AJ Case Management

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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The provider had a strong, open culture of safety and continuous learning which was embedded throughout the service. Incidents were viewed as opportunities to reflect, learn and improve practice rather than simply events to be recorded. Managers reviewed all incidents to identify possible patterns, causes, or risks, to ensure learning was embedded across the service. Incidents were also reviewed to confirm staff had taken appropriate and timely actions to safeguard people and reduce further risk. When staff had reported incidents they and the person’s case manager received feedback about the investigation outcome regardless of any lessons learnt. They also received notification when the incident was closed. We saw incident records which clearly demonstrated the incident had been investigated, updated and reviewed, and lessons learnt had been identified.

Staff were encouraged to reflect on incidents and any lessons learnt were recorded, such as what they could do differently if the incident happened again. Case managers discussed incidents and lessons learnt during staff team meetings. Case managers also reflected on previous incidents during their supervisions with their line managers and lessons learnt were discussed. One case manager told us they supported their teams by reminding them in team meetings and supervisions about their responsibilities. This was also covered in detail during induction training to ensure early awareness, transparency, and risk prevention. This all contributed to a culture where people’s safety was constantly and consistently reviewed and improved.

The provider constantly monitored and reviewed incidents and any concerns about people’s safety. The registered manager told us they viewed any incident or concern as an opportunity to improve outcomes for people across the service. Where needed, managers implemented additional measures such as refresher training for staff, practice guidance or adjustments to people’s care plans. This ensured staff understood what happened, why it happened and how similar incidents could be prevented in the future. This approach helped to ensure learning was used to drive ongoing improvements in the quality and safety of care.
 

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.

Staff planned and organised care and support with people, together with partners and relatives in ways which ensured continuity. The registered manager explained information from partners was reviewed prior to delivering care to any new people. Managers visited people prior to any support starting to ensure they could support the person and to start recruiting their care team. They also ensured all care plans, risk assessments and external resources were in place to maintain the person’s safety.

When people moved between services, staff ensured these transitions were managed safely and effectively. The provider worked closely with relevant stakeholders before people either joined or left the service. This collaborative and coordinated approach prioritised people’s safety and helped maintain continuity of care.

One person had recently transferred to a new care provider, and we reviewed evidence which showed both the person and their family were supported through a series of “meet and greet” sessions. These meetings enabled the individual, their family, and all involved partners, including the new provider to prepare for a smooth transition. Throughout the process, communication remained consistent and proactive. This ensured care plans, staff training, and necessary processes were fully aligned and in place ahead of the agreed transition date, supporting a smooth and safe handover of care.
 

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.

Some people were subject to a legal deprivation of their liberty in their best interests under community Deprivation of Liberty Safeguards (DoLS), authorised by the Court of Protection. Although the provider was aware of these authorisations, they did not hold all the relevant documentation required to fully evidence them or confirm whether any conditions were attached. This was because most authorisations had been granted prior to people joining the service, and documentation was held by court‑appointed deputies. Although the registered manager demonstrated a good understanding of community DoLS, they had not ensured they had sight of these authorisations. The registered manager identified this as a learning action and told us they would liaise with the court appointed deputies to have access to these.

People and their relatives told us they felt safe with the staff who supported them. One relative told us, “They [staff] always have eyes on [person’s name], and I know they are safe.”
Staff had completed training in safeguarding adults and children and demonstrated a clear understanding of how to protect people from the risk of abuse. They were able to recognise the signs when someone may be at risk and knew how to report concerns promptly. One staff member told us when they had supervisions, they discussed their understanding of the safeguarding process they must follow with their line manager. Another staff member told us, “Yes, I feel very supported and capable of raising safety concerns. We have regular supervision as an additional opportunity to discuss any concerns, and I feel AJ Case Management would act immediately to follow their safeguarding policies and procedures.”

The provider had effective systems in place for reporting and managing safeguarding events. Any concerns were appropriately referred to the local safeguarding authority and CQC in line with statutory requirements. We saw evidence where abuse had been identified or suspected the provider had implemented appropriate measures to keep people safe. This included increased monitoring, updated risk management plans and close co-ordination with external safeguarding partners to ensure people remained safe and supported.
 

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.

Staff helped people understand positive risk taking which enabled them to lead fulfilling lives whilst remaining safe. One person told us, “I do what I want to do. They [staff] talk to me about risk and warn me before I do anything.” This person told us about the many outdoor activities they enjoyed which staff supported them with. The risks associated with these activities had been fully considered and measures were in place to keep the person safe so they could enjoy the things which mattered to them.

Risks to all people were assessed and control measures were in place to help minimise these. Risk assessments were completed for identified risks for areas such as people’s mobility, health conditions, skin integrity, medicines administration and any equipment used. These assessments were individual and reflected each person’s wishes, needs, and circumstances. For example, when considering the use of bed rails, staff completed a detailed assessment involving the person, their relative, and their occupational therapist, which ensured the decision was collaborative and in the person’s best interest.

People’s risk assessments were regularly reviewed and updated to ensure they remained accurate and continued to keep the person safe. Staff understood the risks to the people they supported, which helped ensure people received safe and appropriate support tailored to their personal risks. Care records gave staff the information they needed to manage the risks effectively and safely. This strong risk management culture ensured people received safe, responsive support while being encouraged to live active, independent lives.
 

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 risks were assessed when people started using the service. Each person had a household health safety assessment which were individual to their own home. These documents identified how often checks were to be completed on equipment, the location of service utilities, fire prevention equipment and how to maintain security of the property. They also listed staff contacts and emergency contacts.

Some people had equipment to support them with their mobility, sleeping or communication. Clear plans were in place to identify who had the responsibility for each piece of equipment used and when it needed to be serviced.

People had emergency evacuation plans in plans. These included fire escape routes from their home along with actions for staff to take dependent on where a fire may be in the building. Plans were tailored to each person’s needs to ensure staff could support them safely and effectively in the event of an emergency.
 

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.

Each person had their own staff team who worked exclusively with them. They had been involved in recruiting their staff team with the support from the service. One relative told us they and their family member were involved in the recruitment process. They told us, “It worked very well, they [staff] have built really good relationship with [Person’s name].”

People and their relatives told us staff received the training they needed to support them. Staff completed core training before undertaking additional bespoke training which was tailored to the specific needs of each person they supported. This ensured staff had both the foundational skills and the specialised knowledge necessary to provide safe, person‑centred care. One staff member told us their training was focused on what they could do to help the person they supported. Another staff member told us, “The training is excellent and client specific. I feel confident to do the job to the best of my ability and am supported to further my skills in any given area if I feel there is a gap. For example, I have attended understanding self-harm, and mental health awareness training days in the past.”

All staff completed sepsis awareness training, and their awareness was further reinforced in a recent organisational newsletter. This reinforcement had provided an additional prompt to maintain staff vigilance and support the application of safety practice in recognising and responding to sepsis.

The provider monitored staff compliance with their required training. A central spreadsheet was used to capture the training requirements staff needed to safely support each person. The provider kept this spreadsheet up to date and ensured staff received refresher training in line with organisational expectations and the needs of each person.

The provider’s induction process ensured new staff understood people’s routines, preferences, risks and communication needs before they started working with them. When staff first started employment, the case manager went through the whole of the person’s care plan with them to ensure they understood how to support that person.

The provider had systems in place to ensure staff were recruited safely. This included checking their eligibility to work in the UK, obtaining references and Disclosure and Barring Service (DBS) checks. The DBS checks help employers make safer recruitment decisions and prevents unsuitable people from working with vulnerable people.
 

The provider assessed and managed the risk of infection. People and their relatives told us staff wore personal protective equipment (PPE) when they were meant to. Any PPE requirements or cleaning schedules were tailored to the needs of each person.

The service had effective infection prevention and control (IPC) systems in place to help protect people from the risk of infection. The emphasis was on good hand hygiene and staff competency in IPC, which was regularly assessed.

The provider had an IPC policy in place which was reviewed annually to ensure it reflected current best practice. The registered manager was designated IPC Lead and provided oversight of IPC processes, training, monitoring and compliance.
 

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.

The provider had generic protocols in place for when people had their medicine only ‘when required’, such as pain relief. Although these protocols gave staff detailed information, they did not cover every person’s specific ‘when required’ medicine. We found no impact on people because of this. Following our inspection, the registered manager provided evidence of updated and specific protocols.

Some people required their medicines in different formats, such as liquid feeds, liquids or creams and staff had step by step administration guidance available for them to follow. People had medicine care plans in place which had assessed any risks associated with the administration of their medicines and detailed the support people needed.

Staff had completed training to enable them to administer medicines safely. They had competency checks where their practice and record keeping was observed. One staff member said, “They will also ask different questions to see if we know how to respond in different situations.”

Procedures were in place to guide staff on the actions required in the event of a medicine error. Staff reported any medicine incidents or errors promptly, reflecting an open and transparent culture.