This inspection took place on 11 and 13 July 2018 and was announced. We gave the registered manager 48 hours' notice because the location provides a service across four different sites and we needed to make sure the relevant staff and information would be available in the office.

At the last inspection in June 2017 we found the service was not meeting all fundamental standards as required. The provider had not established an effective system that ensured their compliance with the fundamental standards. Following that inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions safe and well-led to at least good. At this inspection we found the provider had taken the action they said they would and had improved the service to an overall rating of good, with a rating of good in all key questions.

Optalis Extra Care Berkshire provides personal care to people living in self-contained flats at four separate specialist ‘extra care’ housing sites. The four sites have a total of 176 flats. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for extra care housing; this inspection only looked at people’s personal care service. Not everyone living at the four extra care facility sites receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of our inspection the service was providing personal care to 58 people across the four sites.

The service has a registered manager as required. A registered manager is a person who has registered with CQC 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 and assisted us on both days of the inspection.

People were protected from the risks of abuse. Risks were identified and managed effectively to protect people from avoidable harm. Recruitment processes were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

People were treated with care and kindness. They were consulted about their support and could change how things were done if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by people and the relatives who gave us their views. People were encouraged and supported to maintain and increase their independence.

People received care and support that was personalised to meet their individual needs. They received effective care and support from staff who knew them well and were well trained. They told us staff had the training and skills they needed when providing their care and support. Medicines were stored and handled correctly and safely.

People knew how to complain and knew the process to follow if they had concerns. People's rights to make their own decisions were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Where people were potentially being deprived of their liberty, the service knew to make the relevant commissioning authorities aware. This was so that commissioners could make applications to the Court of Protection for the appropriate authorisations.

People's right to confidentiality was protected and their diversity needs were identified and incorporated into their care plans where applicable.

People benefitt

This inspection took place on 12 and 13 June 2017 and was announced. We gave the registered manager 48 hours' notice because the location provides a domiciliary care service and we needed to make sure someone would be in the office. This was the first inspection carried out at this location since the provider registered this service as a new location on 23 June 2016.

Care At Home - Berkshire is a domiciliary care service providing personal care to people in their own homes. At the time of our inspection 49 of the 80 people receiving a service were living in their own flats in extra care housing. Thirty one people were living in their own homes in the community.

By extra care housing, we mean purpose-built (or purpose adapted) single household accommodation that is owned or occupied under an occupancy agreement. The accommodation is in a building or campus of similar households specifically designed to facilitate the delivery of care to people, either now or when they need it in the future. There are three extra care facilities where the service provides personal care to those who need it. The provider also staffs each of the three extra care facilities with a 24 hour care worker presence in case people require additional help outside their scheduled call times. This 24 hour staffing arrangement is between the provider and the local authority and is outside our regulatory remit. The accommodation and any other additional services provided at the facilities are also outside the remit of the Care Quality Commission. Only the provision of personal care is registered and inspected.

Up until 22 June 2016 the three extra care facilities were registered as separate locations. On 23 June 2016 the management of the provision of personal care at all three extra care facilities moved to the provider's head office and became one service. The provider also had a separate service providing personal care in people's own homes in the community, called Care In The Home. The management and provision of personal care to the people using that service was transferred to Care At Home – Berkshire on 20 February 2017. Care In The Home was inspected in November 2016 and achieved a rating of Good before merging into Care At Home – Berkshire. This part of the service was not inspected at this inspection as it was only six months since they were inspected as a separate service. The report from that inspection is available on our website.

The service had a registered manager as required. A registered manager is a person who has registered with the CQC 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 and assisted us during this inspection.

People were treated with care and kindness. They were consulted about their support and could change how things were done if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by people we spoke with and relatives who provided feedback.

People were protected from the risks of abuse. Some staff recruitment issues were identified by us during the inspection, but were dealt with by the registered manager immediately following the inspection. People and their relatives confirmed people were encouraged and supported to maintain and increase their independence.

People received effective care and support from staff who knew them well and were mostly well trained. We have made a recommendation about ongoing staff training.

People received effective health care and support. Medicines had not always been handled correctly and safely with a number of medicine errors over the past 12 months. The provider was aware of the issues and agreed to take further action to improve the safety of the handling of medicines. We have made a recommendation ab