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Pulse - Plymouth Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 January 2017

Pulse - Plymouth is part of Pulse Healthcare Ltd and is a domiciliary care service that provides complex care and support to adults of all ages in their own homes. The service supports people, at specific times of the day and/or night, who may have clinical and specialist care needs. At the time of the inspection ten people were receiving support with personal care needs.

A registered manager was employed to manage the service locally. 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.

People were supported, when required with their medicines and healthcare needs. People’s medicines administration records, (MAR) were not always completed accurately, which meant it was difficult to know which medicines had been administered and which hadn’t. Where people had been prescribed medicines to be taken, ‘as prescribed,’ people’s records did not always include details to guide staff when they would need administering. Staff had received training on administering medicines and people told us they responded to any health concerns quickly. Comments included, ““They’re straight on it. They don’t hang about.”

People had risk assessments in place to identify any risks related to their needs but these did not always include clear information about what staff needed to do to help mitigate the risks.

The quality of the service was regularly monitored by the provider who undertook a range of regular audits. The registered manager also spoke with people regularly to ensure they were happy with the service they received. However, these audits had not always identified the issues we highlighted during the inspection and where concerns had been identified, changes had not always reduced the risk of reoccurrence.

The service followed a thorough recruitment procedure. However, staff’s full career history was not routinely requested, as required, to help ensure people were only supported by staff who were suitable to work with vulnerable adults.

People told us they felt safe using the service. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. People told us they received support from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. Comments included, “They’re thoroughly trained.”

People told us staff were caring and staff members described the importance of helping to maintain someone’s privacy and dignity. People were supported staff who gave them choice about how they received their care and used different forms of communication according to people’s needs.

The registered manager and staff had a clear understanding of the Mental Capacity Act 2005 and how to recognise that someone no longer had the mental capacity to make decisions for themselves.

There was a management structure in the service which provided clear lines of responsibility and accountability. A registered manager was in post who had overall responsibility for the service. They were supported by other senior staff who had designated management responsibilities. People told us they knew who to speak to in the office and had confidence in the management and staff team.

We saw accidents and incidents had been reported promptly and any actions had been overseen by the relevant staff team within Pulse Healthcare Limited, to ensure they were sufficient and timely.

We found a breach of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Inspection areas

Safe

Requires improvement

Updated 6 January 2017

The service was not always safe.

People’s risk assessments did not always contain guidance for staff about how to mitigate risks to people.

People’s medicine’s administration records (MAR) were not always completed accurately and there was not always clear information for staff about when to administer medicines that had been prescribed to be taken ‘as required’.

Staff’s full career history was not routinely requested, as required, to help ensure people were only supported by staff who were suitable to work with vulnerable adults.

People told us they felt safe using the service.

Staff knew how to recognise and report signs of abuse. They knew the correct procedures to follow if they suspected or witnessed abuse or poor practice.

Effective

Good

Updated 6 January 2017

The service was effective.

People told us they received support from staff who knew them well and had the knowledge and skills to meet their needs.

Staff were well supported and had the opportunity to reflect on practice and training needs.

Staff had a good understanding of the Mental Capacity Act and were confident they would recognise when someone’s capacity changed.

Caring

Good

Updated 6 January 2017

The service was caring.

People and their relatives were positive about the service and the way staff treated the people they supported.

People’s privacy and dignity was protected.

People’s different communication methods were respected by staff to help ensure people could communicate their needs.

Responsive

Good

Updated 6 January 2017

The service was responsive.

People’s clinical care plans were very detailed and were regularly reviewed and updated.

People received personalised care and support, which was responsive to their changing needs.

People were involved in the planning of their care and their views and wishes were listened to and acted on.

People knew how to make a complaint and raise any concerns. The service took these issues seriously and acted on them in a timely and appropriate manner.

Well-led

Requires improvement

Updated 6 January 2017

The service was not always well led.

Concerns we identified during the inspection, including lack of detail in risk assessments and inaccurate recording on MARs, had not been previously identified or acted upon.

Where concerns had been identified, for example, staff lacking confidence to complete specialist care interventions, changes made had not reduced the likelihood or reoccurrence.

People feedback was sought regularly and their views were valued.

Staff were motivated and inspired to develop and provide quality care.