Archived: Pulse - Bristol

Updated 7 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14, 15 and 19 December 2016 and was announced. We gave the service 48 hours’ notice of the inspection because the location provides a domiciliary care service including nursing so the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in. It was carried out by one adult social care inspector. On the second day of inspection two people were visited; one person was in their own home and one was still in a specialist unit.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information in the PIR and also looked at other information we held about the home before the inspection visit.

During the visits we spoke with one person in detail about their care. Another person had limited communication so we observed them and spoke with their relative. We spoke with three members of staff, the deputy manager and the clinical lead. On the telephone we spoke with one relative, one member of staff and one health and social care professional. Following the visit we spoke with another relative and two more health and social care professionals.

We read three people’s care records and observed care and support in a person’s home and specialist unit. We read five staff files, previous inspection reports, staff rotas, quality assurance audits, staff training records, the complaints and compliments files, staff meeting minutes, medication files, annual surveys, environmental files and a selection of the provider’s policies and other records about the end of life service.

Following the inspection the provider sent us further details including training records and policies all within the time frame we set.

Updated 7 June 2017

This inspection was announced and took place on 14, 15 and 19 December 2016.

Pulse is registered to provide care and support for people in their own homes including nursing care. Most people receiving support from Pulse had complex needs or were older people. As a result many of them have limited communication skills so were unable to speak with us. Recently the service had been part of a pilot scheme for delivering end of life care in people’s own homes. Each person with complex needs had a small teams of staff assigned to them. At the time of our inspection there were eight people using the service plus the end of life care service which had fluctuating numbers.

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. At the time of inspection the registered manager was absent. The deputy manager was in charge with the support of a clinical lead supplied by the provider. There was a team of case managers supporting the deputy manager.

People were supported by staff who had received excellent levels of training and were supervised regularly. This included clinical supervisions for any medical procedures they undertook. The staff often went above and beyond their role. As a result staff had good knowledge about people’s complex care needs. The care plans provided additional guidance to ensure people’s care and medical needs were met. When people were unable to communicate verbally or read their care plans alternative methods were found. People’s care was very responsive to their changing needs. If people required special diets they received them.

People’s choices were always supported and respected by staff. They explained how kind and caring staff were and we observed positive interactions. People’s privacy and dignity was respected. People received excellent end of life care which was personalised and holistic. Staff provided support for the person and their relatives to ensure a dignified end in their own home. When people lacked capacity staff and the deputy manager had understanding about people who lacked capacity to make decisions for themselves. This meant their human rights were respected.

People were supported by sufficient numbers of staff to meet their needs. To ensure people’s needs were met small teams of regular staff were created. There were effective systems in place if staff were running late. People and relatives told us they would receive a phone call from the office so they knew someone was on their way.

People and relatives told us they felt safe. Medicines were managed safely. Any medical procedures were overseen by a qualified nurse who provided clinical guidance. When there were problems the case manager would liaise with other health professionals. This meant the management and staff had built strong links with other health and social care professionals to create positive support for people.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and knew the procedures to follow if they had concerns. Any concerns raised had been appropriately managed. There was a safe recruitment procedure in place and staff received checks before starting to work with people.

Quality assurance systems were in place by the management and provider to identify issues. When any concerns or patterns had been identified they had been resolved and lessons were learnt. There were systems in place to manage complaints and the provider demonstrated a good understanding of how to respond to them.