This service is a domiciliary care agency. It provides personal care to people living in their own home. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. When we inspected there were 23 people receiving personal care. This inspection took place between 24 October and 29 October 2018.

At the last inspection in June 2016 the service was rated Good. At this inspection we found the service had made significant improvements and we rated them as Outstanding in tone domain, namely Caring.

The service had a registered manager. 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 provider and the registered manager displayed their passion and commitment to the service, the people who used the service and their relatives.

People and relatives we spoke with praised the staff for the kind, compassionate and caring attention they provided. The service had built warm and open relationships with relatives which had had engendered their trust, and meant whenever possible each person had a team of carers built around them including the service and their family. Relatives valued highly the levels of communication between them and the staff. They felt better informed and able to respond to any emerging concerns.

Staff had spent time getting to know people well and were able to anticipate if people needed additional support. They were alert to possible changes which may have suggested a person was becoming unwell.

The service had a ‘can-do’ culture. This included problem solving when a person needed additional support. Everyone in the service was proud of how they had with the assistance of a relative responded to extreme winter conditions and got to everyone who needed a service.

There were many examples of staff being exceptionally caring from supporting special family occasions to involving the police when people were at immediate risk.

People who used the service were kept safe by a provider who had systems in place to ensure people received person-centred care based on their assessed needs and risks. Assessments which were carried out were used to develop care plans. Care plans documented the outcomes people wanted and how these were to be achieved. These were reviewed and changes made if a person’s needs changed.

The provider and the manager understood how to meet the regulatory requirements. They had continued to develop the service and look for opportunities which made a difference to people’s lives. Lessons had been learnt by the service and these were described in a CQC publication called, “Driving Improvement” published in June 2018.

The service liaised with commissioning authorities to meet people’s needs and enhance the quality of the lives of people who used the service. People were supported towards the end of their lives and their wishes were respected.

Staff felt they had support from the office staff and the management team. They described to us having confidence to contact the office or the managers directly to discuss safeguarding and other concerns. During our inspection we observed staff carrying out tasks to support people in the community.

The numbers of staff employed in the service was monitored by the registered manager and recruitment processes were carried out when necessary. Pre-employment checks were carried out before staff could start working in the service. Staff underwent an induction and they confirmed to us they received annual training updates. They were also supported through the use of supervision meetings with the registered manager and annual appraisal

This inspection was carried out on 9 and 13 June 2016. Our inspection visit to the office on 9 June was unannounced. We spoke to people by telephone following the visit.

Eboney Home Care provides care to people in their own homes. For some people this may include visits every day to support them, for other people staff may provide support once per week or when their relatives go on their annual holidays. We found Eboney Home Care provided a range of services to meet people’s needs. At the time of inspection the service was delivering personal cae to 17 people.

We carried out our last inspection on 13, 17, 19 and 23 November 2015 and 18 and 21 December 2015. Following the inspection we asked the provider to take action to make improvements to the recruitment, training and supervision of staff, to people’s care planning including the administration of people’s medicines and improve their management oversight of the delivery of care. The registered provider and the registered manager worked with us to demonstrate they were making improvements to the service. During this inspection we found there had been significant improvements in the service.

The service had in place a registered manager. 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.

Staff told us they felt confident to report any concerns they had about people or any safeguarding worries to their manager. They described their managers as approachable.

The registered provider had in place an environmental risk assessment in place which was carried out before staff began working in people’s homes. The assessment looked at areas of the home to enable staff and people using the service to be safe.

The service had in place contacts for people and sought their permission to give them first aid should the need arise. This meant the service was well placed to respond to emergencies.

Since our last inspection the service had put in a programme of staff training. All staff training had been revised. We saw where people had specific conditions staff had been trained to deal with each person’s specific needs. Additional training had been sought by the provider to care for one person when their main relative carer was away.

Recruitment procedures for staff had become more robust. We saw the registered provider signed off a staff member as being ready to deliver care when all their recruitment checks and office induction/ training had been carried out.

Staff had regular supervision and appraisals in place. The registered manager carried out monthly unannounced spot checks on staff to ensure they were appropriately carrying out their duties.

People and their relatives who used the service had responded to a survey sent out by the service. We found people had complimented the service and had ticked the boxes to demonstrate they thought the service was either good or very good.

We found people’s care planning had improved since the last inspection. People and their relatives told us staff had carried out assessments with them and had asked lots of questions about their care needs. We saw care plans had been brought up to date and were revised for example when a person came out of hospital.

Staff were described to us as very caring and friendly. People spoke to us warmly about their staff and told us staff acted in a respectful manner towards them. Relatives expressed trust in the staff and told us if staff were waiting for a person to finish their meal or have a bath they would carry out extra tasks for people.

The registered provider had in place a “Charter of Rights” which included people’s right to confidentiality. Staff signed to state they had read and understood the provider’s policy on co

This inspection took place 13, 17, 19 and 23 November 2015 and was announced.We gave the registered provider 24 hours’ notice of intended visit to ensure someone would be available in the office.  After considering the risks we found at Eboney Home Care Ltd we revisited the service on 18 December 2015 to carry out further checks and visited people in their home on 21 December 2015. This latter visit was unannounced.

The last inspection took place in January 2014 when the service was found to be compliant with our regulations.

At the time of our inspection there were 23 people receiving personal care from the service.

The home had a registered manager in place. 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.

Staff told us recruitment checks including references and Disclosure and Barring Services checks had been carried out, however, some staff told us they had visited the office one day and then asked to start the next day by shadowing other staff. This meant robust checks were not carried out before staff had direct access to people in their own homes.

We found staff were giving people their medicines from a dossette box without knowing what they were giving people and staff were also giving people medicines known as PRN (as and when required) without recording what had been given to the person.

The registered provider carried out an environmental risk assessment to see if there were any risks in people’s homes to staff or to people themselves.

Staff induction included a period of shadowing without the member of staff undertaking any specific training.

We found not everyone had given their consent to have their care provided by Eboney Home Care. The registered provider and the registered manager agreed to address this issue.

The registered provider in following their baseline assessment document asked people about eating and drinking including their favourite food and special diets. However these were not translated into care plans for staff to deliver appropriate care in people’s homes.

People told us the staff respected their homes and did what was asked of them to ensure their homes were kept the way they wanted.

We found staff had not been supported and given guidance about providing consistent care to people.

The provider did not have in place care plans which met people’s needs. In the absence of robust care planning we found that relatives and carers employed by families in other ways had written detailed task lists for Eboney Home Care staff.

Staff we spoke with said they would give people a choice and gave some examples. For example one staff member described giving people a choice of meals. Another member of staff stated people chose what they wanted to wear.

We looked at the records held by the provider and found they were not fit for purpose.

We found when people’s daily records were returned to the office they were not routinely audited. This meant the registered manager and the registered provider were not aware of some of the incidents which occurred in people’s homes.

We found the registered provider in the delivery of their service had not always taken into account the guidance provided to question and support their practices.

The provider had carried out a survey to measure the quality of the service. People’s responses were largely positive.