Archived: Pulse - Newcastle

The service had last been inspected in October 2016 when we had followed up on breaches of legal requirements relating to governance, medicines and safeguarding. Prior to this we had carried out a comprehensive inspection in February 2016 and rated the service as ‘Requires Improvement’.

At this inspection we judged improvements had been sustained and have changed our rating of the service. We found suitable systems were in place for reporting and responding to any safeguarding concerns. Administration and recording of medicines continued to be kept under close scrutiny to ensure staff followed safe practices.

The registered manager had left in recent months and the provider was in the process of recruiting a new manager. Appropriate arrangements had been made to manage the service in the interim.

People’s care was well-planned to reduce risks to their personal safety and welfare. New staff had been thoroughly vetted to assess their suitability before they were employed. There was sufficient staffing capacity and most people now had their own team of allocated support workers for consistency.

The staff were supervised, supported and given training that enabled them to provide effective care. Where it formed part of their care plan, people were provided with the necessary assistance to meet their health care and nutritional needs.

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 systems in the service supported this practice.

People and their relatives spoke positively about relationships with their support workers and their caring approach. They described being treated respectfully and with dignity.

Care plans were individualised and agreed in consultation with the person and their family. Where applicable, the service supported people to take part in social activities and access the community.

There were methods to assure the quality of the service, including seeking people’s views about their care experiences. Most people and their relatives were satisfied with how the service was run and it was evident complaints were taken seriously and acted on.

Further information is in the detailed findings below.

We undertook this focused inspection on 11 and 21 October 2016 to check if the provider now met legal requirements. We requested some additional information, which we obtained from the service on 8 December 2016. This report only covers our findings in relation to the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pulse – Newcastle on our website at www.cqc.org.uk.

Pulse Newcastle is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of the inspection there were 15 people in receipt of a service. Personal care was provided to people across the Tyneside area either by contract with the local authority, the NHS or by private arrangement.

The service had a registered manager in post. 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.

Following our previous inspection we asked the provider to submit an action plan explaining how they would meet the legal requirements. This was not received by us.

We found the provider had complied with the legal requirements in relation to the safe management of medicines and dealing with allegations of abuse. We found further improvements had been made in relation to good governance, although further work was needed to ensure logistical arrangements and travel time were managed efficiently and fairly.

The registered manager and staff had taken steps to ensure that accurate medicines records were maintained. The registered manager had taken steps to ensure staff were aware of incidents that required notification to the Care Quality Commission (CQC) and the local safeguarding team. Management arrangements had been strengthened, however despite improvements in the allocation and planning of visits, staff continued to raise concerns about the impact this had in terms of visit duration, travel time and geographical spread.

Staff had developed care plans outlining the support people needed with their medicines. They also completed Medicine Administration Records accurately and clearly. The registered manager and senior staff audited medicine management arrangements and checked the competency of staff.

The registered manager had provided guidance to staff on responding to and reporting incidents and allegations of abuse. Staff expressed confidence that such incidents would be handled appropriately.

The registered manager had overseen improvements to the way work was allocated to staff and the way visits were planned. We heard mixed views about how successful this had been. Communication with staff had improved and a registered manager was in post.

We made a recommendation about the management and planning of care visits. We also made a recommendation about the way action plans are submitted to CQC.

Pulse Newcastle is a domiciliary care agency that provides personal care and support to people in their own homes. At the time of the inspection there were 30 people in receipt of a service. Personal care was provided to people across the Tyneside area either by contract with the local authority, the NHS or by private arrangement.

The service did not have a registered manager in post. A registered manager from another location was providing support to the location. 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.

People told us they felt safe and were well cared for. Staff knew about safeguarding vulnerable adults. The one alert we received during the past year had been dealt with appropriately, which helped to keep people safe. Some incidents reported to the local safeguarding team had not been notified to CQC. Other incidents reported internally had not been notified to the local safeguarding team or CQC.

We were told staff provided care safely and we found staff were subject to robust recruitment checks. Arrangements for managing people’s medicines were not consistently safe as we found gaps in administration records and occasions when people’s stocks of medicines were not available.

Staff obtained people’s consent before providing care. Arrangements were in place to identify if decisions needed to be taken on behalf of a person in their best interests. Staff were made aware of advanced decisions that would affect future care and treatment.

Staff had completed relevant training for their role and they were well supported by their supervisors. Training included care and safety related topics and further topics were planned.

Staff were aware of people’s nutritional needs and made sure they were supported with meal preparation, eating and drinking. People’s health needs were identified and where appropriate, staff worked with other professionals to ensure these needs were addressed.

People and their relatives spoke of staff’s kind and caring approach. Staff explained clearly how people’s privacy and dignity were maintained.

People had opportunities to participate in activities and in accessing their local communities where this formed part of their package of care.

Assessments of people’s care needs were obtained before services were started. Care plans had been developed which were person-centred and had sufficient detail to guide care practice. Staff understood people’s needs and people and their relatives expressed satisfaction with the care provided.

People’s views were sought and acted upon, through annual surveys, care review arrangements and the complaints process.

There was no registered manager in post and the previous two managers had left their position before their registration was formally concluded. Temporary cover arrangements were in place pending the recruitment of a new manager. Some events requiring notification had not been reported to CQC.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the governance of the service, the management of medicines and the processes used to report and investigate allegations of abuse. You can see what action we told the provider to take at the back of the full version of this report.

We visited three people who used Pulse's services, and their relatives, and spoke with a further two people, or their relatives, on the telephone. Comments included 'The staff are brilliant, they have got to know my (relative) very well and know how to communicate', 'They are great, I couldn't manage without them' and 'The service is very good and the staff are great, very courteous.'

We checked a sample of four people's medication records and found they were complete, up to date and had been signed by staff when medicines had been administered.

We found there were effective recruitment and selection policies and processes in place. We looked at four staff files in detail. We saw evidence that staff employed had been through recruitment checks prior to commencing employment.

During our inspection, we looked at the quality monitoring systems the provider had in place. The service used a range of tools to monitor and assess people's wellbeing. This included regular reviews of people's care and needs, internal audits and team meetings.