Archived: Pulse - Manchester Adults

Updated 21 February 2019

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 was a comprehensive, announced inspection. We gave the service 24 hours notice of the inspection visit to ensure the manager would be available. The inspection started on 8 January 2019 and ended on 18 January 2019. One inspector visited the registered office in Manchester on the 8 January 2019 and completed a home visit and telephone calls to members of staff and relatives the following day. Three inspectors visited people in Yorkshire and the North East. Two further inspectors made telephone calls to members of staff. An expert by experience made telephone calls to relatives and members of staff. 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 had experience of services for people with health needs and learning disabilities.

Before our inspection the provider completed a provider information return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the information we held about the service. We looked at the statutory notifications the service had sent us. A statutory notification is information about important events, which the provider is required to send to us by law.

We contacted seven local authority commissioning teams in the areas where Pulse have support packages. No concerns were raised, further details of the feedback we received is contained within this report.

During the inspection we spoke with six people who used the service, six relatives, 28 members of care staff, one case manager, two senior nurses, the new operations manager, the senior manager and the Nominated Individual. A Nominated Individual has responsibility for supervising the management of the regulated activity.

We looked at records relating to the management of the service including five care files, policies, incident and accident records, five staff recruitment documents, training records, meeting minutes and auditing systems.

Updated 21 February 2019

Inspection site visit activity for this inspection started on 8 January 2019 and ended on 18 January 2019. It included home visits, with permission, to meet people and their relatives supported by Pulse – Manchester Adults (Pulse) and telephone calls to relatives and staff. We visited the office location on 8 January 2019 to see the manager and office staff; and to review care records and policies and procedures.

We announced the inspection 24 hours in advance so the manager could ensure there were staff available at the office to assist us with the inspection.

Pulse supports people with complex healthcare needs and people with autism or a learning disability who have complex behaviours. The support was based on people’s assessed needs, with some people requiring more than one member of staff to be with them at all times.

Pulse – Manchester Adults is the registered office for the North of England packages of support. This covers the North West (Manchester, Liverpool and Lancashire), Yorkshire and the North East (Newcastle, South Shields and Durham). At the time of our inspection Pulse were supporting 33 people.

A new senior manager had been appointed in September 2018 and they were in the process of registering with the Care Quality Commission (CQC). This was a newly created role . A registered manager is a person who has registered with the 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 our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Comprehensive risk assessments and care plans were in place, giving detailed guidance for staff in how to meet people’s assessed needs.

Detailed positive behaviour support plans were used to identify people’s complex behaviours and the strategies and distraction techniques required to reduce their anxieties. Any physical intervention techniques that could be used were specified in the positive behavioural support plans.

These were reviewed fortnightly or monthly, depending on the complexity of people’s needs.

Most people had a stable staff team and shifts were covered. However, we were told of three packages in the North West where there had been issues in recruiting staff, which had resulted in agency staff being used and a few shifts not being able to be covered by Pulse. Contingency arrangement's, often with people's family supporting people, had been implemented on these occasions.

New care co-ordinators had been recruited to cover all rotas and enable the case managers to spend more time monitoring people’s support and supporting the staff teams.

Everyone we spoke with said the training was excellent and bespoke to the specific needs of the person staff were supporting. Staff said they enjoyed working for Pulse and felt well supported by the case managers and nurses. They said there was always someone available to contact.

People and relatives were positive about the staff teams, saying they were safe and were treated with kindness, dignity and respect. Staff knew people’s needs well and we observed positive interactions during our home visits.

Where required communication aids were used, for example flash cards and pictorial boards.

People received their medicines as prescribed.

Each person had a health action plan in place and was supported to maintain their health. Where it was part of the support package people were supported so their nutritional needs were being met.

People's rights were protected. The senior manager and staff were knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were involved and supported to make decisions about their care, support and activities they wanted to do. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

A robust quality assurance system was in place. The senior manager had introduced weekly branch meetings and had reviewed incidents and accidents with the managerial team to try to reduce future incidents.

The service sought feedback from people relatives and staff to look at ways improvements could be made through annual surveys.

Further information is in the detailed findings below