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Archived: Pulse - Bristol Good

Inspection Summary

Overall summary & rating


Updated 7 June 2017

This inspection was announced and took place on 14, 15 and 19 December 2016.

Pulse is registered to provide care and support for people in their own homes including nursing care. Most people receiving support from Pulse had complex needs or were older people. As a result many of them have limited communication skills so were unable to speak with us. Recently the service had been part of a pilot scheme for delivering end of life care in people’s own homes. Each person with complex needs had a small teams of staff assigned to them. At the time of our inspection there were eight people using the service plus the end of life care service which had fluctuating numbers.

The service had a registered manager. 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. At the time of inspection the registered manager was absent. The deputy manager was in charge with the support of a clinical lead supplied by the provider. There was a team of case managers supporting the deputy manager.

People were supported by staff who had received excellent levels of training and were supervised regularly. This included clinical supervisions for any medical procedures they undertook. The staff often went above and beyond their role. As a result staff had good knowledge about people’s complex care needs. The care plans provided additional guidance to ensure people’s care and medical needs were met. When people were unable to communicate verbally or read their care plans alternative methods were found. People’s care was very responsive to their changing needs. If people required special diets they received them.

People’s choices were always supported and respected by staff. They explained how kind and caring staff were and we observed positive interactions. People’s privacy and dignity was respected. People received excellent end of life care which was personalised and holistic. Staff provided support for the person and their relatives to ensure a dignified end in their own home. When people lacked capacity staff and the deputy manager had understanding about people who lacked capacity to make decisions for themselves. This meant their human rights were respected.

People were supported by sufficient numbers of staff to meet their needs. To ensure people’s needs were met small teams of regular staff were created. There were effective systems in place if staff were running late. People and relatives told us they would receive a phone call from the office so they knew someone was on their way.

People and relatives told us they felt safe. Medicines were managed safely. Any medical procedures were overseen by a qualified nurse who provided clinical guidance. When there were problems the case manager would liaise with other health professionals. This meant the management and staff had built strong links with other health and social care professionals to create positive support for people.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and knew the procedures to follow if they had concerns. Any concerns raised had been appropriately managed. There was a safe recruitment procedure in place and staff received checks before starting to work with people.

Quality assurance systems were in place by the management and provider to identify issues. When any concerns or patterns had been identified they had been resolved and lessons were learnt. There were systems in place to manage complaints and the provider demonstrated a good understanding of how to respond to them.

Inspection report

Inspection areas



Updated 7 June 2017

The service was safe.

People�s medicines were managed safely.

People were protected from abuse and avoidable harm.

People were kept safe and able to participate in activities because risks were managed well.

People were supported by sufficient numbers of suitably qualified staff.

Inspection report



Updated 7 June 2017

The service was effective.

People were supported by staff who received excellent levels of training and support.

People who lacked capacity had their human rights considered and respected.

People were supported to see appropriate health care professionals to meet their specific needs. Staff had built strong links with health and care professionals.

People made decisions about their day to day lives and were cared for in line with their preferences and choices. People who lacked capacity had decisions made in line with current legislation.

Inspection report



Updated 7 June 2017

The service was caring.

People received excellent personalised and dignified end of life care.

People received very good care from staff who went above and beyond to support them.

People were involved in making choices about their care.

People�s privacy and dignity was respected.

People�s culture and religious needs were valued by staff.

Inspection report



Updated 7 June 2017

The service was responsive

People had care plans which provided staff with a huge amount of detail and guidance to cover all aspects of their complex needs.

People were supported to access the community and participate in activities.

People received care and support in line with their care plans and staff were familiar all information. Staff were very responsive to people�s changing needs.

People knew how to make complaints and there was a complaints system in place.

Inspection report



Updated 7 June 2017

The service was well-led.

People were kept safe and had their care needs met because there was a quality assurance system in place which identified shortfalls, demonstrated changes occurred and lessons were learnt.

People were supported by staff who were familiar with the culture and vision of the registered manager and provider.

The staffing structure gave clear lines of accountability and responsibility and staff received excellent support.

Inspection report