Archived: Head First (Assessment, Rehabilitation and Case Management) LLP

Head First (Assessment, Rehabilitation and Case Management) LLP, referred to as ‘Head First’ throughout this report, is an independent organisation specialising in providing assessment, rehabilitation and case management for adults, and some young people and children, with an acquired brain injury. The organisation works with approximately 100 brain injured people, their families and care workers, and over 40 people are directly supported by the service. This includes supporting people who use the service to directly employ support workers, some of whom may provide personal care. The service primarily supports people in their own homes but also people in rehabilitation centres and care settings. The majority of people who receive a service live in Sussex (West and East), Hampshire, Kent, Surrey, Essex, Hertfordshire or Berkshire. The service also supports some people who live further afield across England.

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

People’s care and support needs were personalised and they received a bespoke service from Head First. People spoke very positively about the service and the staff who supported them. In addition to people the service directly supported, Head First were proactive in helping people and their families who had not received compensation through legal channels, but were living with an acquired brain injury. This was achieved through sharing knowledge about acquired brain injury, in this country and around the world, to improve people’s lives and support professional knowledge and development.

The service had been instrumental in setting up conferences about brain injury in the UK, invited speakers, including people and their families, at local and national events. Campaigning and promoting the use of bicycle helmets had also helped raise awareness for people about the risk of cycling without head protection, and fund-raised for a local group and the national charity. All these initiatives, and more, had a positive influence and impact on people living with an acquired brain injury.

People were complimentary about the service and staff who supported them. One relative had written, ‘My uncle has some fabulous support workers and they always seem to be trying new ideas to support his progress and improve motivation and quality of life. They show a genuine interest in him and talk positively about him’.

Staff were recruited at the point people were assessed as being suitable to receive a service at Head First. People’s specific needs were identified, new staff were recruited and training was tailored according to what people needed and wanted. Staff had regular supervisions with their line managers. Staff enjoyed working at the service and felt well supported in their roles. Working practices were discussed and areas for improvement were identified at staff meetings.

People were protected from the risk of harm by trained staff. Risk management was pre-emptive and people’s risks were managed effectively.

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 were supported by kind and caring staff who knew them well. Overall management of people’s care and support needs was overseen by case managers. One person commented, ‘Head First have been my happiest care. I feel they’re trained well and know how to assist me specifically’. People told us that their support staff arrived on time.

People were involved in all decisions relating to their care and support needs. Care plans were detailed and personalised. People knew who to contact if they had any concerns or wished to make a complaint.

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 (report published 17 March 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 re-inspection programme. If we receive any concerning information, we may inspect sooner.

Head First employs the care staff in that they direct and control the staff they deploy. They provide a specialist case management service for people with acquired brain injuries and their families living within the community. This includes supporting people who use the service to directly employ support workers, some of whom may provide personal care. The service provides the management, training and supervision of support workers. Head First work with 149 brain injured clients and their families. Head First recruit support / manage support workers for 51 clients (201 support workers in total) and have agency support workers for another 16 clients (25 support workers in total).

The manager was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

We looked at the medication records for eight people. The medication procedure for staff was to prompt people or to administer their medication. Records informed that support staff would record all medication on the provider’s medication record sheets and on their live computer system to inform medication had been provided. There was information in relation to covert medication practices for staff to follow; we were told that no person was receiving this service.

We looked at records relating to the safety of the office premises and its equipment, which were correctly recorded. We were shown where confidential records were stored and saw they were in locked filing cabinets and electronic records were password protected..

People were supported to prepare food and drinks and could choose the meals that they prepared if this was part of their person centred care plans (PCCP). Where people’s weight changed, this was recognised, with appropriate action taken to meet the person’s nutritional needs.

The provider complied with the Mental Capacity Act 2005 and its associated codes of practice in the delivery of care. We found that the staff followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights. The service was providing support to people who did not have the capacity to make their own decisions in different areas of their lives, due to the brain injuries they had sustained.

We found that the person centred care plans and risk assessment monthly review records were all up to date in the eight files looked at on the service’s computerised system. There was updated information that reflected the changes of people’s health.

People told us they felt safe with staff. The management had a good understanding of safeguarding. The registered manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority. The CQC were not being notified as required; this was discussed as managers were uncertain of their duty to report statutory notifications to CQC. This was clarified and the CQC immediately received three retrospective incident notifications.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidents. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

The staffing levels were seen to be sufficient at all times to support people and meet their needs and everyone we spoke with considered there was adequate staff to provide the support the service was managing on their behalf.

The service ensured all new staff had a Disclosure and Barring Service (DBS) check. Three of the nine staff files looked at did not include a photograph of the staff. The staff personnel records did not include all of the relevant information required. We spent time discussing this with the management team and they took action immediately.

The service had an induction programme in place that included training staff to ensure they were competent in the role they were employed for, at Head First. Staff told us they did feel supported by the registered manager, the clinical manager, case managers and senior support workers.

The eight person-centred care plans we looked at gave details of people’s medical history and medication and information about the person’s life and their preferences. People were all registered with their own local GP of their own choice and records showed that people were supported if required to see a GP, dentist, optician, chiropodist or other health professionals as the chose.

We have made recommendations that the provider ensures that audits completed have what actions they have taken recorded to show how their systems used are effective.

People who used the service told us that they were supported with the skills they needed to live independently. People expressed their views and were involved in making decisions about their care and treatment. People told us 'I have a choice, I always have a choice about what I want to do' and 'I'm happy I can employ support workers directly. I can decide who walks through my door, what I do and how many hours I want support for."

People were supported by case managers and support workers who were supervised and trained to deliver care safely and to an appropriate standard. Relatives of people who used the service told us 'Support workers are trained. They are all very good.' Case managers had professional backgrounds and qualifications.

People were protected from the risk of abuse. People told us 'I feel safe.'

People who used the service and their relatives were asked for their views about the service provided and these were acted on. Relatives of people who used the service told us 'They are very good. They are always there if there is a problem or concern' and 'We've been using the service for [some] years and have no complaints.'