Archived: Pulse London

Updated 18 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 19 and 20 February 2018 and was announced. We gave the provider 48 hours' notice because the location provides a domiciliary care service and we wanted to make sure someone was available to talk to us during our inspection.

This inspection was carried out by one adult social care inspector, one pharmacist specialist inspector and one Expert by Experience. An Expert by Experience (ExE) is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we reviewed the information we held about the service. These included notifications of significant events affecting the service that the provider submitted to the CQC as part of their legal responsibility. We also gathered information from 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.

Prior to our visit our ExE’s carried out telephone interviews with seven people who used the service. and one relative who gave us their feedback about the service.

During our visit, we spoke with the group clinical director who was also the nominated individual for the service, the registered manager, the operations manager, one community nurse and two care coordinators.

We looked at records, which included care records for five people, recruitment, supervision and training records for eight staff members. We also looked at other documents relating to the management of the service.

Following the inspection, we contacted and received feedback from five care staff and two external health professionals.

Updated 18 May 2018

Pulse London was first registered with the Care Quality Commission [CQC] in December 2014. The service had changed their address on 3 March 2017. The service is located in central London and provides support to people in London as well as in other counties including Sussex, Kent, Berkshire and Surrey.

Pulse London is a domiciliary care service and a community health care service that provides personal care and support to people living with dementia, learning disabilities and mental health conditions, as well as children and older people with physical disabilities or sensory impairments. At the time of our inspection, the service provided care to 41 people. This was the first inspection of the service at the current location.

During the inspection, we found numerous shortcomings in the quality and safety of the service provided which had not been identified during the provider’s own audits. These related to the management of safeguarding concerns, dealing with complaints, mitigation of identified risk to health and wellbeing of people who use the service, record keeping and notifying the CQC about notifiable events.

We noted that prior to our visit the provider had identified a number of other shortcoming and they had begun taking action to remedy the issues found. These were related to the completeness of care plans and medicines administration records.

Identified safeguarding concerns had been investigated internally and actions were taken to help to protect people from harm. However, the provider had not communicated sufficiently about identified safeguarding concerns within the organisation, had not notified external bodies as legally required and had not identified all safeguarding concerns within the service.

The service had assessed risks to health and wellbeing of people who used the service. However, staff were not provided with sufficient guidelines on how to manage and mitigate identified risks. Consequently, people were at risk of receiving care that was not safe.

Staff received training and assessment of their skills. However, we found that the provider’s training and assessment process was not always fully followed. Staff did not always have the sufficient level of skills to support people with their complex needs. Staff did not always received supervision and appraisal of their skills to help them to support people in a safe and effective way.

The service had not always dealt with complaints promptly and people told us they were not always satisfied with the outcomes of complaints they had made.

We found that there were improvements made in how the service managed people’s medicines. Further improvement were needed in relation to transcribing of medicines onto medicines administration charts (MARs) to ensure people received their medicines as prescribed.

There was mixed feedback on staffing arrangements. The majority of people felt there were enough staff deployed to support them. However, improvements were needed in how the service communicated with people about rotas and changes to staff cover.

The provider followed a safe recruitment procedure, therefore, people were safe from unsuitable staff. There were appropriate systems in pace for recording and management of accidents and incidents. Suitable infection control training and staff practice protected people from avoidable infection.

The service had assessed people’s needs and care preferences before they started providing support to people. We saw that gathered information was then used to formulate people’s care plans.

People were supported to have a nutritious diet that met their needs, preferences and clinical requirements. Staff supported people to have access to health professionals when needed. People said they trusted staff to help them if immediate and emergency help was required.

Staff sought people’s consent before providing care and support. People’s mental capacity had been discussed at the time of the initial assessment. At the time of our inspection all people using the service had capacity to make decisions.

People were supported by caring and respectful staff. Staff listened to people and involved people in making decisions and expressing their views about their care. Staff had taken into consideration people’s communication needs and preferences when providing support. People’s dignity and privacy was respected. People could choose a female or male care worker when receiving personal care.

People’s care plans were personalised and included information about health, wellbeing and social aspects of people’s life. People’s clinical care needs and personal preferences were described in their care plans and staff were provided with guidelines on how to support people.

People’s care was reviewed and the frequency of reviews dependent on the complexity of people’s needs. People said they felt involved in planning and reviewing of their care.

Staff told us they felt supported by their managers. Operational staff spoke positively about the recent changes within the service and they said these were needed and reassuring.

People were encouraged to voice their views. There were regular satisfaction surveys carried out by the service and people were encouraged to give their feedback bout the care and support provided by the service.

We found five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.