Archived: Pulse - London

Updated 14 October 2016

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 inspection took place on 9 and 10 August 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service.

This inspection was carried out by one inspector, a specialist advisor in nursing care and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience supported this inspection by carrying out telephone calls to people who used the service and their relatives.

Before the inspection we reviewed the information we already held about the service. The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give key information about the service, what the service does well and improvements they plan to make. We reviewed notifications, and safeguarding alerts. We also contacted five local placing authorities and clinical commissioning groups (CCG) and received feedback from one CCG.

During the inspection we reviewed six people’s care records, which included care plans, risk assessments and Medicines Administration Records (MAR). We also looked at staff files, complaints and quality monitoring and audit information.

We spoke with three people using the service and eight relatives. With permission, we visited the homes of two people using the service. We also spoke with a clinical director, a senior regional manager, a compliance manager, a group quality manager, a senior case manager, two case managers, a care coordinator team leader, a care co-ordinator, a recruitment administrator, a senior nurse and eight support workers.

Updated 14 October 2016

This inspection took place on 9 and 10 August 2016. This was an announced inspection and the provider was given 48 hours' notice. This was to ensure that someone would be available during the inspection to provide us with the necessary information.

This was the first inspection of the service since it registered with the CQC in December 2014.

Pulse – London is a domiciliary care agency based in central London which provides home based care for people with complex care needs. The service provides up to 24 hour support depending on the assessed needs of people using the service. At the time of the inspection, there were 19 people using the service. Although based in central London, Pulse – London provide care for clients in London and surrounding counties such as Kent, Berkshire, Sussex and Surrey.

There was no 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. A senior regional manager was managing the location on an interim basis and was based at the location three to four days per week. The senior regional manager told us that the registered manager

position is being actively recruited for; however, they have not yet found a suitable candidate.

Medicines were not always managed safely and effectively. We found the administration of medicines was not always recorded accurately. Some Medicines Administration Records (MAR) were not transcribed correctly or counter signed to ensure accuracy. The provider did not record the administration of medicines from a blister pack on a MAR chart.

There was a complaints procedure in place which was displayed for people and relatives. Complaints were logged, investigated and resulting actions and learning points were monitored for trends. However, people and relatives told us that complaints made in relation to staffing and rotas had not been addressed and they had little confidence in the service as a result.

People and relatives told us they felt safe. Procedures and policies relating to safeguarding people from harm were in place and accessible to staff. All staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

People spoke positively about their core team of carers. However, people and relatives had little confidence in the provider to communicate staff changes and provide rota’s in a timely manner.

Detailed current risk assessments were in place for people using the service. Risk assessments in place were reviewed and updated regularly. The risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff were recruited with necessary pre-employment checks carried out. Staff had regular supervisions and annual appraisals.

Staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Staff understood what to do if they had concerns about people's mental capacity to make certain decisions. These safeguards are there to make sure that people who receive support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

People were supported to maintain good health and had access to healthcare services. Referrals to appropriate healthcare professionals were made promptly when concerns were raised as regards people's health.

Staff regularly met with people and their carers to ensure the service was meeting their needs and they were providing a good service.

There was an incident and accident procedure in place which staff knew and understood. There was evidence of learning and improvements as a result of incidents. There was evidence of audits on medicines and overall compliance.

People and relatives told us that staff were caring and respected their dignity and privacy. People were supported to be independent and access the community, where possible.

Assessments of people's care needs were carried out before the service provided personal care to ensure if people’s needs could be met. Care plans had been developed which were person-centred and had sufficient detail to guide staff providing care to people. Staff understood people's needs. People and their relatives expressed satisfaction with the care provided.

The provider had quality assurance processes and procedures in place to monitor the quality and safety of people’s care.

At this inspection we identified a breach of Regulation 12 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.