Westcountry Case Management Ltd

Westcountry Case Management (WCM) 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. Forty case managers worked with people to set up and coordinate their rehabilitation, care and support needs mainly funded by legal compensation claims. Westcountry Case Management staff oversee the recruitment process, training and performance management of support workers employed directly by the people using the service.

The service is registered to provide personal care. At the time of our inspection there were 34 people receiving the regulated activities provided by the service from Cornwall to Hampshire.

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

People were at the heart of the service and 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 and lawyers involved in people's care to ensure they received a high level of care and support. Staff supported people in a very person-centred way, tailored to individual complex needs and preferences to ensure they lived their best lives following life changing events.

There were very robust and high-quality governance systems in place to assess and monitor the service provided, with regular detailed reports also sent to the fee payers, (commissioners and lawyers). People's views were extremely valued and used to drive improvement. There was a complaints procedure in place. Care assessment and planning records were extremely detailed to enable close monitoring of peoples’ care, progress and future planning individual to them.

Risks in people's daily lives were assessed and mitigated with a focus on positive risk taking. Staff were provided with safeguarding training and understood how to keep people safe. Recruitment of staff was bespoke to each persons’ care management package and completed safely with peoples’ involvement. There were sufficient staff numbers and flexibility to provide the care and support required by people to meet their needs. People were supported to take their medicines safely, where this was required. Infection control procedures were in place.

People were matched with bespoke staff teams suitable to meet each individuals’ needs. Staff were very caring and compassionate and knew people extremely well, often building up close long term relationships. A separate WCM staff team were available to respond quickly when peoples’ personal staff were unavailable. People's rights to dignity, independence and privacy were promoted and respected. People's choices were always 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 29 April 2017).

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 reinspection programme. If we receive any concerning information we may inspect sooner.

The provider coordinates the service from their office base in Bishopsteignton. However, services are delivered across a wide geographical area in the south west of England and Wales.

The service had a registered manager. 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. Following our inspection, the care manager was interviewed by CQC and confirmed as the new registered manager. The registered manager was supported by a network of case managers located throughout the service’s area of operations. Each case manager was a registered healthcare professional with a small caseload of clients specific to their area of expertise.

We visited the office on 13 December 2016. We carried out telephone calls to people and their relatives on 15 December 2016. At the time of this announced inspection 37 people were receiving personal care from the service. The service met all of our regulations at the previous inspection in January 2014.

People were happy with the staff who supported them. Comments included “My support worker is brilliant, keeps me on track, listens” and “We get on well, always laughing and joking.” People had stable staff teams who had supported them for a long time and knew them well. Staff enjoyed their role and spoke about people with compassion. People received support from staff who respected their right to make their own decisions. People’s independence was promoted and encouraged. People received support from therapists to regain skills they had lost. Care plans contained information about people’s goals. Where possible staff worked to maintain people’s previous lifestyle.

People and their relatives told us they felt safe when staff were in their home and when they received care and support. Staff knew how to recognise signs of potential abuse when supporting adults and children and understood how to report any concerns in line with the service's and the relevant local authority’s safeguarding policy. Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be unsuitable to work in care.

People benefited from effective care because staff were trained and supported to meet their needs. Staff told us they were happy with their training. Comments included “My training is up to date” and “Training is always on the agenda.” Staff told us they felt well supported and had regular opportunities to discuss their work.

Care plans were detailed and person centred. They included information on what was important to each person, their interests, their goals, and their history. There was detailed information about the support the person needed to manage their day to day care and health needs. People told us they made decisions in relation to their daily activities. One person said, “We’re always out and about.” Care plans contained information about people’s interests and the activities they enjoyed. A list of accessible venues for these activities was included such as the theatre, cinema, swimming pool, hydrotherapy, horse riding, cafes and pubs. People were supported to regain skills in daily living tasks. For example, one person had identified they would like to try cleaning and laundry to become more independent. Care plans were reviewed annually or when people’s needs changed. There was evidence that staff monitored people's health care needs and responded to changing needs.

Risk assessments were comprehensive and took into account the person's needs and views of other people involved in the care provision. This included specialist advice sought from occupational therapists, speech and language therapists, physiotherapists and psychologists, as well as input from family members. Staff had clear information on how to manage and minimise risks to people. For example, we looked at detailed risk assessments relating to mobility, falls, bathing, skin care, and epilepsy. People were supported to take positive risks to develop their skills and independence.

Staff provided support and assistance with medicines where needed. Care plans contained clear information on how to support each person with their medicines and people told us they were happy with the way staff supported them. Staff told us they had completed training in safe medicines management and felt confident when assisting people. Team leaders and the case manager monitored the medication administration record sheets to ensure they were completed correctly.

People and their relatives felt able to raise concerns or make a complaint. They were confident their concerns would be taken seriously. People told us they didn't have any complaints. Where complaints had been received they had been managed in line with the company policy.

People told us they were happy with the service they received. Comments included, “They’re well organised” and “It’s going well.” Healthcare professionals told us they had found the management to be professional and approachable. One professional commented, “Management and communication with Westcountry Case Management has always been efficient.” Staff told us it was difficult for them to get into the office due to the large geographical area covered. However, they told us they felt the management team was approachable and supportive. One staff member said, “If you need anything you get a response.” Another staff member said, “We work remotely and don’t always get into the office but contact is very good.”

Staff told us they had seen positive changes since the new registered manager had started work at the service. One staff member commented “Very good, there’s been additional training.” An audit system was in place to monitor the quality of the service people received. Records were checked by case managers on a monthly basis. The registered manager told us they had started to carry out clinical file audits to monitor quality and ensure information was up-to-date. There were also plans to carry out more regular checks, for example, to observe staff’s competency and obtain feedback from people who used the service.

The provider and registered manager were keen to develop and improve the service. They kept up-to-date with best practice and attended networking events and conferences to share good practice. The service also offered training to external agencies on case management and care.

Workers are employed by the people using the service or have an agent acting on their behalf. The service oversee the recruitment process, training and performance management of the case managers and support workers on behalf of people using the service.

For the purpose of this report we will refer to case managers and support workers as 'workers'.

The main office based in Bishopsteignton in Devon. At the time of our inspection they were providing a service to 50 adults and children from South Wales down across the South West of England.

People told us they were very happy with the service they received from this service. comments included,'all of my support workers understand my needs and allow me to live my life as independently as possible'.

People told us they had been able to make choices and decisions in relation to their care planning. Comments included 'an excellent team who understand me and help me make decisions'.

Training records showed that all workers had received mandatory training and additional training specific to the people they supported.

People told us that they felt the workers had the necessary skills and time to meet their care needs.

We saw that the agency monitored their service and sought regular feedback from people.