This inspection took place on 10 November 2016 and was unannounced.

N-Able Services Ltd provides specialist case management, support and rehabilitation services to people with brain injuries and other complex disability across the North West of England, Cheshire and North Wales. The organisation line manages care staff and employs professional case managers and therapists. They also contract staff through care agencies. The main office base and headquarters is situated in Bromborough, Wirral. The services N-Able offer are privately commissioned via solicitors. N-Able mostly work with people and families of people with complex brain injuries to case manage their individual packages of support. This includes using external recruitment agencies as well as staff directly recruited by people, and working holistically with other medical professionals to offer support for as long as the person needs. N-Able refers to people who use their service as ‘clients’. Also, the professionals who take responsibility for peoples care packages were referred to as ‘Case Managers.’

There was a 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.

People and family members of people who use the service told us they felt safe and reassured.

The staff we spoke with were able to explain what action to take if they felt someone was being abused or neglected in anyway. There were policies in place for staff to refer to and staff were able to describe them.

Risk assessments were well written and gave a thorough and detailed explanation of how to support people, including what action the staff must take to help minimise the risk in the least restrictive way possible. Staff understood the concept of what was acceptable risk taking in order to promote positive experiences for people.

There were procedures in place relating to the safe management, storage, and administration of medication. People told us they received their medications on time and there was training in place for staff with regards to safe medication administration and this was reviewed regularly.

Staff were recruited safely and checks were carried out on staff before they started work at the service to ensure they were suitable to work with vulnerable people. We saw that N-Able often recruited staff using external recruitment agencies and were able to see the checks carried out on these staff before they were introduced to people.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it.

Opportunities were in place to address lessons learnt from the outcome of incidents, complaints and other investigations.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

Staff told us they were well supported through the induction process, regular supervision and appraisal. Staff said they were up-to-date with the training they were required by the organisation to undertake for the job and training records confirmed this.

People were supported to maintain their nutritional wellbeing by staff and some people were supported to cook for themselves to maintain their independence. Some people lived at home with family members so staff were not always required to cook meals with or for people. People told us staff helped them prepare meals and supported them to shop for ingredients to plan meals.

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We spoke with a person who used the service and family members of five other people who were unable to communicate themselves. Everyone we spoke with was positive about their experience of this service. Comments included; "It has changed all our lives for the better", "My [relative] has done a lot better than anticipated thanks to these caring people", "Everyone is professional and helpful" and "Nothing is ever too much trouble". We also spoke with N-Able's registered manager and their nominated individual who was a director of the service.

We found that the service was safe, effective, caring, responsive and well led. We saw that care packages were inclusive and person centred and that the service was led by managers and staff who were well trained and supported in their roles. People who used the service were helped to lead a fulfilling and meaningful life. One person told us "They helped me back to work and now I am helping other people with disabilities".

We reviewed the provider's medication arrangements and saw there was an up to date medication policy which directed that most clients would remain responsible for their own medication. The service became involved in assisting with medication if it was required to do so. Care plans provided detailed information to staff about what was required and staff received medication training.

Staff working for N-Able Services were either directly employed or worked for a professional agency. We spoke to four members of staff who told us they felt very well supported. Comments from staff included; "Fabulous company to work for", "Very well supervised", "Encouraged to progress" and "Trained and motivated through staff meetings and team meetings".

There was a satisfactory system in place for checking the quality of care and the facilities that the service provided. We saw that clients were regularly asked for their views about the care and treatment and their feedback was acted upon.

We found that N-Able Services Ltd. were providing a service that people were very satisfied with. People we spoke with told us:

“Its absolutely outstanding, brilliant”

"They are great, really supportive to myself and my son”.

“They go above and beyond, they are wonderful”.

We also saw evidence in the quality audit, which includes a questionnaire of people who used the service and their relatives/carers, of great satisfaction expressed with the service provided.

We saw that consent and agreement to care and support plans was obtained and documented. Care and support plans were individualised and met the needs of the people who used the service.

People who used the service were safeguarded from abuse; staff were trained and knowledgeable in safeguarding and had access to appropriate guidance and policies. Personal risk assessments identified vulnerability and plans were in place to protect the people who used the service.

Staff were appropriately recruited, qualified, checked upon and supervised according to the provider’s policies and procedures.

Complaints were logged and dealt with appropriately.

We visited the office base of N-Able Services Limited on 6 March 2012. We spoke with some people who use the service, carers and relatives. They all expressed overall satisfaction with the care and support given to them. They told us they felt involved in their care and treatment and were able to make choices in everyday living such as personal routines, financial affairs, and daily lifestyles. People told us:

“They are a very, very good service, they tell us everything that is going to happen”,

“They are excellent, they pay attention to personal detail”.

Family members we spoke to told us the service was not just there for the client but also made a difference to the whole family. They said:

“The whole family is involved and kept informed, we are all very pleased and delighted at the progress made with their support”,

“I would be lost without them”.

People who use the service and their relatives told us they were listened to by staff and were able to contribute views on the service. They told us they were always treated with dignity and respect.