Cardea Healthcare - Uxbridge

About the service

Cardea Healthcare – Uxbridge is a care agency providing personal care and support to people living in Berkshire. They provide a service to children as well as older and younger adults with learning disabilities, physical disabilities, mental health needs and dementia. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection, 43 people were receiving personal care and support.

People’s experience of using this service and what we found

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support: The service supported people to have the maximum possible choice and to make decisions about their lives. People were supported to learn new skills and be independent. Staff focussed on people’s strengths and helped people to have fulfilling and active lives. People were supported to pursue a range of different social activities when this was part of their care. Staff did not restrain people and worked with other professionals to help plan effective care which reduced the likelihood of harm and incidents. Staff understood people’s individual communication needs and provided them with the support they needed to make choices. People received support to take their medicines safely and as prescribed. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care: People were treated well. Their individual and diverse needs were met. Staff understood how to provide care which met these needs. Staff treated people with kindness and respect. People’s privacy and dignity were maintained. Staff understood how to protect people from poor care and abuse. There were enough suitably skilled staff to meet people’s needs and to care for them safely. People who had individual ways of communicating could interact comfortably with staff and others involved in their care because staff had the necessary skills to understand them. People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life.

Right culture: There was an inclusive and positive culture where people received personalised care. People were asked for their opinions, and these were listened to and acted on. People received good quality care and support. There was low staff turnover which supported people to receive consistent care from staff who knew them well. People and those important to them, including advocates, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families, and other professionals as appropriate.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 18 December 2018).

Why we inspected

We had not inspected this service for over 5 years, and we needed to check that they were still providing good quality and safe care.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 stakeholders to ask for feedback about their experiences. The provider made regular checks on staff to ensure they were providing the right care and support and that people using the service were satisfied.

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.