Pulse London was first registered with the Care Quality Commission [CQC] in December 2014. The service had changed their address on 3 March 2017. The service is located in central London and provides support to people in London as well as in other counties including Sussex, Kent, Berkshire and Surrey.

Pulse London is a domiciliary care service and a community health care service that provides personal care and support to people living with dementia, learning disabilities and mental health conditions, as well as children and older people with physical disabilities or sensory impairments. At the time of our inspection, the service provided care to 41 people. This was the first inspection of the service at the current location.

During the inspection, we found numerous shortcomings in the quality and safety of the service provided which had not been identified during the provider’s own audits. These related to the management of safeguarding concerns, dealing with complaints, mitigation of identified risk to health and wellbeing of people who use the service, record keeping and notifying the CQC about notifiable events.

We noted that prior to our visit the provider had identified a number of other shortcoming and they had begun taking action to remedy the issues found. These were related to the completeness of care plans and medicines administration records.

Identified safeguarding concerns had been investigated internally and actions were taken to help to protect people from harm. However, the provider had not communicated sufficiently about identified safeguarding concerns within the organisation, had not notified external bodies as legally required and had not identified all safeguarding concerns within the service.

The service had assessed risks to health and wellbeing of people who used the service. However, staff were not provided with sufficient guidelines on how to manage and mitigate identified risks. Consequently, people were at risk of receiving care that was not safe.

Staff received training and assessment of their skills. However, we found that the provider’s training and assessment process was not always fully followed. Staff did not always have the sufficient level of skills to support people with their complex needs. Staff did not always received supervision and appraisal of their skills to help them to support people in a safe and effective way.

The service had not always dealt with complaints promptly and people told us they were not always satisfied with the outcomes of complaints they had made.

We found that there were improvements made in how the service managed people’s medicines. Further improvement were needed in relation to transcribing of medicines onto medicines administration charts (MARs) to ensure people received their medicines as prescribed.

There was mixed feedback on staffing arrangements. The majority of people felt there were enough staff deployed to support them. However, improvements were needed in how the service communicated with people about rotas and changes to staff cover.

The provider followed a safe recruitment procedure, therefore, people were safe from unsuitable staff. There were appropriate systems in pace for recording and management of accidents and incidents. Suitable infection control training and staff practice protected people from avoidable infection.

The service had assessed people’s needs and care preferences before they started providing support to people. We saw that gathered information was then used to formulate people’s care plans.

People were supported to have a nutritious diet that met their needs, preferences and clinical requirements. Staff supported people to have access to health professionals when needed. People said they trusted staff to help them if immediate and emergency help was required.

Staff sought people’s consent before providing care and support. People’s mental capacity had been discussed at the time of the initial assessment.