The inspection took place on 14 November 2018. We told the provider two working days before our visit that we would be coming because the location provides a domiciliary care service for people in their own homes and staff might be out visiting people.

The last inspection was on 6 March 2018 when we rated the service requires improvement for the key questions of, 'is the service safe?', 'is the service effective?' and 'is the service well-led?' The overall rating of the service was requires improvement. We asked the provider to complete an action plan to show what they would do to improve the service. At the inspection of 14 November 2018, we found the required improvements had been made and we have rated the service good for all key questions and overall.

Cardea Healthcare Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people needing care and support at the end of their lives and to younger adults who have learning disabilities. Some care is provided by 'live-in' care workers, who stayed at people's homes during the day and night. At the time of our inspection 12 people were using a service, six people were supported by 'live in' care workers. All of the people using the service were adults with a learning disability and their care was commissioned by Bracknell Forest Borough Council. The service also provides staff to work in care homes, this part of the service is not regulated by CQC.

The service was the only branch of the organisation, which was a private company. The owner of the company was also the 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 and associated Regulations about how the service is run.

People were happy with the service they received. They said their needs were being met and they liked the care workers who supported them. They were involved in planning their own care and felt able to raise any concerns or discuss changes to the service which they wanted. People's medicines were managed in a safe way. They were supported to access healthcare services and they had the food and drink they needed and chose.

At the time of the inspection, the provider did not access any training or information for the staff about how to provide an inclusive service which promoted the rights of people who identified as LGBT+ (Lesbian, Gay, Bisexual and Transgender). However, following the inspection visit they told us they were looking at ways to support the staff to gain a better understanding of how they could be inclusive.

The provider produced information in an easy to read format for people who had learning disabilities and may find this type of information easier to understand.

The staff were well supported, trained and had the information they needed to care for people. They were happy working for the organisation and enjoyed the work they did. There were appropriate systems for ensuring staff were suitable when they were recruited, and they undertook a range of relevant training to make sure they had the skills and knowledge to care for people. There were enough staff to meet people's needs. 'Live in' care workers had sufficient breaks and familiar replacement staff were allocated to care for people when the regular care workers had time off. Care workers arrived on time for visits and people said they stayed the agreed length of time.

There were processes for safeguarding adults and reporting abuse. The staff and people using the service were aware of these and felt confident raising concerns with the provider. The provider had systems for monitoring the quality of the service and making improvements. They consulted with people using the service and other stak

We undertook an announced inspection of Cardea Healthcare Ltd on 6 March 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available.

This was the first inspection of the service since it registered with the CQC on 20 May 2017.

Cardea Healthcare Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It also provides live in care workers to support people during the day and at night. At the time of the inspection it provided a service to six people who required a 24 hour package of care and home care visits for two people. These care packages were funded by the local authority and clinical commissioning group.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager was also a director of the company. 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.

Risk management plans for some of the risks identified during the needs assessment were not in place for people. Therefore, care workers were not provided with written guidance on how to reduce these risks.

The provider had a process in place for the administration and recording of medicines. However, there were no protocols for the administration of medicated creams or PRN (as required) medicines.

There was a process in place for recording and investigating incidents and accidents but actions were not always recorded where these had been identified to prevent reoccurrence.

There were a range of checks carried out in relation to the service but some of these were not effective because these had not identified the areas for improvement we found during our inspection.

The provider had a process in place in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act to ensure people could consent to their care or that decisions were made in their best interests. We made a recommendation to the provider regarding this issue.

The provider had an effective recruitment process in place and the number of care workers required to provide appropriate care for a person was based on the assessment of the person’s needs.

People using the service and relatives felt the service was safe and the provider had a procedure for the reporting and investigation of safeguarding concerns which they followed.

An assessment of a person’s care and support needs was carried out before they started to receive support from the service.

Care workers received the necessary training and support to deliver care safely and to an appropriate standard.

The care plans identified each person’s wishes as to how they wanted their care provided. People were supported to enjoy a range of activities in their home and in the community.

There was a complaints procedure and people were aware how to raise concerns.

People using the service, relatives of people being supported and care workers felt the service was well-led and effective. Care workers felt supported by the registered manager.

We found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to the safe care and treatment of people using the service (Regulation 12) and good governance (Regulation 17). You can see what action we told the provider to take at the back of the full version of this report.