About the service: Central Case Management is a case management service which coordinates care packages for people who have complex needs because of an acquired brain injury. Services are provided to people in their own homes.

People’s experience of using this service: The person and relatives we spoke with told us that staff were caring.

At the last inspection of the service in May 2016 safe recruitment practice had not always been followed as not all pre-employment checks had been completed on potential staff. We found on this inspection that this issue had been addressed. Staff knew how to safeguard people from abuse and had received the training they needed to carry out their roles effectively.

People’s needs were comprehensively assessed and reviewed. Staff were guided as to the actions to take to minimise any risks identified. Where incidents had taken place these were analysed, lessons were learnt and embedded into practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service was flexible and met people’s needs in an individualised way.

Staff supported people to maintain and develop their hobbies and interests. A system for recording and responding to complaints was in place. The service worked closely with a range of other agencies and professionals to support people well. Staff told us they were supported well by the management team.

Rating at last inspection: At the last inspection the service was rated good overall with safe rated as requires improvement (report published August 2016). The overall rating at this inspection remains the same and the safe domain had improved to good.

Why we inspected: This was a planned inspection to check that the service remained good.

Follow up: We will monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

The inspection took place on 24 May 2016 and was conducted by one inspector. The provider was given two days’ notice of the inspection because it is a community based service and we needed to make sure that someone would be in the office to meet us.

Central Case Management provides a case management and support service to people with acquired brain injury. Support takes place wherever people are living and currently covers locations throughout the midlands. The service operates from an office in Duffield, Derbyshire but staff are recruited locally and are based at the home of the person they are caring for. Each person has a local case manager who manages their care package, supports and coordinates the staff and communicates with other healthcare and legal services. Each person’s care package is unique to them and dependent on their acquired brain injury, level of independence and care needs.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager had not always followed safe recruitment practice when recruiting staff as not all pre-employment checks had been completed. Therefore they could not always be assured that staff were suitable to care for people. When we brought this to the attention of the registered manager, they agreed to review their recruitment process to ensure the suitability of people employed by the service.

However, people were protected from the risk of harm or abuse as staff knew how to recognise abuse and report concerns. People’s care needs were assessed and care plans provided staff with clear guidance about how to meet their individual needs and manage identified risks.

People were cared for by skilled and experienced staff as all staff received an induction into the service and on-going training. People were supported to maintain good health as they were supported to access community healthcare services where needed.

People were cared for by friendly staff who enjoyed their jobs and treated people with respect and kindness. Staff took time to get to know people using the service and understood their needs, wishes and aspirations. This enabled staff to provide a personalised service that met individual needs and supported individual goals.

People’s views and preferences were included in care planning; and people made their own decisions about their daily living arrangements and activities.

Staff were managed remotely by the registered manager and locally by the case manager for the location. Staff were motivated and keen to develop themselves and ensured that people using the service remained as independent as possible.

At the time of our inspection 13 people were being supported by Central Case Management. As part of our inspection we spoke to a family member of one person using the service and four members of staff. We were unable to obtain the views of people directly supported by the service. This was because some people were unavailable for us to talk to and other people would find it difficult to reliably give their opinion about the service they received due to their brain injury.

We considered all the evidence we gathered under the outcomes we inspected. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had policies and procedures in relation to the Mental Capacity Act 2005 and where people did not have the mental capacity to manage their finances, legal deputies had been appointed.

The service had policies and procedures in relation to safeguarding vulnerable adults and staff were aware of these. One staff member told us, “If something was wrong I would report it and if nothing was done I would take it further.”

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. These had been regularly reviewed to make sure people received effective care.

Plans had been made to deal with foreseeable emergencies and staff we spoke with understood what procedures were to be followed at their different work places.

Is the service caring?

Staff shared their experiences of what worked well for people supported by the service so they received appropriate care. One member of staff told us, “It feels like our managers listen to us.” Another person told us, “The care plans and protocols we have in place help all the staff provide consistent care.”

Is the service responsive?

Risk assessments and care plans included information and advice from other health professionals to ensure people’s needs were well supported. Reviews of people’s care included any relevant health professionals so that care and support remained responsive to their needs.

Is the service well-led?

The service had systems in place to identify where improvements could be made.

People's views and experiences were used to improve the quality of services people received.

Staff we spoke with had a good understanding of the policies and procedures used at Central Case Management.

We found that this service worked well with other professional disciplines to provide personalised care packages to each person. This included working with care managers in the local authority, neuropsychologists, speech and language therapists, occupational therapists and physiotherapists. Evidence was seen to demonstrate that people using the service and their representatives were involved in the development and on-going review of their care package.

Support plans provided clear and up-to-date information that ensured people’s needs were met and their preferences respected.

People’s care packages were tailored to meet their needs and preferences. People’s cultural and spiritual preferences were also included in their support plans.

One relative told us, “my partner has had the same member of staff working with them for a while now. It’s great because they are about the same age and get on really well. Without them my partner would not be able to access the community services they enjoy.”

Recruitment records demonstrated that thorough recruitment checks were undertaken before staff commenced employment, this ensured that the provider and registered manager had assured themselves that the staff employed, were considered safe to work with the people using the service.

Systems were in place to monitor the support and services provided, and to identify and manage risks to ensure the service was run safely.

People using the service and their representatives told us they were fully involved in the care they received and everything had been discussed with them.

One person told us, “I have one member of staff that supports me, so we have got to know each other very well and they know exactly what help I need”.

People told us that they were able to contact case managers at any time and confirmed that this included out of hours, such as evenings and weekends. One person said, “I can always get hold of my case manager if I need to, but I also have the registered manager’s number and the director’s number just in case I need them.”

People that we spoke with confirmed that they felt safe and that staff supported them in a safe way.

One person said, “If I need anything I just ring my case manager, I think the support I get is excellent, nothing is too much trouble.” This person said,” both my care worker and case manager are very good, I have a good relationship with them and am very satisfied with the support I get.”

People who use the service and their representatives told us that they could express their views and felt supported to do this. People spoken with were aware of the complaints procedure and confirmed they would feel comfortable to raise any concerns they had with their case manager.