The inspection took place on 30 May and 5 June 2018 and was announced.

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 sy

Wilberforce Healthcare is registered to provide personal care to people living in the community who may be living with dementia, have a learning disability, mental health needs or a physical disability. The office is based in Hull city centre and is accessible to people with physical or mobility difficulties.

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

Wilberforce Healthcare is registered to provide a service to people living in the community who are over the age of 18 who may have dementia care needs, a learning disability, mental health needs or a physical disability. The office is based in Hull city centre and is accessible to people with physical or mobility difficulties.

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.

Wilberforce Healthcare provides a service to people living in the community who are over the age of 18 who may have dementia care needs, a learning disability, mental health needs or a physical disability.

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, repositioni

Wilberforce Healthcare is registered with the Care Quality Commission [CQC] to provide personal care to people living in the community and who may be living with dementia, have a learning disability, and have mental health needs or a physical disability.

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 spoke with the registered provider and care co-ordinator for the service who told us what changes had been implemented since the previous inspection in April 2013.

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.

We spoke with one relative and three people who received a service from the agency, they told us they were very pleased with the care offered. Comments included, "The staff are respectful and they turn up on time", "I'm really impressed with the training they have had and I feel the carers understand how to meet my husband's needs."

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.

We spoke with three relatives and five people who received a service from the agency. They told us the care and support offered to them was good. Comments included, “It’s alright, I have no problems with the agency” and “I am happy with everything.” However, one person who used the service did express their concern regarding the lack of consistency, staff not turning up on time and missed calls with no explanation. The provider showed us evidence that consultation had taken place with the person, their advocate and social worker and a review meeting was to be carried out to resolve the situation.

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.

We spoke with people who received a service from the agency. They told us that they were consulted and able to make decisions about their day to day lives. Some people told us the carers were supportive and helpful and commented, “The girls are all nice, they turn up on time and we have a laugh”, “On the whole they are pretty good and I have no complaints.”

People also told us that they had the choice of a male or female worker.

People told us that they were happy with the service they received and that the staff were supportive. Some comments included; "They help me with my eye drops and get my meals ready” and “Everyone is friendly, polite and respectful.”

People we spoke with confirmed that the care staff arrived at the time planned and

remained with them until all tasks had been carried out. Some comments included, "Yes usually they arrive on time, sometimes they are a bit late but I understand” and “Yes they do turn up on time and I am happy with the service."

People who used the service told us staff were pleasant and respectful towards them and commented, “On the whole they are pretty good and I have no complaints.”

People told us their views were listened to and one person said, "I just pick the phone up and speak to the manager, she always sorts it out” and “I often ring to have a chat and they are always friendly.”