Pulse 8 is a domiciliary care agency that provides personal care to people living in their own homes. Pulse 8 provides a service to people living with dementia, learning disabilities or autistic spectrum disorder, mental health, older people, younger adults, sensory impairment and physical disabilities. At the time of our inspection visit they provided a service to 56 people. Care calls provided to people ranged from 30 minutes to nine hours.

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 abou

This inspection took place on 4 April 2017. Pulse 8+ Limited provides domiciliary care to people living in their own homes. At the time of our inspection, the agency supported 37 people who received personal care.

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