This comprehensive inspection took place on the 9 and 10 January 2017 of Head First (Assessment, Rehabilitation and Case Management) LLP

Head First employs the care staff in that they direct and control the staff they deploy. They provide a specialist case management service for people with acquired brain injuries and their families living within the community. This includes supporting people who use the service to directly employ support workers, some of whom may provide personal care. The service provides the management, training and supervision of support workers. Head First work with 149 brain injured clients and their families. Head First recruit support / manage support workers for 51 clients (201 support workers in total) and have agency support workers for another 16 clients (25 support workers in total).

The manager was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

We looked at the medication records for eight people. The medication procedure for staff was to prompt people or to administer their medication. Records informed that support staff would record all medication on the provider’s medication record sheets and on their live computer system to inform medication had been provided. There was information in relation to covert medication practices for staff to follow; we were told that no person was receiving this service.

We looked at records relating to the safety of the office premises and its equipment, which were correctly recorded. We were shown where confidential records were stored and saw they were in locked filing cabinets and electronic records were password protected..

People were supported to prepare food and drinks and could choose the meals that they prepared if this was part of their person centred care plans (PCCP). Where people’s weight changed, this was recognised, with appropriate action taken to meet the person’s nutritional needs.

The provider complied with the Mental Capacity Act 2005 and its associated codes of practice in the delivery of care. We found that the staff followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights. The service was providing support to people who did not have the capacity to make their own decisions in different areas of their lives, due to the brain injuries they had sustained.

We found that the person centred care plans and risk assessment monthly review records were all up to date in the eight files looked at on the service’s computerised system. There was updated information that reflected the changes of people’s health.

People told us they felt safe with staff. The management had a good understanding of safeguarding. The registered manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority. The CQC were not being notified as required; this was discussed as managers were uncertain of their duty to report statutory notifications to CQC. This was clarified and the CQC immediately received three retrospective incident notifications.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidents. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

The staffing levels were seen to be sufficient at all times to support people and meet their needs and everyone we spoke with considered there was adequate staff to provide the support the service was managing on their behalf.

The service ensured all new staff had a

People experienced care and support that met their needs and ensured their safety and welfare. People told us they were happy with the care and support they received and said “Everything is done really well. They’ve done really good things for me.”

People who used the service told us that they were supported with the skills they needed to live independently. People expressed their views and were involved in making decisions about their care and treatment. People told us “I have a choice, I always have a choice about what I want to do” and “I’m happy I can employ support workers directly. I can decide who walks through my door, what I do and how many hours I want support for."

People were supported by case managers and support workers who were supervised and trained to deliver care safely and to an appropriate standard. Relatives of people who used the service told us “Support workers are trained. They are all very good.” Case managers had professional backgrounds and qualifications.

People were protected from the risk of abuse. People told us “I feel safe.”

People who used the service and their relatives were asked for their views about the service provided and these were acted on. Relatives of people who used the service told us “They are very good. They are always there if there is a problem or concern” and “We’ve been using the service for [some] years and have no complaints.”

During our visit we spoke with staff at the office and examined a range of records and documents, including initial needs assessments, care plans, staff files and information held on computer.

We telephoned some people to gain their views on the service. We spoke with five people who used the service, four relatives, and the Local Authority representative for one person.

People who used the service told us that they felt involved in how their support was planned and provided and that they were satisfied with the support they received. They said that since using the service they had gained in confidence. Comments included “They talk to me as I get very anxious and take me out “, “I would be lost without them, they are brilliant, and quality”, “my support team is fantastic” and “ they are very caring and understanding, life is getting better”.

Relatives we spoke with said the service communicated well with them and they were happy with it. They appreciated the support they were given as a relative of a person with acquired brain injury. Some of the comments they made were, “All we ask is that carers care, they do, and we certainly have some good ones”, “They hold reviews and help us with appointments” and “They take her out to have her hair done”.