We carried out this announced inspection on 27 and 28 November 2018. At our last inspection, in June 2016, 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.

Greenbank Care provides care and support to adults of all ages, in their own homes. The service provides help with people's personal care needs in and around the Liskeard area of Cornwall. This includes people with physical disabilities and dementia care needs. The service mainly provides personal care for people in short visits at key times of the day to help them get up in the morning, go to bed at night and support with meals. Longer visits to provide respite care for families and companionship and emotional support for people are also provided. At the time of our inspection the service was providing personal care for 32 people. These services were mostly purchased direct by people, either through their own funds or through the direct payments scheme.

Without exception everyone we spoke with were extremely satisfied with the quality of the service they received and consistently praised staff for their caring attitude. People told us they felt safe using the service and they trusted the staff who supported them. People told us they received a reliable service and had regular staff who visited them. They had agreed the times of their visits and were always kept informed of any changes. Comments included, "If I have any worries I know I can just pick up the phone and talk to someone", “I am very happy with the service”, "I am more than happy with the care, it’s just fantastic", “I'd ring the office if I had a complaint" and “The office tell me that if I am worried about anything just ring and they will sort it out.”

The registered manager and staff were able to tell us about how they went 'the extra mile' for people and the difference this had made for them. Staff were highly motivated and had gone out of their way to support people and find ways to help them in manner that was individual to the person. Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. People said they were treated respectfully and staff asked how they wanted their care and support to be provided.

Staff had achieved exceptional outcomes for people, especially for people who had dementia or mental health needs. The service offered befriending visits to provide companionship and emotional support. These visits had enabled staff to find out about the person’s life and what was important to them. This had helped develop more personalised and holistic care plans and enabled staff to understand how to provide care for people who may become anxious or have memory difficulties.

Care plans provided staff with direction and guidance about how to meet people’s individual needs and wishes. These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. People were aware of their care plans and had a copy in their homes. People who needed help taking their medicines were appropriately supported by staff.

Risk assessments clearly identified any risks and gave staff guidance on how to minimise the risk. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Staff were aware of the repo

This inspection took place on 21 and 23 June 2016 and was announced.

Greenbank Care is a domiciliary Care Agency which provides care and support to people with learning disabilities, autism, old age and dementia. At the time of the inspection, the service was providing care to 42 people.

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.

People and their relatives told us staff were caring. One person said; “Now I have experienced Greenbank I would be very upset if they left me”. Staff demonstrated kindness and compassion for people through their conversations and interactions. People’s privacy and dignity was promoted. People were actively involved in making decisions about how they wanted to live their life. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the care planning process and to attend care reviews. This helped to ensure the care being provided met people’s individual needs and preferences. Care plans were used to help people focus on their future goals as well as recognising their strengths.

Risks associated with people’s care were effectively managed to ensure their freedom was promoted. People were supported by adequate staffing to help meet their needs. The provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were managed safely.

People received care from staff who had undertaken training to be able to meet their needs. People were supported where required, to make decisions because the registered manager and staff were working within the principles of the Mental Capacity Act 2005 (MCA). People’s nutritional needs were met because staff followed people’s care plans to make sure people were eating and drinking enough. People were supported to access health care professionals to maintain their health and wellbeing.

The service was well led by a registered manager who demonstrated the provider’s values. There were quality assurance systems in place to help assess the ongoing quality of the service and to help identify any areas which required improvement. The provider and registered manager promoted the ethos of honesty, learned from mistakes and admitted when things had gone wrong.

At the time of our inspection at the agency office, the service was providing support to 52 people in their own homes. The deputy manager reported that people were supported with personal care and the service also provided domestic assistance. During the inspection we looked at the records available to us and discussed how people's needs were met. We spoke with the deputy manager and five other members of staff. Following our inspection visit, we contacted people that used the service. We spoke with six people and asked them about their experiences of receiving a service from Greenbank.

Peoples’ comments were positive, and included “we are very happy”, “very friendly staff”, and “nice bunch of people” and “nothing is too much trouble”, “I wish all other services were as good as Greenbank”. None of the people we spoke with reported any missed visits from Greenbank.

We found peoples’ privacy and dignity was respected, and people experienced care and support that met their needs.

People were protected from the risks of unsafe equipment, as the provider had a process in place to ensure that equipment used by staff in peoples’ homes was safe.

People who received a service from Greenbank were protected because there were appropriate checks undertaken before staff began working.

We found people had access to the complaints procedure.

We inspected Greenbank Care as part of our planned schedule of inspections. The inspection was unannounced; this meant that the manager, staff and people that used the service did not know we were going to visit.

At the time of our inspection at the agency office the service was providing support to 29 people in their own homes. The registered manager reported that people were supported with personal care and the service also provided domestic assistance. During the inspection we looked at the records available to us and discussed how people's needs were met. We spoke with the registered manager, the deputy manager and a member of staff. Following our inspection visit, we contacted people that used the service, spoke with one of them and two staff.

One person we spoke with told us: "I couldn't have better people. They are wonderful. I am more than satisfied with the staff who come to see me".

During the inspection we saw that people who used the service were provided with information about the agency, the terms and conditions and what they could expect. People had care plans and risk assessments in their own homes. A person we spoke with confirmed that they had spoken to staff about them. This meant that people were involved and included in important decisions about their care.

The service had a complaints procedure in place and people we spoke with knew how to make a complaint if they needed to.

Staff we spoke with said they received appropriate training.

During our visit to Greenbank Care office we heard the staff interacting with the people who used the service in a positive way. One person we spoke to told us that the staff treated people in a friendly, yet professional and respectful way. We were also told that the service was flexible in order to meet people’s changing needs, such as changing the times of their visits to allow for people to go to hospital appointments or social gatherings.

People told us they were happy with the care and support they received from Greenbank Care.

People said that the staff were “all lovely” and that they “were very helpful” adding that they did not “know what they would do without them”.

We saw that people who used the service, their relatives or representatives and staff were happy to approach the agency in person or by phone. People told us that they felt safe when receiving a service and that they could discuss anything with any of the staff.

People who used the service told us that new staff always shadowed a more experienced staff member for a period of time until they felt confident to visit on their own.