Pulse8+ Ltd

Service for Independent Living is a domiciliary care agency providing personal care to people in their homes.

People's experience of using this service.

Not all people who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any broader social care provided, people’s experience of using this service and what we found.

People were supported with their medication when required. Risk assessments were completed, and staff had appropriate training.

Staff told us they felt well-trained and supported in their role. Staff felt listened to and able to contribute to the running of the service. For example, any ideas that could improve the service for people. The managers regularly observed staff practice to ensure people were supported safely and as they chose. People were fully involved in all aspects of their care.

Staff had completed training to identify signs of abuse and escalate concerns as and when required risks to people’s health and well-being. Individual risk assessments were completed to ensure staff had the information to support people safely.

Staff identified when people were unwell or needed additional support, and referrals were made to medical professionals as required.

The service employed a recruitment manager to complete the necessary checks on new staff to ensure that only appropriate staff were employed.

Infection control measures were implemented to reduce the risk of spreading infection.

Incidents and accidents were investigated, information was used to improve, and lessons were learned. However, not all incidents were correctly coded, which meant investigations were not always relevant.

Risk assessments were completed, and the staff had appropriate training.

The managers had an open-door policy that meant staff had the opportunity

to speak with the managers if they had any concerns.

Staff had regular supervision, spot checks, and appraisals, which gave the manager and staff the opportunity to address any concerns and progress in the organisation.

Audits were carried out regularly by senior staff to monitor the service provided and assess where improvements were required.

Preventing and controlling Infection

Control measures were put in place to reduce the risk of infection spreading. Incidents and accidents were investigated, the provider ensured personal protective equipment was available. This included gloves, aprons, and masks. All staff had completed training in infection control.

People and their relatives gave positive views about the service provided and some areas for improvement. The managers welcomed feedback and used the information to improve.

Staff were provided with induction and training opportunities to provide them with the skills required to meet people's needs. The registered manager was proactive in sourcing additional training for the staff when required.

People were supported to have maximum choice and control of their lives; staff supported people in the least restrictive way possible and the best interests; the policies and systems in the service supported this practice.

People were treated with kindness, dignity, and compassion. Staff took the time to get to know people and encouraged them to maintain their hobbies and interests.

People’s communication needs were understood, and people told us that they felt comfortable and confident expressing their views and sharing any concerns.

People were supported with their medication when required. Risk assessments were completed, and the staff had appropriate training

At the last inspection in April 2017, the service was rated overall, ‘Requires Improvement’. This was because the provider had not sent us statutory notifications in line with their legal responsibility. This was a breach of the regulations. We served a requirement notice and asked the provider to complete an action plan to show us what they would do, and by when, to improve their systems so we would be notified of important and serious events. This action plan was received by us within the requested time frame. At this inspection we found that improvements had been made and the regulation specified in the requirement notice had been met.

This inspection was a comprehensive inspection so we have inspected all key questions under the new framework to make sure all areas were re-inspected to validate the rating. Since our last inspection we received some information that continuity of staff was not always provided and we found there was some evidence to support this, although improvements had started to ensure staff consistency was maintained.

The office visit was completed by one inspector which took place on 14 June 2018 and was announced. We told the provider we were coming so they could arrange to be there and so they could contact people, to seek their permission for us to speak with them about their experience of using this service.

The service had a 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.

There were procedures to keep people safe and manage identified risks to people’s care. People and their relatives felt safe using the service and staff understood how to protect people from abuse and potential harm.

Where staff administered medicines, staff were trained and assessed as competent to do so. The provider’s recruitment process continued to ensure pre-employment checks were completed prior to staff starting work, to ensure staff were suitable to support people who used the service.

Staff used protective clothing when needed, such as disposable gloves and aprons when providing personal care tasks, which minimised the risk of infection.

People had an assessment of care completed before they used the service to make sure staff could meet people’s care and support needs. The provider put people’s needs first and if they felt they could not meet people’s needs without it having an impact on the people already receiving care, the package was not taken.

People said care staff stayed long enough to provide the care outlined in their care plans and were willing to help provide additional support if needed. However, people and relatives said care calls times were not always provided at consistent times, and the staff teams were not always the same, especially at weekends. Some people did not know in advance, who was providing their care. Measures were in place to improve this and people said in the last few weeks, consistency had improved.

Care plans provided information for staff about people’s care needs and the details of what they needed to do on each call and people and relatives were involved in making care decisions.

The registered manager and staff followed the principles of the Mental Capacity Act (MCA). Staff respected decisions people made about their care and gained people’s consent before they provided any care or support.

People told us they received care from staff who were kind, caring and considerate to their needs. People said staff always treated them with dignity and respect and relatives were confident their relations were looked after well. Staff knew the people they visited and spoke about people in a caring and considerate manner.

People’s care needs were regularly reviewed. The registered manager and office staff were in regular contact with people, or their relatives, to check the care provided was what people needed and expected.

People knew how to complain and information about making a complaint was available for people when they started using the service. Some people told us if they contacted the office, calls were not always returned.

Staff felt supported to do their work effectively and said the managers and provider were approachable and available. There was an ‘out of hours’ on call system, which ensured support and advice was available for staff.

The provider's quality monitoring systems included asking people for their views about the quality of the service. The management team regularly checked people received the care they needed by observing staff during visits and through feedback from people and staff. The office team and registered manager worked well together and were committed to providing a high-quality service to people. However, records and the audit processes were not thorough enough to demonstrate what improvements had been made. The provider assured us they would take action because they were driven to deliver a service that they and their staff team were proud of.

The service registered with us in June 2015 and had not been previously inspected. This was the first rating inspection.

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.

People felt safe receiving care from staff that had been checked by the provider to ensure they were of the right character to work for the service. The provider’s recruitment process included pre-employment checks prior to staff starting work. This helped ensure their suitability to support people who lived in their own homes.

Staff knew how to keep people safe from abuse or poor practice. Staff received training to safeguard people from abuse. They were supported by the registered manager, who ensured staff followed safeguarding protocols and procedures and reported any concerns to the local authority. However, we found two safeguarding incidents which had been referred to the local authority, but not notified to us. We were satisfied necessary actions had been taken to protect people.

Risks to people’s safety were identified and there was clear guidance for staff on how to protect people from harm or injury.

Care plans provided guidance for staff in how to support and follow people’s preferred and agreed routines. Some care records referred staff to guidance for specific and complex health conditions which was not in the care plans we sampled. However, from speaking with staff they knew people’s current risks, health conditions and how they should be effectively managed and cared for. The registered manager agreed to review some people’s care records so staff continued to provide consistent and safe care.

Most people were able to administer their own medicines or had family members who assisted them. Some people were given their medicines by staff who were trained and assessed as competent to give medicines safely. Records showed people’s medicines were given in a timely way and as prescribed. Checks ensured medicines were managed safely and staff were observed by senior staff to ensure they were competent to do so.

There were enough staff to meet people’s needs. Most people told us they had some consistency from staff who supported them, which they appreciated. However, people and relatives said recent staff turnover meant this did not always happen and there was no process to let them know in advance, who was providing their care and at what time.

People told us staff sought their consent before undertaking any personal care tasks. Where people were able to make their own decisions, staff respected their right to do so.

People and relatives told us staff treated them with dignity, kindness and respect. People’s privacy was maintained and people felt comfortable when staff supported them with personal care.

The registered manager and provider sought feedback from people by annual surveys and at face to face review meetings or when care was given. The provider recognised what improvements they needed to make to ensure people received the information they wanted to, for example receiving a copy of a rota in advance of their care being provided.

People were supported to attend appointments with health professionals when needed and the care and support provided was in line with what was recommended.

People and relatives felt able to raise concerns with the registered manager and were confident they would be listened to and responded to in a timely way. There were systems to monitor the quality of the service provided, however they did not always record what actions had been taken and whether improvements were taken and sustained.

The registered manager had not submitted statutory notifications to us in accordance with their legal responsibility to do so. They gave us assurances in future, they would send us relevant statutory notifications for incidents or important events.

We found a breach of the 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.