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Archived: Care Management Services (CMS) Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 14 October 2016

This inspection took place on 8 and 9 February 2016 and was announced because we wanted to ensure there would be someone at the service’s office when we called.

Care Management Services (CMS) is registered to provide the regulated activity of “Personal Care'' to young physically disabled adults. CMS carries out assessments of people's needs and produces direct payment proposals forwarded to local councils to obtain the required funding to meet their needs. The provider then enters into a contract with the individual to provide support for the funded care package, including the provision of staff. CMS currently support people in various locations across England. At the time of our inspection the service was supporting three people with personal care, one of whom was the registered provider.

At the time of our inspection there was a registered manager in place. Our records showed he had been formally registered with the Commission since October 2010. 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. The registered manager was also a director of the company.

People told us they trusted the care workers who supported them. Staff told us they had received training in relation to safeguarding adults and would report any concerns to a senior member of staff. The registered manager told us there had been no recent safeguarding issues. However, we identified one significant event which should have been reported as a safeguarding incident. The registered manager told us the matter was investigated internally. There was a potential ongoing safeguarding matter at time of the inspection. We will monitor the outcome of this issue.

Processes were in place to recruit staff and to carry out checks to ensure they were suitably experienced to support people with their personal care needs. Staff who joined the service had been subject to checks with the Disclosure and Baring Service (DBS). We found references for some part time staff were not detailed and only identified that they were attending a university course. We have made a recommendation that fuller reference checks be undertaken on these staff in the future. People told us that staff were almost always available to meet their needs. Some staff told us they were required to work a considerable distance from their home and family. They also said they had been required to work shifts of 48 hours or more, without relief.

Staff told us there was always a team leader available to provide information and advice. Team leaders could also call on the registered manager and other managers in the organisation for advice and support, if necessary.

People told us that staff supported them to take their own medicines. They said they had a good understanding of the medicines they were required to take and staff responsibilities in this area was to help them take their medicines at the correct time. A record was made when staff supported people with their medicines. An agreement was in place with one individual around self-management of their medicines, although we noted this had not been recently reviewed.

People told us they felt that staff had the right skills to support their care needs. Staff told us they had received sufficient training to carry out their roles and that this training was individualised to the person they were supporting. They said that if they were required to support a different individual then they received training specific to that person’s needs. Where specific training was required, on specialist equipment or specialist techniques, this was initially provided by a qualified health professional. The registered manager said the provider was an accredited training provider.

The Care Quality

Inspection areas


Requires improvement

Updated 14 October 2016

The service was not safe

Staff had undertaken training and had knowledge of safeguarding issues. We found one potentially significant safeguarding incident had not been formally reported.

Staff recruitment processes were in place, although a small number of staff had not been subject to detailed references being taken up. Staff were required to work long hours, often in different parts of the country. People told us staff on duty adequately supported their care.

People were supported to take their medicines appropriately. Risk assessments were in place for supporting people in different situations, such as trips away.


Requires improvement

Updated 14 October 2016

The service was not always effective.

Staff told us, and records confirmed a range of training had been provided that was personal to the individual people staff supported. We did not have sight of up to date supervision and annual appraisals, although historical documents contained good detail.

All the people being supported by the service had capacity to make their own decisions although where requested, staff supported people to make day to day choices. No one was under any restrictions or orders from the Court of Protection.

People made their own decisions about the food and drink they consumed. The provision of special diets was supported by staff when needed.


Requires improvement

Updated 14 October 2016

The service was not always caring.

People's privacy and dignity was not always fully supported. People, relatives and staff confirmed that staff had been required to share bedrooms with people they cared for on a temporary basis, including female staff sharing with male service users.

People and relatives told us the care workers were caring and helpful. We observed staff supporting people with kindness and understanding. People had access to a range of health and social care professionals, for assessments and checks, to help maintain their health and wellbeing.


Requires improvement

Updated 14 October 2016

The service was not always responsive.

There had not been any recent formal complaints. Concerns were often raised and dealt with informally, with no recognised record to monitor these matters.

Care plans were detailed and reflected people�s individual needs. They contained an assessment of risks associated with people�s care and instructions for staff to follow when delivering care. It was not always clear how care plans in people's homes had been updated or reviewed.

People were supported to engage in activities which interested them and were helped to make trips and visits within the community.


Requires improvement

Updated 14 October 2016

The service was not well led.

The registered manager had not returned in a timely manner the Provider Information Return record issued by the Commission prior to this inspection. This meant important information was not available to the Commission to inform the planning of the inspection.

Daily records maintained at the home of people who used the service were limited and did not contain information on the range of care and support provided. People had mixed opinions of the registered manager�s style.

Regular audits of care provision were undertaken by team leaders, including obtaining the views of people who used the service. Formal management meetings were not currently taking place at the time of our inspection.