Breakthrough Case Management

Updated 18 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector. As part of the inspection an Expert by Experience also contacted people and families by telephone. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 24 March 2022 and ended on 31 March 2022. We visited the location’s office on 31 March 2022.

What we did before the inspection

We reviewed information we had received about the service since registration. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection. We visited the service's office in in Woolacombe, Devon and visited one person with their families’ consent in their own home. We spoke with one support staff member, and the registered manager/director, co-director and received feedback from 14 support staff via email. We also spoke to a team leader over the telephone. We spoke with 11 relatives about their experience of the care provided. We reviewed a range of records. This included three people's care records, medication records, audits, training records and three staff files.

After the inspection

We received feedback from a health professional working closely with the service.

Updated 18 May 2022

About the service

Breakthrough Case Management provides a specialist support and rehabilitation service, co-ordinating bespoke care packages for adults and children who have sustained complex life changing injuries such as an acquired brain injury, spinal injury or cerebral palsy. Eleven case managers work closely with people and families to set up and coordinate their rehabilitation, care and support needs mainly funded by legal compensation claims. Breakthrough Case Management staff oversee the recruitment process, training and performance management of support workers often employed directly by the people using the service. The service is registered to provide personal care. At the time of our inspection there were 12 people receiving the regulated activities provided by the service across Devon, Somerset, Gloucestershire and in London.

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

People were clearly at the heart of the service and they and their families spoke highly of the care they received. Comments included, “The caring is unbelievable, he is always treated with utmost dignity and respect”, “You genuinely can’t fault them, staff are very keen to make sure he gets the right care” and “It is so much more than a work relationship.”

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 needs assessments fed into the skills required of the bespoke staff team before care was commenced. Staff had completed a high level of specialist training tailored to individuals which provided them with the expertise to assess, monitor and support people with their complex needs. The service worked very closely with other health and social care professionals and lawyers involved in people's care to ensure they received a high level of care and support. Secure online feedback was shared regularly including videos which enabled health partners to see how people were progressing and if treatment/exercises were effective. Staff supported people and their families in a very person-centred way, tailored to individual complex needs and preferences to ensure they lived their best lives following life changing events.

There were many examples of how excellent care and support had resulted in improvements for peoples’ quality of life. Staff meticulously followed specialist health professional programmes to great effect.

There were very robust and high-quality governance systems in place to assess and monitor the service provided, with regular detailed reports also sent to the fee payers, (commissioners and lawyers). People's views were extremely valued and used to drive improvement. As a growing service, the two directors had worked hard to ensure the service remained one with a personal touch. They knew people well and supported staff in navigating complex family dynamics and emotions to promote the best outcomes for people. There was a complaints procedure in place. Care assessment and planning records were extremely detailed to enable close monitoring of peoples’ care, progress and future planning individual to them.

Risks in people's daily lives were assessed and mitigated with a focus on positive risk taking. Staff were provided with safeguarding training, adults and children, and understood how to keep people safe. Recruitment of staff was bespoke to each persons’ care management package and completed safely with peoples’ involvement. There were sufficient staff numbers and flexibility to provide the care and support required by people to meet their needs. People were supported to take their medicines safely, where this was required. Infection control procedures were in place.

People were matched with bespoke staff teams suitable to meet each individuals’ needs before the service started. Staff were very caring and compassionate and knew people extremely well, often building up close, long-term relationships sharing common ground. People's rights to dignity, independence and privacy were promoted and respected. People's choices were always sought, valued and used to plan their care as well as staff offering up ideas and creative ways to enhance life quality and opportunities.

The values and culture of the service focussed on striving to achieve the best quality of life for people. This included being pro-active and using innovation, research and accessing specialist health professionals for people’s benefit.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 12 July 2019 and this is the first inspection.

Why we inspected

This was a routine, planned inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.