N-Able Services Limited

N-Able Services Ltd provides specialist case management, support and rehabilitation services to children and adults with acquired brain injuries and other complex disabilities. N-Able services are commissioned through personal and medical injury firms and they manage the day to day care packages on behalf of clients. N-Able Services Ltd employs professional case managers and therapists and is also responsible for the recruitment and line management of support staff, utilising the services of other care providers where appropriate. At the time of inspection, the service was supporting 19 people who received care and support.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People received consistent person centred support from staff who were kind and caring. People's needs had been fully assessed and support plans were detailed and reflected people's individual needs and preferences. Support needs were reviewed regularly. Staff understood the needs of the people they supported and had developed positive relationships.

Risks to people had been identified and staff had clear guidance to manage and reduce risk. People were protected from the risk of harm and abuse and everybody we spoke to felt confident to raise any concerns.

Safe recruitment practices were in place and people were supported by staff who had undertaken a thorough induction process and training relevant to their roles. Enough staff were employed to meet the needs of the people using the service. Staff were supported through regular supervision and team meetings, and felt well supported by the registered manager.

Medicines were administered by trained and competent staff and staff had access to personal protective equipment (PPE) to prevent and control the spread of infection.

People 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.

People's independence was promoted and their right to privacy and dignity respected. People and their relatives spoke positively about the staff and management team and told us their views and feedback were regularly sought.

People knew how to make a complaint and they were confident about raising concerns should they need to.

The registered manager was described as supportive and approachable. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

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 rating for this service was Good (published 29 December 2016).

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 re-inspection programme. If we receive any concerning information we may inspect sooner.

N-Able Services Ltd provides specialist case management, support and rehabilitation services to people with brain injuries and other complex disability across the North West of England, Cheshire and North Wales. The organisation line manages care staff and employs professional case managers and therapists. They also contract staff through care agencies. The main office base and headquarters is situated in Bromborough, Wirral. The services N-Able offer are privately commissioned via solicitors. N-Able mostly work with people and families of people with complex brain injuries to case manage their individual packages of support. This includes using external recruitment agencies as well as staff directly recruited by people, and working holistically with other medical professionals to offer support for as long as the person needs. N-Able refers to people who use their service as ‘clients’. Also, the professionals who take responsibility for peoples care packages were referred to as ‘Case Managers.’

There was a registered manager in post.

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.

People and family members of people who use the service told us they felt safe and reassured.

The staff we spoke with were able to explain what action to take if they felt someone was being abused or neglected in anyway. There were policies in place for staff to refer to and staff were able to describe them.

Risk assessments were well written and gave a thorough and detailed explanation of how to support people, including what action the staff must take to help minimise the risk in the least restrictive way possible. Staff understood the concept of what was acceptable risk taking in order to promote positive experiences for people.

There were procedures in place relating to the safe management, storage, and administration of medication. People told us they received their medications on time and there was training in place for staff with regards to safe medication administration and this was reviewed regularly.

Staff were recruited safely and checks were carried out on staff before they started work at the service to ensure they were suitable to work with vulnerable people. We saw that N-Able often recruited staff using external recruitment agencies and were able to see the checks carried out on these staff before they were introduced to people.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it.

Opportunities were in place to address lessons learnt from the outcome of incidents, complaints and other investigations.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

Staff told us they were well supported through the induction process, regular supervision and appraisal. Staff said they were up-to-date with the training they were required by the organisation to undertake for the job and training records confirmed this.

People were supported to maintain their nutritional wellbeing by staff and some people were supported to cook for themselves to maintain their independence. Some people lived at home with family members so staff were not always required to cook meals with or for people. People told us staff helped them prepare meals and supported them to shop for ingredients to plan meals.

People and relatives told us they felt that the staff cared about them and respected their privacy and dignity. Staff were able to describe how they did this.

People’s independence was encouraged. Assessments were undertaken to identify people’s care, health and support needs. Care plans were developed with people who used the service and relatives to identify how they wanted to be supported.

The registered provider had a system in place for responding to people’s concerns and complaints. People and relatives told us they knew how to complain and felt confident that staff would respond and take action to support them. People and relatives we spoke with did not raise any complaints or concerns about the service.

A wide-range of comprehensive audits or checks were in place to monitor the quality and safety of care provided. These were used to identify developments for the service

We found that the service was safe, effective, caring, responsive and well led. We saw that care packages were inclusive and person centred and that the service was led by managers and staff who were well trained and supported in their roles. People who used the service were helped to lead a fulfilling and meaningful life. One person told us "They helped me back to work and now I am helping other people with disabilities".

We reviewed the provider's medication arrangements and saw there was an up to date medication policy which directed that most clients would remain responsible for their own medication. The service became involved in assisting with medication if it was required to do so. Care plans provided detailed information to staff about what was required and staff received medication training.

Staff working for N-Able Services were either directly employed or worked for a professional agency. We spoke to four members of staff who told us they felt very well supported. Comments from staff included; "Fabulous company to work for", "Very well supervised", "Encouraged to progress" and "Trained and motivated through staff meetings and team meetings".

There was a satisfactory system in place for checking the quality of care and the facilities that the service provided. We saw that clients were regularly asked for their views about the care and treatment and their feedback was acted upon.

'Its absolutely outstanding, brilliant'

"They are great, really supportive to myself and my son'.

'They go above and beyond, they are wonderful'.

We also saw evidence in the quality audit, which includes a questionnaire of people who used the service and their relatives/carers, of great satisfaction expressed with the service provided.

We saw that consent and agreement to care and support plans was obtained and documented. Care and support plans were individualised and met the needs of the people who used the service.

People who used the service were safeguarded from abuse; staff were trained and knowledgeable in safeguarding and had access to appropriate guidance and policies. Personal risk assessments identified vulnerability and plans were in place to protect the people who used the service.

Staff were appropriately recruited, qualified, checked upon and supervised according to the provider's policies and procedures.

Complaints were logged and dealt with appropriately.