Archived: Care Management Services (CMS)

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 Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals. The registered manager confirmed that everyone supported by the service had capacity to make their own decisions and no one was subject to a deprivation of liberty order under the Court of Protection (CoP).

People told us that they found staff caring and supportive. We observed there to be good relationships between the person we visited and the care worker who supported them. Staff and people we spoke with said their relationships although professional, were as much on a friendship level as a caring one. People said their privacy and dignity was respected during the delivery of personal care and support. We were made aware that for a period of time, some care staff had been required to sleep in the same room as the person they supported, whilst accommodation was being refurbished. The registered manager told us this had been with all parties’ agreement. We have made a recommendation that wider consideration of people’s privacy and dignity needs is undertaken in the future. People were also supported to maintain their well-being, as staff supported people to attend general practitioner or hospital appointments, as necessary.

People’s care needs were assessed before the service started delivering care. Following this assessment a care proposal was developed that detailed people’s needs and their aspirations for the future. Staff told us there was sufficient information for them to carry out care effectively. They said that the people they were caring for knew about their own condition in detail and directed staff to provide the most appropriate type and level of care. People said their care plans evolved as their needs changed. However, it was not always possible to see how plans and been reviewed to ensure they fully reflected these changing needs. The provider had a complaints procedure in place. Records showed there had been no formal complaints within the last 12 months. People told us they had not raised any recent formal complaints. Some people told us they had raised concerns and that these tended to be dealt with informally.

Team leaders carried out regular checks on care delivery, through a system of observing staff practice and gathering feedback from individuals in receipt of care. The registered manager said this was to ensure that care delivered effectively met the needs of the person. People had mixed views about the registered manager and his approach. Some individuals told us he was supportive. Others we spoke with said that he did not always listen to their views and that they found the registered manager’s approach intimidating.

The registered manager said there had been no recent formal management meetings because senior managers in the service had been so busy travelling round the country to support service delivery. Day to day management issues were dealt with through regular telephone contact. Daily records were limited and did not contain a description of the types or levels of care delivered by care staff on a daily basis.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to good governance and staffing.

Relatives and staff told us peoples consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes. A relative told us, "They have encouraged him to be independent and assertive." One staff member told us, "B has capacity to make all his decisions and we support him."

We found people's care and support needs were appropriately assessed and their care and support was planned. They received care and support safely and to an appropriate standard. A relative told us, "We have total confidence in the care and support given."

We found staff were well trained and supported to carry out their role. A relative told us, "Skilled, staff team." Staff told us, "I feel we are supported and trained to provide the best team to give individualised support."

We saw the provider had a complaints policy and procedure in place and people told us they would confidently raise any concerns they had with the manager. A relative told us, "I can express any worries and staff will sort it out."

People told us they were happy with the care and support they received. They confirmed they were given choices in life and staff supported them to take some risks and be independent. People we spoke with said, "I am really happy" and "Overall I have had my system going for 3 years and so the day-to-day routines are well established and meet my needs."

People said they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within their home and the wider community. People we spoke with said "I have lots of holidays and am about to have my next one, staff help me to achieve this" and "I can follow my interests and staff are supportive." They said staff were kind and caring and seemed to be well trained. People confirmed they were given the opportunity to comment on the service, change routines or raise concerns but were not always satisfied on how concerns were managed.