Tania Brown Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Upon being referred to the service, detailed assessment reports were completed by case managers. These ‘needs assessments’ covered personal details, medical history, social, economic and environmental situation, clinical profile, daily living skills, daily and weekly routines, main problems, client’s goals, any barriers to rehabilitation and a treatment plan. We asked case managers about this process. One told us, “The most important person is the client and their family, and their story is so valuable. The initial needs assessment is a good place to start, but usually, by my first visit to the client or representative, I have read communication from the solicitor, medical notes and have a medical and social history for the client. Over time as trust develops, I can understand the client and their needs and then, using a collaborative approach, I can gain a deeper understanding of their needs and how to support them to achieve their goals.”

Most families and people had prior experience of case management before working with Tania Brown Limited. However, as each case management company is different, case manager’s representing Tania Brown Limited, ensured they sought the views and opinions of the person and their family, and what it was they wanted. Once assessments were completed, they talked through these with families and set clear expectations about what the case manager’s role was, what they would cover and assist with, how they would communicate and how often they would visit. This ensured everyone was in agreement before involvement officially commenced.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People’s dietary needs were assessed, with clear guidelines in place for support workers to follow. For example, one person had dysphagia, which is medical condition which affects the ability to safely swallow. Guidance indicated this person should have a minced and moist diet. Support workers and case manager’s knew people’s needs, and how to meet them. Comments included, “I am aware of the specific dietary needs of the people I support, including requirements related to Speech and Language Therapy recommendations, diabetes, and other health conditions” and “Within my role, I monitor intake during shifts, encourage regular fluids and support appropriate choices when out. I record this in shift notes and handover to parents.”

The management of Tania Brown Limited were mindful of the importance of staying up to date with best practice, especially within the fields of case management, chronic and degenerative neurological conditions, brain and spinal cord injury. As such they were members of both the British Association of Brain Injury and Complex Case Management (BABICM) and the Institute of Registered Case Managers (IRCM), and attended meetings with each which covered best practice, case studies and provided a peer support network. The clinical lead at Tania Brown Limited, had written a guidance document for the IRCM on the importance of working collaboratively with therapists. This was also seen as a helpful tool for aspiring case managers on working collaboratively with others.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

People, relatives and professionals involved with the service, spoke extremely positively about how effectively Tania Brown Limited (TBL) worked with them. One professional told us, “The clients we are involved with have usually suffered a severe brain injury and require significant input from a number of professionals, including us (acting as Deputy for the client), a case manager, and wider team providing care and support. Clients are often extremely vulnerable and have challenging behaviours, which can include impulsivity and substance misuse. I work very closely with TBL to ensure the client’s needs are effectively managed. A collaborative approach is essential. I have regular, often daily, communication with TBL to ensure we are all working together efficiently to ensure client’s needs are being met.TBL demonstrate a consistent approach and show professionalism and commitment, but also empathy, adapting to a client’s individual needs.”

Another professional stated, “We work closely with TBL, especially [registered manager]. She ensures all information is shared with the multi-disciplinary team (MDT). We currently have bi-monthly meetings, these have reduced from monthly meetings as [registered manager] has ensured the MDT work cohesively and honestly, and this has created a positive culture, allowing all professionals to feel safe to challenge each other.”

We reviewed a range of meeting minutes and related documentation which supported this positive feedback. To help ensure continuity of care, prior to going on leave, case managers completed a ‘holiday handover’ document for each of their clients which covered background, contacts, professionals involved, support workers and rota, current goals, any actions, barriers which may affect case management, safeguarding concerns and any other issues. This ensured whoever was overseeing their cases temporarily, had all the information they needed, to provide seamless support.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People received support to manage their health and wellbeing, with input from a range of medical and therapy professionals as and when required. The case manager acted as the coordinator for all of these services and professionals, making appointments, attending where needed and summarising feedback, to ensure people understood what had been discussed.

People’s care records included information on any medical conditions along with how these would be managed.

Where treatment and follow up actions had been assigned, case managers ensured support workers were aware of these and then monitored completion. For example, following oral surgery, the case manager had monitored a person’s recovery, and ensured they continued to eat well, which included liaising with the person’s dietician about changes to the persons diet due to the number of teeth which had been extracted.

We asked case managers about how they supported people’s health and wellbeing. One told us, “I have a current client with a number of health conditions, along with severe health anxiety. There were concerns they may have functional neurological disorder (FND). I liaised with the neuropsychologist and neuropsychiatrist, and it was agreed to refer to a neurologist that specialised in FND. We supported the client through the process positively. In this job we can’t work in silo, to achieve the best for our clients we need to be open and transparent and work as a team.”

Support workers also told us how they met people’s health and wellbeing needs. Comments included, “I involve people in conversations about their health and well-being by listening to their preferences and supporting them to make choices” and “I support my client to attend health/wellbeing appointments and will always direct conversations and questions through them first. I’m there to explain things or help if they need it.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider used a range of tools and outcome measures to both assess people and monitor the effectiveness of their care and support. These included the hospital anxiety and depression scale, community integration questionnaire and the World Health Organisation quality of life tool, alongside more widely used measures such as Waterlow Score, which identifies the risk of a person developing pressure sores.

Case managers completed monthly reviews which included a review of people’s goals and feedback on their progress in achieving these. Actions for the next month were then set.

Support workers were knowledgeable about the daily monitoring tools they may need to use, which included fluid charts, food charts, observation charts, weight charts and repositioning charts. Completion of these had also been overseen by the case manager.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Care records contained consent forms, which people or their legal representative would sign to give consent for case manager to access and share their personal information, and for other professionals involved to do the same.

We asked case managers how they sought people’s consent. One told us, “It is difficult as most of the clients I work with have a brain injury (and therefore lack capacity). However, their views and wishes should be respected as far as possible. I will ask for a capacity assessment if needed. I will also ensure the client has the opportunity to express their wishes. If needed the client can be supported by an independent advocate and they can be part of the best interest meetings. I will always advocate for the least restrictive option and continuously review any decision.”

Where people’s capacity to make certain key decisions was unclear, case managers had commissioned formal assessments by neuropsychologists. For example, these had been completed to assess a person’s capacity to refuse treatment, to assess a person’s capacity to write a will and make decisions about their property and wider financial affairs. Where people were deemed to lack capacity, decisions had been made using the best interest process. A best interest decision making checklist had been used to support this process.