The inspection took place on 13 and 14 December 2016. This was an announced inspection and the provider was given 48 hours' notice. This was to ensure that someone would be available at the office to provide us with the necessary information to carry out the inspection. When we last visited the service on 13 January 2014, we found the service was meeting all the regulations we looked at.

Pulse@Home is a domiciliary care service registered to provide personal care in people's own homes. The provider employs a combination of registered nurses and care workers to support people who currently use the service. At the time of the inspection there were 40 people using the service. Some of the people who used the service had complex nursing needs.

The home does not have 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. An interim manager was in post and had applied to become the registered manager for the service.

People told us they were safe. Medicines were managed safely. Risk assessments identified the risks to people and how these could be minimised. Staff were available to meet people's needs.

People were involved in decisions about their care and how their needs would be met. Managers and staff had received training on the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005.

Staff had access to ongoing training. They were knowledgeable about their roles and responsibilities.

Staff knew how to respond to people's needs in a way that promoted their individual preferences and choices regarding their care. People were supported to eat and drink.

People were treated with dignity and respect. Staff understood people's preferences, likes and dislikes regarding their care and support needs.

Care was planned and delivered in ways that enhanced people's safety and welfare according to their needs and preferences.

People were supported to maintain good health and had access to healthcare services. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people's needs.

The service regularly requested feedback from people who used the service. People, relatives and staff said the management were approachable and supportive.

Systems were in place to monitor the quality of the service. People felt confident to express any concerns and these were addressed by the manager.

People told us they were happy with the services they received. One person told us, "The service was great from day one." Care was planned in a way that took people's views on board and detailed risk assessments were completed.

The provider had policies to safeguard adults and children and staff told us that they were trained to recognise abuse and to respond appropriately. We saw that staff had different levels of training depending on their clients.

We saw that the provider had clear guidance for staff when dealing with medicines, including a policy and advice sheets in care records to assist them. People we spoke with told us that they were clear as to who obtained and administered the medicines.

Staff were supported through extensive and regular training. The provider had a system to remind staff that their training was due. One member of staff told us, "It is a brilliant employer and I get a lot of support." We saw that staff received supervision and appraisal regularly and they were able to discuss their professional development with their manager.

The provider used a range of methods to monitor the quality of services.

All three people we spoke with told us they were happy with their care and treatment. One person said they were "looked after well" and another said “[the staff] are excellent”. People felt they were involved in their care and treatment and had signed their care plans. They felt staff knew what knew what to do to meet their needs.

The manager said that all staff had received induction and were familiar with people’s needs. She said there was a robust recruitment process and all staff had been vetted to ensure that they had appropriate skills, qualification and experience to provide care and treatment that people needed. We saw evidence of criminal record bureau (CRB) checks and written references in the staff files. This indicated that staff were vetted properly and were fit to provide care and treatment for people who used the service.

Care plans and risk assessments were updated to ensure people received appropriate care. We noted that systems were in place for safe administration of medication. This included training for staff in the administration of medication. All the medicines administered to people were recorded and monitored by the staff to ensure people had received their medication as prescribed by their doctors.

Information relating to the people who used the service was recorded accurately and was kept securely at the agency's office. This meant that people received care and treatment that reflected their needs.

People who use the service told us that they were happy with the care they received from Pulse@Home. The people we spoke with via telephone interviews told us that the care and support they received was very good. They appreciated that the care workers spend time talking to them. People told us that they had a care plan which they were involved in developing and have signed their care plan to confirm agreement.