Tania Brown Limited

Updated 11 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a planned comprehensive inspection which took place on 16, 17 and 19 July 2018. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be in to facilitate the inspection.

The inspection was undertaken by one adult social care inspector.

Before the inspection visit we reviewed the information we held about the service, including information we had received since the service registered with us. We did not ask the service to complete the Provider Information Return (PIR), prior to the date of the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the care and support records of five people who used the service in the North West and records relating to the management of the service. We looked at five staff personnel files, policies and procedures and quality assurance systems. We spoke with the relatives of two people living in the North West the relative of one person living in the South.

During our inspection we went to the provider’s head office and spoke with the general manager and six staff members and received feedback from six staff who worked remotely from the office via a questionnaire we sent them.

We also received feedback from three solicitors who made referrals to the service and spoke with the manager of a health and social care establishment that accommodated one person who was being supported by the service and with the relatives of two people who used the service as part of the inspection; this was to seek feedback about the quality of service being provided because people who used the service were unavailable or unable to speak to us themselves.

Updated 11 October 2018

Tania Brown provides Case Management, rehabilitation and specialist clinical services for both adults and children in addition to an expert witness service for the courts along with specific services for independent and statutory sectors including the NHS.

The organisation offers a nationwide service with consultant clinicians and case managers located across the country, all of whom are highly trained with considerable expertise to work alongside adults and children with complex physical, emotional and social needs.

Tania Brown is a domiciliary care service offering a wide range of specialist community services on a nationwide basis for people with life changing, chronic and degenerative neurological conditions in addition to specialist services for people who have sustained serious or catastrophic injuries such as brain injury and spinal cord injury.

Services are also provided for people who have sustained serious multiple orthopaedic injuries including amputation as well as services for people with chronic pain conditions and those suffering from industrial disease. At the time of our inspection 76 people were using the service across the whole country.

Not everyone using Tania Brown receives a regulated activity; Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager in post. A registered manager is a person who has registered with 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 was extremely dedicated, enthusiastic and knowledgeable. They were very visible in the team and proactive throughout the inspection in demonstrating how the service operated and how they worked closely with other health and social care professionals to lead improvements in the service. Feedback about the service from other professionals was overwhelmingly positive and complimentary.

The management team had incredible oversight by scrutinising all areas before issues occurred, which showed they had strong control measures in place. Staff confirmed the management team were keen to listen to their ideas and encouraged them to raise any concerns.

People told us they felt safe because of the care and support they received. The service had comprehensive safeguarding policies and procedures in place and all staff had received training in safeguarding vulnerable adults and children which was regularly refreshed and demonstrated an excellent understanding of how to report both safeguarding and whistleblowing concerns. Staff were confident any concerns raised would be actioned by management.

During this inspection, we found multiple examples to demonstrate the staff and management team were passionate about providing an innovative, excellent service. People were provided with a service that was bespoke to them and they were fully involved in identifying their needs and goals to be achieved for the future.

To ensure outstanding care and consistency continued to be delivered, the service completed regular monitoring, spot checks and formal audits of service provision. The management team also worked alongside staff to provide support and complete additional observations of practice; staff received high levels of support to enable them to provide outstanding care. In depth induction training was provided upon commencing employment and ongoing refresher training, regular supervision, team meetings and appraisals were also provided.

All staff were viewed as being an integral part of the service and were very much involved in providing feedback on how to improve the service. Staff were highly motivated and proud of their work, had in-depth training and we observed they demonstrated their understanding in practice by continuously promoting a highly inclusive environment. It was very clear they respected each person's rights and treated them as individuals and they were not afraid to display their love towards people.

People we spoke with were complimentary about the support they received to ensure medicines were taken when required and as prescribed. We saw the service carried out audits of medicine administration record (MAR) charts each month to ensure medicines had been administered and documentation completed correctly. All staff administering medicines had received training and had their competency assessed.

People’s relatives were, without exception, highly complimentary about the service and told us that they and [their relatives] always felt involved and could ask questions, say how they wanted to be supported, and felt valued as a result. This approach ensured the person was central to everything the service did and ensured they were in control of their own lives. The care records we saw showed people had signed agreeing to the support they would be receiving.

Our discussions with staff showed that they had a detailed and in-depth understanding of the Mental Capacity Act (MCA) and staff had received training in the MCA and the Deprivation of Liberty Safeguards (DoLS) which was offered to all staff within the service. The registered manager told us that if they had any concerns regarding a person's ability to make a decision they worked with the local authority to ensure appropriate capacity assessments were undertaken. This was in line with the Mental Capacity Act (2005) Code of Practice.

We saw robust recruitment procedures were in place to ensure caregivers working for the service met the required standards. This involved a Disclosure and Baring Service (DBS) check, at least two references and full work history documented. We saw medicines were managed safely and effectively, with detailed guidance in place for care staff to ensure they knew what medicines people took and why. People were involved in regular reviews of their medicines to ensure their continuing therapeutic value and to reduce any unnecessary medicines.

We saw that people's care plans and needs were regularly reviewed which was completed with the involvement of people, their relatives and other associated health and social care professionals. Multidisciplinary meetings were regularly held to discuss people’s progress.

There was an up-to-date complaints policy in place and people who used the service and their relatives told us they knew how to make a complaint. Feedback on how the service was managed and the culture within the team was very positive. There had been no complaints received from anyone who used the service, their relatives or any other associated health and social care professionals.

Systems were in place to monitor the service and identify where improvements could be made.

The service had a business continuity plan in place which included details of the actions to be taken in the event of an unexpected event such as bad weather.

There was a full range of policies and procedures in place which were available in paper copy format and electronically.