Tania Brown Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 78 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had an up to date accident and incident policy in place, along with a guide for staff to follow. All staff we spoke with knew how to report and escalate concerns. Completed accident / incident forms were reviewed by the case manager, who completed an initial action plan to manage the situation and help prevent recurrence. Forms were then reviewed by the management team before being added to the provider’s electronic systems, where the data could be analysed to look for patterns and trends. All incidents were reviewed weekly during meetings with the clinical lead from Active Care Group, the company who owned Tania Brown Limited. Additional reviews and learning were completed monthly during internal quality meetings. Feedback from these meetings was cascaded to staff through written communication or verbally during supervision or reviews.

Complaints were managed in a similar way, albeit none had been received in the last 12 months.

Staff told us there was a proactive and collaborative approach to learning and dealing with incidents. One staff member told us, “I feel able to safely challenge my supervisor, the clinical lead or registered manager. It is a very grown-up approach, which means we can always ensure that debates about the delivery of care are always made with the client front and centre, and the right people are involved.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked collaboratively with people, relatives and other professionals involved to ensure continuity of care was maintained. Relatives spoke positively of their experiences, telling us Tania Brown Limited communicated and coordinated effectively, which took the pressure off them, and ensured their family member received the best care possible.

Not everyone using the service had experience of case management and what it entailed. A case manager told us, “Often clients do not understand case management, so this takes time to understand. I always explain they should ask and refer to me for everything and I will help signpost. The key is to maintain regular contact with the client with meetings, face to face and calls, so you are part of the process.”

We looked at how transitions into the service were managed. Staff told us communication was effective, with key information shared through referrals, assessments, and care planning. Staff learned about people’s needs, wants, and wishes by reading their care plans, risk assessments and by speaking with the person directly. Information was also gathered from family members and professionals involved to ensure support was person-centred.

The provider used a number of systems and processes to support people’s transitions, including hospital passports and a client file handover checklist. The hospital passport contained all relevant information about support needs, risks and how to meet these, to support an effective transition into hospital. Easy read versions were available, which contained pictures and simple text, to ensure they were accessible to the people they belonged to.

The client file handover checklist detailed the documentation and processes which needed to be followed, before a person could transition into the service. This was to ensure continuity of care was maintained and included information about the person, along with their current support network.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Up to date safeguarding policies and procedures were in place to ensure people were safe and safeguarding concerns were reported timely. Training had been provided to all staff, with a safeguarding lead in place to provide additional advice and support. A staff member told us, “My supervisor, the clinical lead and safeguarding lead are always available for a quick call to discuss any safeguarding issues. Often with safeguarding’s, I will speak with [registered manager] to talk it through and agree actions such as a referral to the local authority.”

Safeguarding referrals were documented on dedicated forms, before being added to the provider’s electronic system. Records detailed actions taken, outcomes and any learning.

Professionals involved with the service shared their experiences of working with the service to keep people safe and manage safeguarding concerns. One told us, “There have been a number of safeguarding concerns which have come to light over the years. Tania Brown Limited have always demonstrated a strong awareness of such issues and responded promptly and appropriately. They have been proactive in escalating concerns to the relevant authorities when required. Client’s often have unpredictable and high-risk behaviours, so the responsiveness from Tania Brown Limited is critical.”

Case managers had a clear understanding of the legal processes which may be required when people lacked capacity to consent to any restrictions in place, and what their role was in advocating for people. Where people requiring case management support resided in residential care, the relevant legislation is Deprivation of Liberty Safeguards (DoLS). A case manager told us, “I have a client who resides in a nursing home. They are consistently saying they want to leave the nursing home and live in a different town. I contacted the DoLS team and informed them my client was raising an objection about their DoLS, and as a result they appointed an independent paid advocate. A best interest meeting is taking place soon to look at their situation.”

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

People’s risks were effectively and consistently assessed and managed. Relatives spoke positively about the improvements they had noted in this area since the service had been involved. One told us, “I feel the health and safety monitoring and risk assessments are much tighter since Tania Brown became involved. The care plan is thorough and reviewed regularly.”

A risk register and risk assessment matrix was used to log all risks, the level of risk and how these would be managed. Care records contained a range of individualised risk assessments, which provided clear guidance for staff to follow. Staff found these easy to follow. One told us, “I feel care plans and risk assessments give clear guidance on how to manage risks, as they explain the person’s needs, known risks, triggers, and the agreed control measures in place.”

Tania Brown Limited promoted positive risk taking and were open to exploring different ways of supporting this. There was evidence noted of positive risk taking being promoted, and of technology being used to support this process. For example, for one person, a goal had been set to reduce support levels from live in care, to day care whilst maintaining safety and engagement in daily tasks. As part of this process, it was agreed the person would need to learn how to independently call for help if and when needed. The person identified this would be best done using a telephone with voice activation, as they were unable to dial manually. To facilitate this, the service connected the person’s phone to a smart speaker, and when they required help, they just need to ask the speaker to call their personal assistant.

Another person had been supported to plan and attend what they called ‘daredevil activities’, such as indoor skydiving, ice skating and other similar pursuits. This person’s relative told us, “Between Tania Brown, the physios and myself, we organise events, and the carers come with me. Tania Brown always support any ideas to get him to do something different and I really value that.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risk assessments completed at people’s properties, identified risks to people and staff and considered how these would be minimised. These covered a variety of areas including moving freely around the home, security, electrical appliances, gas, heating and firefighting facilities, gardens and external areas.

Where necessary, fire risk assessments had been completed. These detailed fire risks within the person’s home, control measures in place and what to do in the event of a fire.

Staff completed a number of safety checks within people’s properties. These included water temperature checks, food temperature checks and ensuring mobility vehicles were safe to use.

People using the service were provided with a health and safety folder. This covered a range of areas including legionella, fire, first aid, medication, electrical testing, vehicles and lone working.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Although the support workers or personal assistants, who supported people were not employed by Tania Brown Limited (they were employed by the person’s solicitor or deputy), the service had taken on responsibility for ensuring safe recruitment processes were followed. Necessary training was provided and staff received ongoing supervision and support, to ensure they could provide safe and effective care. Case managers continually reviewed people’s care to determine whether current support levels were suitable and where necessary would make recommendations to solicitors or financial deputies.

A recruitment tracker was used to ensure all necessary employment checks had been completed, induction training courses booked and supervision meetings scheduled in. A separate support worker induction guide was used by administration staff, to ensure all necessary pre-employment checks had been completed. Records showed staff had been recruited safely.

Training completion was monitored via a spreadsheet, and through training audits carried out by case manager’s, who were the line managers of any support staff or personal assistants. Overall, these showed staff were up to date and had the knowledge and training to meet people’s needs. A support worker told us, “We have had more training (both online and in-person) since Tania Brown’s involvement than we have had for some time before that.”

Case managers working for Tania Brown Limited were either self-employed or associates. We asked them for their views on recruitment, training and support. One told us, “Tania Brown Limited (TBL) recruits people with skills and experience they need to work as a case manager. We all have a significant work history; this means that we come with knowledge. However, TBL provide the training and updates, and support with re-validation. Another stated, “As I am self-employed, I am responsible for my training, including mandatory training. TBL ensures I have completed mandatory training, such as safeguarding, Prevent, epilepsy etc. They provide annual training and other opportunities and always include self-employed case managers.”

Both support workers and case managers told us they received enough support and supervision to help them carry out their roles. A case manager stated, “Supervisions are three monthly but sometimes more often. If a case is complicated, we may meet to discuss this specifically. Supervisions are detailed.” A support worker said, “I’ve had monthly supervisions face to face for the last 7 months. Also, informal catch ups via teams or phone call in between. It’s been rejuvenating to feel valued.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had an up to date health and safety policy in place which covered infection, prevention and control (IPC). This was located on a shared drive which staff had access to.

IPC audits had been completed by case managers as part of the review process, when visiting people at their home. These covered whether the care plan had identified any IPC issues, if staff knew how to manage an outbreak, whether hand washing facilities were available and staff competency in hand washing, if the environment and any equipment was clean, if food hygiene practices had been followed and if PPE was available and used. Where any issues had been identified action plans had been drawn up and reviewed at the next visit.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Overall, medicines were managed safely. As the majority of people receiving regulated activity were children or young adults who lived at the family home, their parents maintained a lot of involvement and responsibility for medicines administration and oversight. However, case managers ensured support staff and personal assistants, had received training in medicines and had their competency to administer these safely assessed. One support worker stated, “My competence is normally checked during my supervision sessions, which helps ensure I continue to administer medicines safely and follow all procedures correctly.”

MAR charts reviewed during the assessment had been completed correctly, and either signed by the parent or staff member. These indicated people had been given their medicines as prescribed. Stock checks had been completed by support workers and case managers.

Where people had been prescribed medicines to be taken as and when needed (PRN) such as for pain relief, guidance was in place to help staff give these safely and correctly. However, further detail was required. Where medication could be given as a variable dose, for example take 1 or 2 tablets, there was no information to guide staff on how many should be given, if the person was unable to tell them. Similarly, for pain relief medication, it was not always clear if the person could request this and if not, how staff would know it was needed. However, relatives told us the support workers had been in place for many years, and as a result, knew their family member very well, so this was not an issue. A support worker stated, “I understand what each medication is for, how and when it should be administered, and any potential side effects to watch for.”