Anglia Case Management Limited

Anglia Case Management is a specialist agency which provides 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. The service is registered to provide personal care and treatment of disease, disorder and injury. It supports both adults and children. At the time of our inspection there were 41 people receiving the regulated activities provided by the service in Suffolk, Norfolk, Essex, Hertfordshire, London and Northamptonshire.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff had completed a high level of specialist training which provided them with the expertise to assess, monitor and support people with their complex needs. The service worked closely with other health and social care professionals involved in people’s care to ensure they received a high level of care and support. Staff supported people in an innovative way to maintain a healthy diet by using creative ideas to encourage people eat and drink sufficient amounts.

People received an extremely personalised and bespoke service, which was tailor made to meet their complex needs and preferences. People were central to the care and support they received and their decisions about their care were valued, including the decisions they had made regarding their end of life. There was a complaints procedure in place.

There were very robust and high quality governance systems in place to assess and monitor the service provided. The service had continued to improve the service since our last inspection. People’s views were extremely valued and used to drive improvement.

Risks in people’s daily lives were assessed and mitigated. Staff were provided with safeguarding training and understood how to keep people safe. Recruitment of staff was completed safely and there were sufficient staff numbers to provide the care and support required by people to meet their needs. People were supported with their medicines safely, where required. Infection control procedures were in place.

People were supported by staff who were caring and compassionate and who knew them well. People’s rights to dignity independence and privacy were promoted and respected. People’s choices were sought, valued and used to plan their care.

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

Rating at last inspection

The last comprehensive inspection rating for this service was good (published 22 September 2016). The service was rated in good in the key questions safe, effective, caring and well-led and rated outstanding in the key question responsive. We undertook a focussed inspection on this service and they were rated outstanding in effective (published 8 December 2017). This meant the overall rating for the service was outstanding.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 were required to go into hospital they were supported by staff to help maintain the continuity of care.

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 introduced for all staff.

Risks to staff delivering the care were clearly documented and staff were supported through induction, training, and on-going support and development so they could work in a safe way.

Risks to people using the service was very clearly documented and staff balanced supporting people safety with their right to self-determination and proportionate risk taking. This was documented and took into account people’s preferences, life styles and life choices along with their right to choose how they wished to live. People were living full lives and fully engaged with their communities.

People had a range of additional care needs which staff were able to accommodate through the support and training they received and working with other health care professionals who had the specialist knowledge. Health care needs were recorded in good detail with step by step guides for staff to follow and bespoke to the person. Hospital admissions were avoided where possible by successful staff interventions and monitoring of people’s health. Where people were required to go into hospital they were supported by staff to help maintain the continuity of care. People’s last wishes or a person’s wishes if they required urgent medical intervention were not always documented in people’s records but staff told us how they had these conversations with people when they considered the time to be right.

The service is responsive to people’s needs because each package of support and care is tailored and written around the needs of the individual. The team of staff are employed directly by the person receiving the care and the court appointed person. Staff employment and training is managed by the agency unless the person prefers to source their own training above and beyond the mandatory training. Staff work in partnership with other health care professionals and family members involved in the person’s support. The teams supporting people had exceptional knowledge about the people they were supporting.

People were supported to develop new skills and maintain existing ones by having the right support and expertise to help motivate and enable them to achieve and reach their potential. Support was flexible according to the person’s wishes and also taking into account the needs and wishes of extended families. Families whenever possible were very much part of the support given to the person but also had quality time away from the ‘care situation’. Staff were respectful and helped people maintain their independence.

The agency was well led with clear lines of accountability, primarily to the person using the service. There were systems to develop and support staff and develop professional excellence.

There were systems in place for continuous feedback about the service received and innovative ways of how to improve people’s experiences and life enhancing opportunities.

There were in depth auditing practicing across the company overseen by the registered manger and Deputy manager to ensure safe systems were in place albeit bespoke and compliance with their own internal policies and procedures. This included medication systems and finance policies.

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.