Archived: Pulse - Norfolk

Updated 12 September 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 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 announced comprehensive inspection on 5 July 2018, was carried out by one inspector.

The provider was given one days’ notice because it is a domiciliary service and we wanted to be certain the registered manager and key staff would be available on the day of our inspection.

As part of our inspection planning, we requested that the provider complete 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. This was received from the provider. We also reviewed information we held about the service including feedback sent to us from other stakeholders, for example the local authority and members of the public. Providers are required to notify the Care Quality Commission (CQC) about events and incidents that occur including unexpected deaths, injuries to people receiving care and safeguarding matters. We reviewed the notifications the provider had sent us.

Inspection activity started on 5 July 2018 and ended 16 July 2018. The inspector visited the office location on 5 July 2018. We spoke with the registered manager, head of quality and governance and seven staff of differing levels of responsibility at the agency. This included case managers, branch nurses and care workers. We reviewed the care records of three people to check they were receiving their care as planned. We spoke to three people in receipt of a service and three professionals who had commissioned the service. We looked at records relating to the management of the service, staff recruitment and training, and systems for monitoring the quality of the service.

Updated 12 September 2018

At the time of this announced comprehensive inspection of 5 July 2018, there were 22 people who used the service. The provider was given a days’ notice because it is a domiciliary service and we wanted to be certain the registered manager and key staff would be available on the day of our inspection. We then contacted people using the service, staff and involved professionals by phone and email up till 16 July 2018.

This service is a domiciliary care agency. The area currently covered is Norfolk and Suffolk, but also extends to Cambridge, Peterborough and South Lincolnshire if needed. It provides personal care and/or treatment of disease, disorder or injury to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and children. Care and support is usually commissioned by health and social care statutory bodies. People who use this service can have complex heath needs such as spinal injuries, use a ventilator, have a tracheostomy or have an acquired brain injury.

At the previous comprehensive inspection on 11 August 2017 we had rated the service Requires Improvement and were in breach of the regulation for receiving and acting upon complaints. At this inspection we found matters had greatly improved.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Safe to at least a rating of good. At this inspection, we found that complaints were listened to, responded to in a timely way and in line with their own policies and procedures. This service is now rated as good overall.

There was a registered manager in place who was present throughout our inspection visit. 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.’

This service provides a bespoke service to adults, children and their families to enable them to live within their community. Most of what they do is highly complex and therefore based upon detailed assessments and provided by highly skilled staff. We found a service that was diligent in ensuring the care, support and health interventions were based upon up to date assessments and detailed care plans and that staff were only supplied to people if they had the appropriate skills to complete the tasks required to keep the person healthy and safe whilst in their care.

The oversight of this service was key to ensuring staff were up to date in their skills and current best practice. Systems in place for reviewing care needs and making adjustments and changes to treatment and referring to other health professionals was of a high and meticulous standard, completed by appropriately qualified clinicians. Staff were trained and their competencies tested and then appropriately supported to ensure the outcomes for people were in line with their needs and wishes.

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. Procedures and guidance in relation to the Mental Capacity Act were followed which included steps that the provider should take to comply with legal requirements.

People consistently fed back to us that this was a good service that provided them with the support they required. People told us they felt safe. They told us that staff were kind and caring and responded to their needs. The only one comment made about areas of improvement was that people did not like the on-call system being answered in another part of the country by people they did not know, people told us, that previously, the out of hours service was triaged and brought back to the on-call system more locally.