We undertook an announced inspection of Brownbill Associates Limited on 26 March 2018.

Brownbill Associates provides a brokerage service for people with an acquired disability to enable people to employ their own carers. The agency acts as an intermediary between the person needing the service and specialist agencies who supply people to provide the care (care workers). Brownbill Associates supply case managers that provide training and support to carers directly employed by people receiving support. At the time of the inspection 88 people were using the service.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Further information is in the detailed findings below.

Why the service is rated Good:

People remained safe. Risk assessments were carried out and promoted positive risk taking which enabled people to live their lives as they chose. People received their medicines safely. The service had robust recruitment procedures which ensured there were sufficient, skilled and qualified staff to meet people’s needs.

People continued to receive effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

The service continued to provide support in a caring way. Staff supported people with kindness and compassion. Staff respected people as individuals and treated them with dignity. People were involved in decisions about their care needs and the support they required to meet those needs.

People had access to information about their care and staff supported people in their preferred method of communication. Staff also provided people with emotional support.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly and their views were sought and acted upon.

The service was well led by a manager who promoted a service that put people at the forefront of all the service did. There was a positive culture that valued people, relatives and staff and promoted a caring ethos. The manager was in a process of registering with the Care Quality Commission.

The manager monitored the quality of the service and strived for continuous improvement. There was a very clear vision to deliver high quality care and support and promote a positive culture that was person-centred, open and inclusive. This achieved positive outcomes for people and contributed to their quality of life.

We undertook an announced inspection of Brownbill Associates Ltd on 29 October 2015. We told the provider two days before our visit that we would be coming. Brownbill Associates provides a brokerage service for people with an acquired disability to enable people to employ their own carers. The agency acts as an intermediary between the person needing the service and specialist agencies who supply people to provide the care (care workers). Brownbill Associates supply case managers who provide training and support to the care workers who are employed by people receiving the care. At the time of our inspection 50 people were receiving a personal care service.

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.

Where risks to people had been identified, risk assessments were in place and action had been taken to reduce the risks. Staff were aware of, and followed guidance. People received their medicine as prescribed.

People told us they benefitted from caring relationships with the staff. There were sufficient staff to meet people’s needs and people received their care when they expected. The service had robust recruitment procedures.

People received personalised care. Care packages were tailored to people’s individual needs and were provided by dedicated teams selected by people and their relatives. Many care teams contained healthcare professionals with specific skills to meet people’s specific needs.

Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

Staff had a good understanding of the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected.

People told us they were confident they would be listened to and action would be taken. The service dealt with complaints appropriately, sought people’s views and acted upon them. The service had systems to assess the quality of the service provided. Learning was identified and action taken to make improvements which improved people’s safety and quality of life.

Staff spoke positively about the support they received from the registered manager. Staff received support through supervision and training. Staff told us the registered manager was approachable and there was a good level of communication within the service.

People told us the service was friendly, responsive and well managed. The service sought people’s views and opinions and acted upon them.

The registered manager had systems in place to monitor the quality of the service. Information from audits and quality monitoring was used to improve the service.

We carried out this visit because when we last visited in March we found some people's care plans had not been updated and management policies, some relating to care processes, had not been reviewed.

The provider had told us that they had taken action to address the issues identified. This visit was to see whether the action had been carried out. We also looked at how people were cared for and the means by which the provider monitored their service.

We met with the company director and the care manager. We also spoke with a person who used the service and with five relatives.

People we spoke with were very pleased with the care management and planning support they received. A person told us "We are thrilled with the support". We looked at care plans. We saw that they were current, detailed each persons' needs and they included actions care staff needed to take to meet the needs identified.

The provider had systems in place to monitor quality and obtain feedback from people who used the service.

We found significant progress had been made in bringing care plans up to date and in reviewing and updating policies and procedures.

People told us they were happy with the service they received and staff felt well supported.

People told us that they had been involved in planning their care. Where this was not possible best interest decisions had been taken in accordance with legal requirements.

Individual packages of care were in place for all people. One person told us they were, "very happy with the package" and "they respect everything we ask for". People appointed their own care support staff to carry out the tasks in their care plans.

One person commented that they felt "very safe with the carers". All support workers had been trained in safeguarding and received updating on a three yearly cycle. The provider’s safeguarding policy was clear and comprehensive.

Staff were well supported. One member of staff said supervision and support was, "as top is it could be". Staff training was professionally provided.

The service listened to the people who used it. A relative told us, "they call out once a year to review the care and ask if we are happy". An annual care satisfaction survey was conducted.

Records kept were comprehensive and wide ranging. However, there was insufficient evidence that records and policies were updated. A number of records and policies did not have a date of when they were last reviewed or updated.

People we spoke with were very positive about the quality of the care they received. People told us that they knew who to contact within the agency and that the staff were well trained and knowledgeable about their care needs. People told us that the agency provided them with information about prospective care workers for them to make a decision as to who they wanted to provide the care for them. People then became the care workers’ employer. People we spoke with told us that their care was regularly reviewed and that if there were problems the proprietor or case managers would look into it personally. People told us that they would be listened to and that action would be taken if they had a complaint.