Anglia Case Management is a specialist agency which provides highly skilled case management support and advice to children and adults who have sustained complex life changing injuries such as an acquired brain injury, spinal injury or cerebral palsy. Each person using the service receives a service which is unique to them and designed to meet their individual needs. Case managers use their specialist knowledge to develop bespoke packages of care which are delivered by staff recruited by the service but employed directly by either the person themselves or by a deputy appointed by the court of protection to manage the person’s finances. The service works in partnership with the person, their family, health care professionals and other organisations including, work placements, schools and colleges to maximise people’s independence and to support people to live meaningful and fulfilling lives.

Our last inspection of the service took place over a week between 28 June and 1 July 2016. The service was rated as good overall and outstanding in the domain of responsive. This inspection took place on 23 February 2017 and was announced. It was a focused inspection conducted to reflect on the quality of service provided by the agency in supporting people to achieve the highest quality of life.

There was a very experienced 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.

Staff had completed a high level of specialist training which provided them with the expertise to assess, monitor and manage the complex needs of the people using the service. This specialist knowledge meant that case managers were able to work in innovative ways to support people, maximise their potential and empower them to regain control over their daily lives. The case managers were all highly experienced professionals who worked closely with other organisations and health and social care professionals to ensure the most effective support for people. The service was proactive in supporting, educating and empowering staff. It was evident that as a result of this the service had a staff base who were confident in their roles and motivated and passionate about their work. The service supported staff to continuously develop their skills and knowledge through regular supervision sessions and annual appraisals.

New staff members were required to complete a robust and extensive induction programme to ensure that they had the appropriate skills and knowledge in place before working with people using the service.

Case managers demonstrated advanced understanding of the Mental Capacity Act (MCA) and of their responsibilities to ensure people were given choices about how they wished to live their lives. They used this knowledge to empower people, balancing risk taking whilst supporting people to make choices without placing unnecessary restrictions upon them.

Staff supported people to maintain a healthy diet by using innovative and creative ideas to encourage people to remain well hydrated and eat well, the results of which were shown to have a positive impact upon people’s well-being.

Many people using the service had complex health needs. The service continuously sought to improve their care by working alongside other organisations and health care professionals to implement best practice and improve people’s quality of life. Records relating to people’s health care needs were individualised and contained detailed guidelines for staff outlining how to support people according to their needs and preferences. Where possible, hospital admissions were avoided because staff had the specialist skills and knowledge to assess and monitor people's health. Where people w

The inspection took place over a week between the 28 June and the 1 July 2016. During the week of the inspection we carried out an announced visit to the office, we carried out visits to people who use the service and met with their care staff and family members. We also spoke with a range of staff from the management team and other health care professionals. We also telephoned a number of people using the service for further feedback.

The service is registered to provide personal care and treatment of disease, disorder and injury. It supports both adults and children. Anglia case management provides a specialist service and coordinates services on behalf of people using the service most of whom have a brain acquired injury or other complex, life- changing injury. The service each person receives is unique to them and bespoke packages of care are delivered by staff recruited by the service but employed directly by the person themselves or a deputy appointed by the court of protection to manage the persons financial affairs. Anglia Case Management, case-manages people’s care following legal cases for compensation for acquired brain injury. Awards are made, so that funding is available to pay for people’s care. Families are often put in touch with the agency through the solicitor and will help the family with legal aspects of litigation and will represent them in court as well as helping them manage their care, support and housing needs.

There is an experienced registered manager in post. They are supported by a team of case managers who are all health and social care professionals. ‘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.’

The service was registered in 1998 and has always been judged as compliant by the Care Quality Commission. The agency has always communicated effectively with the CQC about the service they deliver. They have informed us of any events and, or changes affecting the delivery of the service or individual events affecting the welfare and, or safety of people they support. The agency has been proactive in their information sharing and have given us clear details of actions they have taken to improve the service and learn from events. In addition the agency often work with other providers including registered care homes. Staff are vigilant and have at times identified poor practice with other providers and have brought this to the attention of the local safeguarding teams and CQC to ensure the person is appropriately protected.

People told us they felt safe and staff were fully accountable to the people who employed them. The agency had robust processes in place for staff selection and recruitment, which people were fully involved in and had the final say. People told us they felt in control.

Staff had some initial training and induction from the agency which was robust and prepared the staff member for their duties. The agency were proactive in supporting, coaching and developing its staff. Staff spoken with showed motivation and passion for what they were doing.

Staff received training in key areas of responsibility such as medication administration, safeguarding people and the Mental Capacity Act 2015. Staff spoken with understood key elements of their training and how to put it in place to ensure people received safe care. The service had systems in place to manage and monitor the safe administration of medicines but the systems were individual to each person. This demonstrated how the agency strives to offer a bespoke service. The agency had a robust process for reporting medication errors which had resulted in changes to how they supported staff including medication competency assessments being introduc

We spoke with five people or their representative who use the service. People told us that they were very involved with their care, support and treatment in many ways and a good example was that they recruited their own staff. One person told us “They help me to pick staff and I use them as a sounding board, but ultimately it is down to me”.

All five people spoken with said they were involved in developing and writing their care plans. One person typically said “We know what is in the care plan; we were part of drawing it up for staff to follow”.

One person told us “I have a team of ten staff. I have a good rapport with all of them. I believe they are well trained and have the skills I need. They are individuals but have the right qualities for a team. There are no gaps in staffing”.

One person told us “My staff support me above and beyond. They are the best”.

A relative said our support worker “Is brilliant, the motivation they bring is just right”.

One person told us “They (the agency) do ask me what I think. But I can’t complain about anything. They are just at the end of the phone if I want anything”.

Another person said “My experience is that they do listen, nothing is pushed on us. I do have a copy of the complaints procedure. I used it about four years ago and everything was sorted out well”.

Another person told us “They do spot checks, but I’m very pleased with the service. They are listening and they are coming up with ideas”.

During this inspection we visited two people in their own home and spoke with four people who used the service, three relatives and eight staff. Everyone we spoke with was positive about their experience of this service. One relative said, "My relative is definitely safe. I trust them. They look after my relative so well." A person using the service told us, "My personal assistant helps me go out. I’m happy. They (meaning support staff) are very good at their jobs."

Our overall findings were that this service was safe, effective, caring, responsive and well led. We found that all support packages in place were customer focussed, and led by managers and staff who were well trained and supported in their roles. Staff were very knowledgeable about the people they supported and responsive to their individual needs. People told us that they felt safe and happy using the service. We found safe systems in place for medication and for people with complex medical and care needs.

People using this service were enabled to lead a fulfilling life. This included accessing community activities appropriate to their age and lifestyle chosen. The service helped people to access education, transport and social activities. People were also supported to be independent where possible with activities of daily living.