North East Care Management is specialist brain injury service, based in Blyth, Northumberland. They provide personal care to one adult with a brain injury. The service also offers support to adults and families of children with brain injuries. This included overseeing private care arrangements, recruiting and training support workers, placing personal assistants and facilitating access to welfare, housing, medical and legal rights. In addition they offer behavioural and family therapy, other services, advice and guidance. This aspect of the service is not regulated by the Care Quality Commission.

The inspection was carried out on 3 August 2016 by one inspector and was announced. We gave 24 hours' notice of the inspection because we needed to seek the permission of the person who used the service to visit them at home. We needed to be sure staff would be available to access records. We previously inspected this service in January 2014 and found they met all of the outcomes they we inspected.

The service had two registered managers in post, one of which was also the registered provider. 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. We liaised with the registered provider as the other registered manager was unavailable during this inspection.

The person who was supported at home with personal care told us they felt safe with the support from their care team. Their relative confirmed this. Policies and procedures were in place and up to date to protect people from harm and were available for staff to ensure they understood their responsibilities.

There had been no incidents or accidents within the service. The provider told us a procedure was in place and incidents and accidents would be investigated and reported in a timely manner to external agencies such as the local authority or CQC. The provider told us they would analyse incidents and accidents and review care needs, risk assessments and implement preventative measures as necessary.

The service managed risks associated with the health, safety and wellbeing of the person who lived at home, including staff being vigilant for changes in care needs. The person’s care needs had been assessed for all aspects of daily living and we saw evidence which demonstrated records were reviewed and monitored regularly.

Medicines were managed safely and medicine administration records were thorough, accurate and signed by two members of the care team. Medicine was stored appropriately. The staff followed strict guidance regarding the ordering, receipt, storage and disposal of medicine. All other records relating to the management of the service were well maintained.

We saw there was enough staff employed by the service to meet the person’s needs and support them safely at home and in the community. Staff records showed the recruitment process was robust and staff had been safely recruited. Training was up to date and staff had a mix of skills and experience. The provider gave staff opportunities to develop themselves and achieve qualifications in health and social care.

The provider carried out staff supervision and appraisals which were regular and documented. The care team and a relative attended meetings held with the person in their home on a regular basis and minutes were recorded. The management also held regular staff meetings. This demonstrated that the person, their relative and the care team had plenty of opportunities to speak to the management and raise any concerns. Competency checks were undertaken by the management and a senior care team member to assess the staff’s suitability for their role.

There was evidence to show the provider and care team had an understanding of the Mental Ca

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with relatives and other professionals involved in people's care.

People were supported to give consent to care and support through meetings and discussions with all parties involved, including reference to parties legally appointed through the courts if necessary.

We saw that people's needs were assessed in an inclusive way. Care was planned and regularly reviewed with people and their representatives. Relatives reported a high level of satisfaction with the care. One relative said, "We have care team meetings every two months or so. These are really helpful and keep us all up to date with any changes." Another relative said, "These compare better than any other agency I have used." And a third relative described the service as "Worth every penny." Relatives also reported that the agency had good communication arrangements. One relative said, "I am more than happy with the care. We can call, email, ring anytime."

We found that the agency had adequate numbers of experienced and skilled staff.

People and their representatives were supported to raise concerns and told us they were confident to do so.

Written records were accessible and securely stored when not in use.

We inspected the agency office and spoke with two people who used the service and two staff members. People who used the service said they were pleased with the care and support provided by the agency. Nothing was too much trouble for the staff. They said the service was excellent.

We found people were given appropriate information and were involved in making decisions about their care and treatment. People told us staff treated them with respect and courtesy and that they were well cared for. One person said, "The care team are excellent, nothing is too much trouble." We found that care was planned and delivered in a way that ensured people's safety and welfare.

Staff received professional development and people told us staff were well trained.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.