Care and Case Management Limited was inspected between 10 and 26 September 2018 and was announced. We gave the service 48 hours’ notice of the inspection as this was a small service and we wanted to ensure management and staff were available to speak with us.

Care and Case Management Services Limited is a private case management service, providing case management, personal care and support services. It is an independent company predominately commissioned by Deputies appointed by the Court of Protection or litigation solicitors. The service undertakes assessments, and provides and reviews care and therapeutic services for children and adults who, as a result of medical negligence or personal injury, have suffered brain injury, spinal injury, or other serious medical conditions.

The service coordinates services from an office base in Stokesley. However, services are provided across a wide geographical area in the north of England. At the time of the inspection, 14 people were receiving personal care support.

Care and Case Management Limited was last inspected on 16 December 2016. The overall rating for the service was good. On our last visit the well-led question was rated as outstanding. This inspection has found the service has improved it’s rating from good to outstanding.

There was a registered manager in place at the time of our inspection. 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 we spoke with told us of the excellent support for their personal and professional development. There was a proactive support system in place to encourage staff to develop and deliver outstanding care.

People were supported by staff who were extremely well trained. All staff received what one member of staff referred to as an “exceptional” induction, which introduced them to what excellent care meant for each individual person. Staff received mandatory training in addition to specific training for people’s individual needs delivered by specialists in that field. The service had innovated to deliver observational training across a wide geographical area. Staff consistently expressed an enthusiastic commitment to providing excellent care. The service was proactive in seeking professional advice and in working with other specialists to give people the best possible outcomes for a fulfilled life.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were both innovative and dedicated in their approach to supporting people to make informed decisions about their care. People were fully 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. Staff advocated on behalf of people to challenge decisions about people's care and also to challenge poor practice by other services ensuring people got the rights and services they were entitled to.

We heard how the staff team by their dedication, knowledge and kindness had helped people and families live meaningful and fulfilled lives following the tragedy of an acquired brain injury, often caused in highly traumatic circumstances. We heard so many stories of the practical and emotional support provided to people and their families that had helped their lives. On an individual basis, staff recognising when people were in danger of becoming overwhelmed and offering their personal time or specialist help to keep people and their family or loved ones together.

People were placed at the heart of the service by strong, caring leadership which promoted an open culture. The m

Care and Case Management Services Limited is a private case management service, providing case management, personal care and support services. It is an independent company predominately commissioned by Deputies appointed by the Court of Protection or Litigation Solicitors. The service undertakes assessments, and provides and reviews care and therapeutic services for children and adults who, as a result of medical negligence or personal injury, have suffered brain injury, spinal injury, or other serious medical conditions.

The service coordinates services from an office base in Stokesley. However, services are provided across a wide geographical area in the North East of England. At the time of this inspection the service provided the regulated activity personal care to 27 people. The service employed 52 staff who were involved in providing the regulated activity.

The service had a registered manager, who had been registered with us since April 2009. 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.

People benefited from a service with strong leadership and an ethos of providing high quality, bespoke care and support. The registered manager was very well qualified and experienced, and an appropriate management structure was in place to support them. People who used the service, relatives and professionals expressed a very high level of satisfaction with the standard of care provided. All told us the service was very well led, with a clear focus on providing individualised and person centred care. Staff were passionate about providing high quality services that focused on the individual.

Quality monitoring took place and included listening and acting on feedback from people who used the service, staff and other professionals. Checks and audits took place to monitor the quality of the service’s work. People who used the service, relatives and other professionals were routinely involved in meetings, reviews and on-going work so that their feedback could be taken into account.

The service was committed to continuous learning and development and proactively embraced community involvement, keeping up to date with developments in their areas of expertise and sharing good practice. Professional networks and contracts with support organisations were in place, to help staff remain up to date with best practice and share their own professional skills and expertise with the wider community. Staff were members of the appropriate professional bodies and associations to help support their work.

People were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe and could raise concerns if they needed to. Staff were aware of safeguarding procedures and could demonstrate how they had taken action to safeguard people when necessary. Staff also told us that the registered manager listened and acted on their feedback.

Safe arrangements were in place for staff recruitment, with people who used the service being involved in the recruitment process and decisions about which staff supported them. New work was only taken on if staff felt that they had time to do it well. Care workers were organised and deployed in a way that met people’s individual care needs, with small individual teams of staff who knew people well. People who used the service and their relatives told us that they received an individual, consistent and reliable service.

The service had health and safety related procedures, including emergency plans, in place. The office had been assessed for safety, with appropriate maintenance in place. Systems for reporting and recording accidents and incidents, including detailed review

During our visit we spoke to the registered manager, the business manager and a case manager. We also spoke with one person who used the service, two relatives of people who used the service and three support workers by telephone. Comments made to us by people who used the service included “Everything gets talked through properly”, “We’ve moved on leaps and bounds and we are chuffed to bits with it all” and “I couldn’t wish for a better case manager.”

Staff demonstrated a good understanding of issues around capacity and consent and the importance of gaining informed consent in the work that they did. This helped to ensure that people’s legal rights were protected.

Thorough assessment, care planning and review systems were in place, which involved people who used the service in decisions about their support. This helped to ensure that people’s care and support was planned and delivered in a safe and individual way.

Equipment was provided on the basis of assessed need, with appropriate maintenance arrangements in place. This helped to ensure that equipment was safe and suitable for the people who used it.

Thorough recruitment and induction processes were in place. This helped to ensure that the service employed safe and suitable staff, who had the skills needed to do their jobs.

Systems were in place to gather feedback from people who used the service and to monitor the quality of service people received.

We spoke to three people who use the service, a mixture of clients and relatives, who told us about their experiences. They told us “it’s brilliant, I’m very happy”, “the staff are all approachable and professional” and “without the support they give my world would be upside down.” People told us that they were always involved in any care planning with the agency.

We spoke with two of the agency’s support workers and the business manager. Staff told us “I’ve had all the training I should and you always get well supported” and “we’re listened to and can say what we think.”

Records were detailed and up to date, and people using the service confirmed their views were taken into account as to what was important to them in relation to the care provided.