PULSE Community Healthcare Support Service 20-23 Woodside Place Glasgow G3 7QF Telephone: 0333 577 3670 Type of inspection: Unannounced Inspection completed on: 3 May 2017 Service provided by: PULSE Healthcare Limited Service provider number: SP2012011784 Care service number: CS2012306529
About the service This service registered with the Care Inspectorate on 24 August 2012. Pulse Community Healthcare is a support service registered to provide a care at home service to adults and children living in their own homes who have complex support needs. Support from the service can be provided to the following client groups: learning disability, mental health, physical disabilities, neurological conditions, acquired brain injury, traumatic brain injury, paediatric, spinal injury, palliative care and end of life. Support for service users is provided in their own homes and the wider community. The service is managed by Pulse Healthcare Limited, which is a UK wide organisation with its head office based in Broxbourne, England. A senior team including the manager, community nurse, case manager and co-ordinator are based in an office in the centre of Glasgow. At the time of the inspection the service was supporting 4 people in the community and a further three people still in hospital. The overall aim of the service is to provide: "a thoroughly personalised service to each of our clients. Our core values are to provide "Quality, Choice and Independence" to our clients, commissioners, carers, family members and our support workers". What people told us We spoke to two of the four people currently using the service in the community. We also spoke to a friend of someone using the service. Everyone we spoke to was positive about the staff and support provided. They felt it had supported them to live at home and not have to be in a hospital setting. People told us they felt confident to raise any concerns they had and that they would be listened to. Self assessment The Care Inspectorate has not requested services to complete a self assessment for this inspection year. We looked at the services own improvement plan and quality assurance paperwork to see how they were able to demonstrate their priorities and areas for improvement. From this inspection we graded this service as: Quality of care and support Quality of staffing Quality of management and leadership 5 - Very Good 4 - Good 3 - Adequate Quality of care and support page 2 of 12
Findings from the inspection The service provides opportunities for feedback about the service through regular reviews both from a social care and nursing perspective. Either the case manager or community nurse meets with the service user on a regular basis (usually monthly) to review their care. This enables regular feedback to be given about the quality of care, support and staff and for changes to be made as required, addressing any issues as they arise. Although we saw that people are given opportunities to feedback about the service, the manager should consider how they evidence actions taken on feedback from service users, relatives and stakeholders. This could be in the form of a short report, 'you said we did' type responses or newsletter items that gives feedback about how satisfied people are with the service and how the service has responded to any issues/comments raised. This helps to promote the positive aspects of the service as well as providing transparency in relation to how less positive comments are addressed which may also encourage others to make comment on the service if they see their comments are taken on board and actioned. The care plans we sampled showed that the service undertakes thorough and detailed assessments for each individual when they start the service which inform their care plans. These care plans are regularly reviewed and assessments updated as required. Risk assessments are in place to support staff minimise any risks identified and additional guidance is available to support staff with a range of tasks such as moving and handling, external feeding and passive exercise (physiotherapy). Whilst we saw that there had been some improvements in the care plans, we found examples of where the most up to date information was not in the care plan in the service users home. This is important as this is the information that staff have access to on a daily basis to guide them in the support an individual requires. The service supports individuals with a range of complex health needs, some who also have input from a variety of different health and social care professionals. We found that overall the service works well with these professionals and additional support is requested as required. Each service user has contingency plans in place to provide guidance in emergency situations, some of these require inputs from other professionals such as the ventilation teams. The service enables people to stay at home and receive the clinical care they need with the support of staff and their wider health care teams. We saw photos and heard about a recent outing for a service user who has been unable to get out of their house for two years. This was a great achievement for both the service user and the staff supporting them. We also heard how the support provided enables families to stay together as the support the service provides means the person can be supported to live at home rather than in a hospital setting. We discussed with the manager the need to move towards more outcome focussed support planning and how outcomes should be incorporated into the care and support planning process. This should include better identification of individuals outcomes and how people are supported to meet these which can then be clearly reviewed. We signposted the manager to the "Talking Points" document on outcome focussed support planning by the Joint Improvement Team. (http://www.jitscotland.org.uk/wp-content/uploads/2014/01/talking-points- Practical-Guide-21-June-2012.pdf) Requirements Number of requirements: 0 page 3 of 12
Recommendations Number of recommendations: 1 1. The manager should ensure that all care plans include the most up to date information required for staff to provide the appropriate care and support to an individual. National Care Standards, Care at Home, Standard 3: Your personal plan Grade: 5 - very good Quality of staffing Findings from the inspection Due to the complex needs of the people using the service, all staff have to have previous experience in care prior to coming to work in the service. The staff have to complete a number of training courses specific to the needs of the people they will be supporting and be assessed as competent in undertaking a range of healthcare tasks by the community nurse. This is good practice as it ensures that staff have experience and basic knowledge of care practices before working in the service which are then built on to address individual service users' needs. Staff we spoke to were very positive about the induction process and told us they were able to ask for additional shadow shifts if they felt they needed support. We heard that the online training offered was very thorough and that it required staff to pass each module to complete their training. We saw that a new induction process was being introduced called 'safe to start' but this is not yet fully implemented as it requires further work to ensure that it accurately reflects staffs skills, support provided and areas for development. We found that there could be better evidence of the support provided during the induction period especially in relation to contact with managers/supervisors and more specific guidance as to the actual process itself. This includes ensuring that formal reviews of progress/supervision are undertaken regularly. Overall people we spoke to were positive about staff and felt they had the right training to meet people's needs. Staff were also positive about the quality and amount of training available to them. In the last inspection report a recommendation relating to ensuring staff competencies were completed prior to them lone working with people. We saw that there has been work on the computer system to make it more robust in this area and it was demonstrated to us how it prevents staff being booked to work shifts where they have not completed the identified competencies. However we also saw from incident reports that there was still on occasion staff being booked to work shifts where they had not completed the necessary competencies. This suggested to us that there was still something that the service needed to look at to ensure their systems were as robust as they could be to ensure staff have the skills and knowledge to provide the best support they can. We saw that some team meetings had been undertaken but these had been infrequent and poorly attended. The minutes of these meetings did not evidence the discussion of best practice. A recommendation was made in relation to this in the previous two inspection reports and we have repeated this again in this report. There is a new supervision process and template in place and training is being provided for those in a supervisory role. This is a positive development since the last inspection but there are still areas that could be page 4 of 12
improved on. There remains a couple of staff who are still to undertake the supervision training, there are still some staff who are not receiving supervision as per the organisational policy and there are still actions being identified during supervisions that are not being followed up on. There has been a lot of turnover of staff including most of the management team (for a second year running). Staff we spoke to raised communication between support staff and office based staff as something they felt could be improved on but they were generally happy with the level of support they had from their line managers. Requirements Number of requirements: 0 Recommendations Number of recommendations: 3 1. To support the personal and professional development of staff, the manager should ensure that all staff providing formal supervision have undertaken training to provide them with the appropriate skills and knowledge to support and supervise staff. National Care Standards, Care at Home, Standard 4: Management and Staffing Arrangements 2. Staff forums/meetings should ensure that staff are kept up to date with relevant best practice that reflects, both clinical and non-clinical support needs of clients. The minutes of these forums/meetings should be available for reference and for staff unable to attend the actual meeting. National Care Standards, Care at Home, Standard 4: Management and Staffing Arrangements 3. The manager should ensure that all relevant competencies (training and or development sessions) are completed for each individual staff member prior to working with specific service users based on their identified needs. This includes ensuring that the shift booking system is up to date with information on the required competencies for each individual so that any outstanding training needs can be identified. This is to ensure that only appropriately qualified and competent staff are working with individuals. National Care Standards, Care at Home, Standard 4: Management and Staffing Arrangements Grade: 4 - good Quality of management and leadership page 5 of 12
Findings from the inspection The service has had a large turnover of staff since the last inspection including almost all of the senior and management team which has understandably caused some disruption in the service and how it is managed. As the current registered manager has not been in post long, it is difficult to see the impact they have had on the service. Where we have seen some small improvements across the service, it is too early to see how these have impacted on outcomes for people and whether they can be sustained. As a result of the above changes we have been unable to see how the management and leadership of the service has made any significant development since our last inspection and none of the six recommendations made at the last inspection have been fully met (many of these have been in place now for over 2 years) therefore we are unable to increase the grade for this quality statement. We saw that the organisations quality team undertook quarterly audits of the service but we were unable to see what standards or expectations were being audited against and the management team did not know this either. We also noted that where issues had been raised through the audits, some of these had not been actioned as we found some of the same issues for the same individuals despite the audit document stating these issues had been addressed and resolved. We also saw that where a tool had been put in place to support staff in monitoring the administration of medication, this was not being completed properly and this had not been picked up by senior staff. This showed us that the quality assurance processes in place at present are not as robust as they need to be to ensure the quality of the service and support provided. A service development plan was started at the beginning of this year but we felt it required further development to ensure it clearly identified the focus and priorities for the development of the service, what action will be taken to show continuous improvement and the involvement of key people. This also needs to include timescales, identify responsible people and have scope for review/updating progress. We looked at the accident and incident recordings with the manager and found that for a number of incidents recorded, there was a lack of information relating to the incident itself and how it was managed. We also saw on one occasion where inappropriate management responses had been recorded in relation to a medication incident. Incidents are managed centrally and information input by someone outside of the service. We were pleased to see that the manager was as concerned as we were about some of the recordings we saw and was clear about the need for this to be addressed as soon as possible to ensure that there are clear outcomes and lessons learned from incidents. We discussed with the manager the need for a local quality assurance policy to identify how this particular service monitors the quality of service they are delivering. This would include what actions are taken, when and by who. This would help ensure everyone was clear about what tools are being used and when and what each individuals role in the process is. Requirements Number of requirements: 0 page 6 of 12
Recommendations Number of recommendations: 4 1. The service development plan should identify what action will be taken to show continuous improvement of the service and the involvement of key people. 2. The manager should ensure that notifications are made in line with the guidance document issued to services by the Care Inspectorate entitled "the Records that all registered care services (except childminding) must keep and guidance on notification reporting." 3. The manager should ensure that there is clear guidance about the local quality assurance processes for the service. This includes details of standards, processes, timeframes and responsible people to ensure that quality assurance tasks are completed to a consistent standard and at regular intervals. This is to ensure that the management team are clear about their responsibilities in assessing the quality of staff and support provided and there is clear documentation in place to evidence how this has been done. 4. The manager should ensure that all incidents are appropriately and fully investigated and that there are clear learning points identified (where appropriate). This is to help the service identify areas for development and issues around poor practice to enable them to address these issues and prevent further occurrences. Grade: 3 - adequate What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The provider must ensure that the registered manager for the service is engaged in a programme of study that will enable them to achieve the relevant qualifications as stated by the Scottish Social Services Council (SSSC). This is to ensure that the manager achieves an appropriate formal qualification that supports their knowledge and experience and enables them to register as a manager with the SSSC. page 7 of 12
This is to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, SSI 2011/210 regulation 7- to ensure that managers have the necessary skills, knowledge and experience. Timescale 6 months from receipt of this report This requirement was made on 27 May 2016. Action taken on previous requirement This requirement is no longer relevant due to a change in registered manager. Met - within timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The manager should ensure that all care plans include the most up to date information required for staff to provide the appropriate care and support to an individual. National Care Standards, Care at Home, Standard 3: Your personal plan This recommendation was made on 27 May 2016. Action taken on previous recommendation Whilst we saw some improvement in this area, we saw that some information in service users homes had not been updated to reflect changes in their needs. this remains ongoing, recommendation not met. Recommendation 2 To support the personal and professional development of staff, the manager should ensure that all staff providing formal supervision have undertaken training to provide them with the appropriate skills and knowledge to support and supervise staff. This recommendation was made on 27 May 2016. Action taken on previous recommendation Good progress has been made in this area and we heard about new training in place to support those with supervisory responsibilities and those new to the service had undertaken tor were in the process of undertaking page 8 of 12
this training. There are still some members of staff to complete this which means this remains ongoing, recommendation not met Recommendation 3 Staff forums/meetings should ensure that staff are kept up to date with relevant best practice that reflects, both clinical and non-clinical support needs of clients. The minutes of these forums/meetings should be available for reference and for staff unable to attend the actual meeting. This recommendation was made on 27 May 2016. Action taken on previous recommendation We saw that some meetings were happening but these were not consistent across the service, regular or well attended. This remains an area for improvement along with the recording of discussions held and the evidencing of where best practice has been discussed. This remains ongoing, recommendation not met Recommendation 4 A) Staff forums should ensure that staff are kept up to date with relevant best practice that reflects, both clinical and non-clinical support needs of clients. B) Management should ensure that staff receive training or an appropriate development session prior to supporting clients with needs associated to dementia or acquired brain injury. This recommendation was made on 27 May 2016. Action taken on previous recommendation Progress has been seen in this area in terms of the system being updated to try and ensure it is more robust. Despite this, we saw there were occasional incidents where staff were still being booked to lone work in services where they were not deemed fully competent. It is unclear how this has happened at the moment and is something the manager will be looking further into as to how this can be addressed. This remains ongoing, recommendation not met Recommendation 5 The service should develop a process that will invite more focused feedback on the quality of management and leadership. and Standard 11: Expressing Your Views This recommendation was made on 7 July 2015. page 9 of 12
Action taken on previous recommendation This remains an area for development to ensure there is a working plan in place which accurately reflects the priorities and areas for improvement in the service along with clear timescales, responsible people and evidence of updates/review. Ongoing, this recommendation has not been met Recommendation 6 The quality assurance statement should be developed further to show more detail on how quality is assessed locally, and how this fits into organisational processes. The process for updating policies/procedures should be explained within quality assurance processes. This recommendation was made on 7 July 2015. Action taken on previous recommendation The service has made progress in this area but some improvement is still required to ensure all notifications are made in line with the guidance. This recommendation has not been met Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 27 May 2016 Unannounced Care and support 5 - Very good Environment Not assessed Staffing 4 - Good Management and leadership 3 - Adequate page 10 of 12
Date Type Gradings 7 May 2015 Announced (short notice) Care and support 5 - Very good Environment Not assessed Staffing 4 - Good Management and leadership 3 - Adequate 5 May 2014 Announced (short notice) Care and support 5 - Very good Environment Not assessed Staffing 5 - Very good Management and leadership 3 - Adequate 24 May 2013 Announced (short notice) Care and support 5 - Very good Environment Not assessed Staffing 5 - Very good Management and leadership 5 - Very good page 11 of 12
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 12 of 12