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Archived: Pulse - Plymouth

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Inspection report

Date of Inspection: 10, 11, 16 October 2013
Date of Publication: 14 November 2013
Inspection Report published 14 November 2013 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Meeting this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 10 October 2013, 11 October 2013 and 16 October 2013, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and talked with other authorities.

Our judgement

Care and treatment was planned and delivered in a way that would ensure people's safety and welfare.

Reasons for our judgement

Pulse provided care and support to people with multiple care needs related to their physical/mental health and medical needs across twenty four hours, seven days a week. This meant care workers either worked long shifts of twelve hours or they provided a "live in" service which meant they stayed at the person's house for approximately two weeks. Some people had their care and support provided by Pulse care workers and their family; other people were totally reliant on "their team" of care workers.

We looked at the care records for one person held in the agency's office and two people's care records kept in their homes. These included daily logs that the care workers completed during each shift that were periodically collected and taken to the agency's office for safe storage. We found that each plan held detailed information about the person, their medical history and assessments of the person's care needs. This included information about what people could do for themselves and what they would need prompting, encouragement and / or assistance to do. We found there were risk management plans about the person's home, assisting the person with personal care, medication management, and individual plans in place, for example, accompanying the person when they wished to go out. We also saw a copy of a service agreement (contract) that identified the required competencies of care workers, for example, understanding and knowledge of spinal injury care. This meant people's risk of receiving inappropriate care and support was reduced.

We read the daily logs and saw that care workers recorded detailed information in a diary style about the tasks they had completed and any observations they made about people's health and/or well-being. For example, one daily log noted that during a pressure and skin check, the care worker had seen a "small red mark" which on further checks they had attributed to the person's finger nails needing to be filed. We also saw that any marks or bruises were recorded on pressure area charts and/or body maps, with a note in the daily log stating where else this information was recorded. The daily logs included diet and fluid intake, any incidents, and any relevant comments about changes in the person's care needs. We also saw records of night checks. These were less detailed however provided sufficient information to show, for example, the person's sleep pattern and pain management.

We spoke with four care workers who told us they looked at the person's care plan at the beginning of their shift to ensure they were up to date about the person's care and support needs. The care workers told us they worked mainly with the same person and team. They said they had had to complete specific training to ensure they had the required competencies to work effectively and safely with the person.

One person told us they had a small team of five care workers and it was "a good team". This person said "staff ask and I tell them. They do cleaning, cooking, accompany me out and when I need to go to hospital appointments". They also told us they were totally reliant on the care workers for help with all their personal care and management of their medicines. This person confirmed they could choose the gender of care workers, particularly with personal care and intimate medical treatments. This meant people received consistency and continuity in their care, and were involved in choosing who provided their care and support for them.

We found care plans contained documentation providing care workers with information about particular chronic health conditions, illnesses and conditions. We noted additional information was sent out during a period of hot weather reminding care workers to ensure people stayed hydrated. This included people who received their fluids by other means because they were unable to take food/fluids orally. There was also information about the effects of heat on people with certain conditions and how car