reduce the possibility of developing pressure sores or fundamental care such as personal care and toileting did not receive safe care and treatment because of the registered provider’s failure to ensure staff delivered care and support at agreed times.

Safe recruitment practices were not established and operated. One member of staff had been employed without a Disclosure and Barring Service (DBS) check being undertaken and another member of staff’s DBS check showed they had been charged with battery and handling stolen goods. The registered provider had failed to ensure a risk assessment was in place to mitigate risks regarding employing a person with recent criminal convictions or document the reason for their employment. This exposed people who used the service to the risk of being supported by staff who may not be suitable to work with vulnerable adults.

Care plans had not been created for two people who used the service and other people’s care plans failed to reflect people’s current support needs. Subsequently, risk assessments had not been created to manage and reduce where possible known risks to ensure people received the care they required in a consistently safe and effective way.

The registered provider’s business continuity plan failed to include relevant information such as how to manage staffing shortages.

Staff were not supported to deliver high quality effective care. Newly recruited staff with previous experience working in the care sector were allowed to support people without having their skills and abilities checked. This exposed people to receiving support from unskilled staff.

Staff did not receive adequate supervision, monitoring or appraisal and their competencies and abilities were not assessed on a regular basis. The registered provider failed to assess the competency of care staff and we did not see any evidence that checks were occurring. Records showed some staff had not had their abilities assessed by the registered provider since 2014. There was minimal evidence of one to one support and no evidence of yearly appraisals taking place.

People who used the service told us they were supported to eat and drink sufficiently but raised concerns about staff failing to arrive at specified times adversely impacted on when they ate their meals.

People confirmed that they had consented to the care and support they received.

Staff did not always support people in a caring way. Call monitoring records showed staff had changed the order of their care calls which meant people did not receive their care and support at agreed times. Staff leaving care calls early impacted on how care tasks were delivered and showed a lack of support for the people who used the service.

Information was not available to staff regarding people’s life histories which would have enabled them to engage people in meaningful conversations.

Appropriate action was not taken when people’s needs changed or developed. When people had returned from hospital admissions assessments were not completed to ensure staff were fully aware of people’s needs.

When people raised concerns or made complaints they were not always responded to as required. Investigations into complaints were not completed in a robust or effective manner and action was not taken to learn from complaints which could have prevented similar issues reoccurring.

The registered provider’s quality monitoring systems were inadequate. There was no evidence to show that auditing of care plans, risk assessments, staff training and supervision, care delivery, staffing hours, recruitment or complaints was carried out within the service.

The Commission were not made aware of notifiable events that occurred within the service as required.

The office is based in Hull city centre and is accessible to people who may need support with their mobility and wheelchair users.

This inspection took place on 14 December and was announced; due to nature of the service the registered provider was given 24 hours’ notice. The service was last inspected July 2013 and was found to be compliant with the regulations inspected at that time.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were trained to recognise the signs of abuse and how to report this to the investigating authority. They were able to describe the types of abuse they may come across while doing their job. They were confident if they raised any concerns with the registered manager they would take the appropriate action. Staff had been recruited safely and were provided in enough numbers to meet people’s needs. Environmental risk assessment had been carried out so staff could go about their duties safely. Staff were provided with the appropriate personal protective equipment so this lessened the risk of cross infection and contamination.

People were cared for by staff who had received the relevant training to equip them to meet their needs. Staff received support and supervision to enable them to develop their understanding and experience. People were supported to eat food of their choosing, this was monitored by staff and referrals made where appropriate. People were supported to access health care professionals when needed and staff supported them to lead a healthy life style. Staff were trained in and understood the principles of the Mental Capacity Act [MCA] and understood when these principles applied.

Staff understood people’s needs and were kind and caring. People had good relationships with the staff and they had been involved with the formulation of their care plans and reviews. Where people needed support to agree their care this had been arranged and family members or advocates had been involved.

People’s needs had been assessed and staff had access to information about how to meet these and what to monitor, so people were safe and their welfare was maintained. Assessments were updated regularly or as and when people’s needs changed. People knew they had the right to raise concerns and complaints and to expect these to be investigated and to be taken seriously. The registered manager had systems in place which showed how complaints had been investigated and the outcome. Complainants had the opportunity to make comment about their level of satisfaction about how the complaint had been investigated.

People were involved with the running of the service, their opinions were sought and changes were made as a result of their suggestions. The registered manager undertook audits to ensure people received a safe service which effectively met their needs.

We looked at two care files belonging to people who used the service and saw that the care plans, risk assessments and behaviour management plans had been further developed to include more detailed information about potential risk, signs and triggers to look for and what action would need to be undertaken.

We looked at incidents and how these had been reported and recorded and could see that the service had made changes to the process, ensuring that all incidents were reported immediately and people who used the service were protected from the risk of abuse.

We spoke with the local authority contracts and safeguarding teams who told us they did not have any ongoing concerns about the service. They also confirmed that improvements had been made to the way incidents of a safeguarding nature were dealt with.

People told us they were supported to make decisions and were involved in the planning of their care.

We saw that incidents were not always reported and acted upon in a timely way and we could not be sure that people were fully protected from harm or abuse.

People who used the service and their relatives told us their views were listened to and complaints acted upon.

People told us that they were happy with the service they received and that the staff were supportive. Some comments included, 'My husband has a really good relationship with all of the carers who come and they have a good yarn and a laugh' and 'We had a meeting to talk about communication issues, but we have got this sorted now.'

People who used the service and relatives told us the staff were polite, courteous and respectful towards them. They also told us that they felt the staff had the skills to care for them properly. One relative said, 'I do feel the staff have the right skills and training now, they have addressed my concerns."

People who used the service and their relatives told us their views were listened to and complaints acted upon.