Archived: Pulse - Bournemouth

Updated 23 November 2016

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.

The inspection took place on 27 September and was announced. The inspection continued on 4 October and 5 October 2016. The provider was given notice. This is so that we could be sure the manager was available when we visited. The inspection was carried out by an inspector and specialist advisor on the first day. The specialist advisor was a paediatric nurse. The inspector completed the inspection on days two and three.

This was the first inspection that the service had had since registering with CQC. Before the inspection we looked at notifications we had received about the service. We spoke with the clinical commissioning group (CCG) to get information on their experience of the service.

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 spoke with two people who use the service and met with three family members.

We spoke with the registered manager and two case managers. Case managers were responsible for delivery of a number of different peoples care and support packages. We met with eight staff in various roles from recruitment staff and support workers to a paediatric and adult nurse. We reviewed three people’s care files, policies, risk assessments, quality audits and the 2015 quality survey results. We visited four locations and met with the people and family members in their own homes. We looked at three staff files, the recruitment process, staff meeting notes, training, and supervision and appraisal records.

Updated 23 November 2016

The inspection took place on 27 September and was announced. The inspection continued on 4 October and 5 October 2016.

Pulse Healthcare Limited provides domiciliary health and social care support services to people in their own homes. Pulse Bournemouth works with a variety of organisations to provide bespoke 'care packages'. The agency provides care and support to a wide range of people including children, people who are elderly, people diagnosed with dementia and people with learning or physical disabilities. At the time of our inspection there were 20 people receiving personal care from the service. There was a central office base which was open plan shared space where recruitment, nurses, case managers, coordinators and the registered manager were based.

The service had a registered manager in place. 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 provider did not have an appropriate system to ensure that they complied with conditions of their registration. The service was in the process of moving to another location which had not been registered with CQC. We advised the provider of their legal; responsibilities to ensure people were protected by services being appropriately registered. The provider postponed the move pending the outcome of their application to registered the new location.

We were told that there were times when medicines had arrived with items missing. We identified one incident when the person had to go without a medicine which resulted in them becoming unwell. The management team were informed 10 day prior that the medicine was running low. This did not demonstrate effective quality monitoring and showed us that actions were not acted upon within appropriate timeframes.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding adults and protection of children.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their life. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines generally were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, oral suction, nebulisers and pressure area care.

Staff told us they received regular supervisions and annual appraisals which were carried out by the management team. We reviewed records which confirmed this. A staff member told us, “Supervisions are regular and effective. They provide an opportunity for both parties to air concerns and for me to develop my skills”.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Peoples capacity was assessed when necessary and best interest decisions made as appropriate.

People were supported to eat and drink enough whilst maintaining a healthy diet. Food and fluid intake was recorded for those who were under monitoring for this. The training record showed that staff had received food hygiene training.

People were supported to access healthcare services as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs.

People told us that staff were caring. During home visits we observed positive interactions between staff and people. People said they felt comfortable with staff supporting them. Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before using the service and care packages reflected people’s needs in these. We saw that these were regularly reviewed by the nurses and case managers with people, families and other health and social care professionals.

The service had systems in place to capture and respond to people’s feedback. People were asked if they were happy with the support they are receiving and if they would like any changes made during people’s regular review meeting. The registered and quality manager told us that surveys were sent out every six months and that the last one was in January 2016. We saw that questions asked in the surveys were grouped into sections for example; your care, your care team, compliment and complaints. We were told that no actions had come from January’s survey so no action plans were in place. We were shown the results of a bespoke survey sent out to people shortly after the current registered manager started. The registered manager told us that the purpose of this was to capture people’s current views regarding the quality of service in two areas.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints in place.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

Staff, people and families told us that the thought the management was good at Pulse Bournemouth. We found that the registered manager promotes an open working environment and was flexible. A family member told us, “The service is managed well. Our case manager is always available and we know who the registered manager is”.

We saw that quality monitoring across the services took place regularly by the nurses, case managers and registered manager. These included paperwork checks which were carried out at people’s homes to make sure that record keeping is of a good quality, observations are being recorded and charts are up to date.