Archived: Pulse - Norfolk

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.

Pulse - Norfolk provides a domiciliary care service to adults and children across Norfolk and Suffolk in their own homes. People using the service have complex health care needs. At the time of our inspection, there were 20 people using the service.

There was a registered manager in post, who took up her management role at the end of 2016, and completed registration with the Care Quality Commission (CQC) in April 2017. A registered manager is a person who has registered with 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.

At the last inspection of this service in June 2015, we found it was good in all areas. At this inspection, we identified some concerns that the service was not always as responsive or safe for people as it should be.

People expressed some frustration at the length of time it took to investigate and resolve any concerns that they raised. The provider's own timescales for resolving complaints, or agreeing an extended response period with complainants, were not adhered to.

This was a breach of Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full report.

Systems for monitoring the safety of medicines management and ensuring people received them as prescribed, had declined and did not robustly identify concerns so they could be followed up promptly. The provider's representative had already identified this and directed the reintroduction of more regular checks. However, staff did receive training and checks on their competency, if they needed to administer medicines for people.

People had experienced missed calls, where there were insufficient staff with the right skills to deliver the care they needed to ensure their safety. There were contingency plans in place but sometimes people were without the right support at the right time. The registered manager had improved this over recent months and was exploring options for further action.

The registered manager ensured staff were recruited in a way that contributed towards protecting people from the employment of those unsuitable to work in care. However, the provider's systems for were not always robust in supporting the process. Staff who were appointed, understood their obligations to report concerns and suspicions that people might be at risk of harm or abuse and were confident these would be acted upon. They knew how to blow the whistle on poor practice and how to raise concerns with the provider.

Staff were trained to be able to deliver effective care. This included training to meet the complex needs of people they supported and their competence to deliver care was assessed. People felt their regular carers had a good understanding of their needs and preferences for how they wanted their care delivered. This included their preferred routines, their health and social care and support they needed with eating and drinking where appropriate.

People's needs were regularly reviewed with them and there were checks in place to ensure their records remained up to date, or to take action if there were shortfalls. This enabled the service to be responsive to people's needs. People also felt that their regular staff had built up good, caring relationships with them and treated them with respect.

Staff understood their legal obligations to seek consent to deliver care and ensuring they acted in people's best interests where they were concerns about their capacity to make an informed choice.

Although relatively newly in post and only recently registered with CQC, the registered manager had a grasp of the risks and challenges within the service and had begun to make improvements. Staff could see what these were and felt that the service was becoming more proactive in identifying and dealing with issues that needed addressing.

The provider's quality assurance processes enabled people to express their views both formally through regular questionnaires and as part of visits to individuals. Where appropriate, there were clear action plans for the registered manager to make improvements where audit processes showed these were needed.