Cloud Homecare Limited

People’s experience of using this service:

People told us they were happy with the service they received. They said staff treated them with respect and promoted their privacy, dignity and independence.

Medicines were not always safely managed. Records showed the recommended timescale between dosages had not always been adhered to for one person.

Staff had documented they had administered people’s prescribed medicines but had not consistently signed the medicine administration record.

We made a recommendation for the registered managers to undertake further monitoring, to ensure the safe management of people’s medicines.

People were encouraged to make decisions and be in control of their support. People were fully assessed before being offered a service and were involved in developing and reviewing their support plan.

People were always supported by staff who knew them well. Established relationships had been built and staff knew exactly how people liked their care to be delivered.

A registered manager told us staff often went the “extra mile” with people. This included, “popping in” to see people, to ensure their safety and wellbeing.

People had support with meal preparation and to keep their home, clean and tidy if required. One person experienced “silver service” from staff, as they were unable to go out to a restaurant.

People and their relatives were very complimentary about the staff. There were comments such as, “They care about how you’re feeling” and, “They do everything I ask, perfectly, I cannot fault any of them”.

Person-centred human rights were at the centre of all interactions with people. There was a strong focus of ensuring people received good quality care.

People felt safe and relatives had no concerns about their family member’s safety. Staff had time with people and were not rushed. There was a clear focus on “the person” rather than just the tasks to be completed.

There were enough staff to support people, which enabled a reliable service. Staff were given enough time to travel to everyone, so were rarely late arriving at a person’s property.

People were encouraged to give their views about the service they received. This was through surveys, one-to-one discussions and within reviews of their support.

People and their relatives knew how to make a complaint. They were confident any concern would be properly investigated and resolved.

There was a positive approach to risk taking. People were encouraged to take assessed risks, with measures in place to enhance safety if required.

There was a strong focus on learning and developing staff’s knowledge, performance, potential and progression. A registered manager told us, “I get great joy in getting staff to achieve things they think they can’t.”

The service had two registered managers. Both worked closely together and had clear roles and responsibilities, based on skills, knowledge, preferences and experience.

Staff told us they were well supported and enjoyed their role. They were very complimentary about the registered managers and the overall management of the service.

There were a range of audits, which assessed the quality and safety of the service. However, we made a recommendation to give particular attention to the procedures for checking the medicines systems.

There was a clear desire to ensure people received quality support and for the agency to grow steadily, in a safe, targeted manner.

Rating at last inspection: At the last inspection on 13 July 2016 and 09 August 2016, the service was rated as Good. The report of this inspection was published on 5 November 2016.

Why we inspected: This was a planned, comprehensive inspection, based on the rating at the last inspection.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme.

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

Cloud Homecare is a small domiciliary care agency, which provides care and support to people in their own homes on a short and long term basis. The agency currently supports people in Warminster and the surrounding villages.

The agency 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. The registered manager was present throughout the inspection.

People and their relatives were very happy with the service they received. They were fully involved in the development of their support plan and able to confidently tell staff what help they required at each visit. All support plans were comprehensive and well written in a respectful manner. People’s visits were undertaken at a time which was convenient to them. They were always supported by the same staff who knew them well. This ensured good continuity and close relationships to be developed. Staff encouraged decision making and promoted people’s rights to privacy and dignity. People told us the reliability of the service made them feel safe. They were very complimentary when talking about their views of the staff and registered manager.

Staff felt well supported and received a range of training to help them do their job effectively. The training involved courses which were deemed mandatory but also those more specific to people’s needs. Staff were aware of their responsibilities to report a suspicion or allegation of abuse and to keep people safe. They safely supported people with their medicines and helped with meal preparation in line with people’s wishes.

The agency was well managed with clear leadership from the director and registered manager. There was a strong value base and a commitment to provide people with high quality, person centred care. Good communication had been established with the staff team, which meant this approach was adopted across the service. There were organised systems to ensure the smooth running of the business. The quality of the agency was monitored through a range of audits and opportunities for people to give their views. Organised recruitment procedures were in place and there were sufficient staff to meet people’s needs effectively.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found '

Is the service safe?

People told us that they felt safe when staff supported them in their home. They told us that staff treated them with dignity and respect. One person told us "first class service. I can't find any complaints whatsoever' and 'I would go straight to the manager if something was wrong'.

People's safety was promoted because the service obtained advice and support from other health and social care services that people required in order to meet their needs effectively.

There were safe recruitment procedures in place. Staff were subject to checks being made before they were employed so that people were protected from being cared for by unsuitable staff. The manager undertook spot checks to evaluate care workers performance and to see that people were satisfied with the care provided.

Staff had attended safeguarding training and knew how to recognise and report abuse. They demonstrated good awareness of safeguarding issues and their responsibilities in reporting concerns. They confirmed that they would feel comfortable raising and reporting any concerns with the manager.

CQC monitors the operation of the Depravation of Liberty Safeguards (DoLS) which applies to care settings. While no applications have been submitted, appropriate policies and procedures were in place. Relevant staff had received training in the Mental Capacity Act and the application of DoLS.

Is the service effective?

People's needs were assessed and they told us that they were involved in planning their care. One person told us 'they (the care workers) make you feel you are of great importance'. We saw from the care records kept in their home that they were involved in making decisions about their care and that these were respected by staff.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. This ensured their needs were clearly identified and the support they received was meaningful and person centred.

Is the service caring?

We spoke with one person who told us 'nothing is too much trouble. They (the care workers) are very caring'. They confirmed they had not had any missed calls and that care workers always arrived on time. All the comments we received were of a positive nature and confirmed that the person and their relatives were happy with the support received.

Care workers had sufficient information about people's needs and how they should be cared for. This included their preferences and the things that were important to them. The care records we looked at when we were at the agency office demonstrated that people were consulted about their care needs and that the service offered had been tailored to the individual.

Is the service responsive?

People's care had been reviewed regularly. Other agencies were consulted with when there were changes to people's care. All those involved in the person's care were aware of changes so they could respond appropriately and consistently. Staff confirmed they reported any concerns to the manager on the same day and that appropriate action was taken to ensure people's care and welfare needs were met.

There had been no complaints received by the agency. There were procedures to show that if complaints were made these would be investigated within an appropriate timespan with a record kept of the outcome.

Is the service well-led?

People were asked for their views about the service to help ensure their views contributed towards improvements and further development of the service.

The service had quality assurance systems in place so that shortfalls could be identified.

Although the agency was small there was a clear staffing structure in place. Staff we spoke with were clear on their roles and responsibilities and there were defined reporting lines so all staff knew who to report to.