Archived: Pulse - Manchester Adults

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

Pulse – Manchester Adults supports people with complex healthcare needs. The service provides up to 24 hours support for people with complex needs; the hours vary depending on the assessed needs of people. The service also provides two ‘runs’ to provide support at key times of the day for some people. One of the ‘runs’ is to provide a second member of staff for personal care tasks for people supported 24 hours a day by Pulse – Manchester Adults’ staff. The service currently supports 29 people.

The registered manager of the service had left three weeks before our inspection. The Pulse national quality manager was managing the service until a new registered manager was recruited. 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.

All the people we spoke with, and their relatives, said they felt safe supported by staff from Pulse – Manchester Adults. Staff had received training in safeguarding vulnerable adults and knew the correct action to take if they suspected any abuse had occurred. Staff said the case managers and nurse practitioners would listen to any concerns raised. Case managers managed the staff teams providing the support for people and the nurse practitioners assessed and reviewed people’s clinical needs.

Where Pulse – Manchester Adults had responsibility to administer people’s medicines they were administered safely. Medication Administration Records (MAR) were correctly completed and checked at each review. Any errors were looked into.

The service was working within the principles of the Mental Capacity Act (2005) (MCA). People and their families, where appropriate, were involved in agreeing the support to be provided by the service with the funding Clinical Commissioning Group (CCG).

Comprehensive care plans and risk assessments were in place for each person who used the service. These gave clear guidance to staff on how to support people and mitigate the identified risks. The plans were reviewed every two to four weeks depending on the assessed clinical need of the individual. A commissioner from the CCG said, “The care records, care plans and risk assessments are of a very high standard.” This enabled staff to support people effectively and safely.

A robust system of recruiting and training staff was in place. Staff had to complete all mandatory training and any training to meet people’s specific needs, such as airway management, before they were able to support people. People and their relatives told us the staff were well trained and competent in the use of various types of equipment required to support people with complex clinical needs. Training was refreshed on an annual basis.

Staff received regular supervisions and appraisals with the case managers. Annual observations of staff competencies were completed by the Pulse nurse practitioners. This meant the staff had the skills, knowledge and support to provide effective care.

Contingency plans were in place for each person being supported by the service. Where agency staff were used, a verification form was completed by the agency to ensure the agency staff member had the required training to support the person using the service.

People who used the service and their relatives spoke highly of the staff teams. Staff had a clear understanding of people’s needs. Staff could clearly explain how they delivered person centred care and respected people’s dignity and privacy. Staff supported people with their nutritional and health needs where applicable.

An annual survey was conducted by the Pulse central office. Feedback from September 2015 had raised issues about the office staff responding to phone calls in a timely manner. The people we spoke with during this inspection did not raise this as an issue.

The case managers and nurse practitioners checked all paperwork was in place and current at people’s fortnightly or monthly reviews. The central quality team were due to re-commence audits every three months following the introduction of a new computerised care planning system.

There was a system in place to record, investigate and learn from complaints. Incidents and accidents were reviewed to reduce the likelihood of the incident reoccurring.

People who used the service told us:

'They treat me very well, they're very good.'

And:

'I need people (carers) with a sense of humour and with things in common to me. So if their personality didn't match they would change the person. They've always accommodated that.'

Relatives told us:

'We feel very lucky.'

'I think we've landed on our feet, they've put my (relative) at ease.'

And:

'The staff are really good and non-invasive. They respect all the family, this had been a worry for my (relative).'

We found the Pulse Manchester service completed person-centred assessments and plans of care with people who used the service. These also involved the person's relatives or representative and relevant health professionals as required.

We found that staff received up to date training.

People were able to comment on the quality of the service they received.

The provider checked to make sure people received support in a manner which promoted their wellbeing and safety.