The inspection took place on 15 May 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.

At the last inspection of 8 August 2017 we rated the service Requires Improvement overall and in the key questions of Safe, Responsive and Well-led.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Responsive and Well-led to at least ‘Good’.

At this inspection of 15 May 2018 we found that improvements had been made and have rated the service Good in all key questions and overall.

Avant (Ealing) is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community living within the London Borough of Ealing. It provides a service to older adults and younger adults with physical disabilities, learning disabilities and mental health needs. The number of people using the service varied but at the time of our inspection there were 127 people using the service. A small number of these people were supported with domestic visits only (staff cleaning their houses). CQC does not regulate this part of the service. The majority of people received support with personal care, which included the administration of medicines.

Avant (Ealing) is one of three branches for the provider Avant Healthcare Services Limited. The branch was located in the same offices as the other two branches (which provided services to people living in other London boroughs). All three branches were overseen by an operations manager. Additionally, there was a branch manager employed for each branch. The operations manager was registered as the manager with CQC. 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 using the service were happy with the care they received. They felt their needs were being met in a personalised way. They told us that the care workers who supported them were kind, caring, compassionate and knowledgeable about their role. People had the same regular care workers who they were familiar with and had built positive relationships with. Care workers arrived on time and completed all the required task.

People using the service and their relatives had been involved in planning and reviewing their care. They had been invited to take part in the assessment of their needs and were regularly asked for their feedback on the service, so that changes could be made when they wanted these. People received support to access healthcare services and the provider liaised with other healthcare professionals to make sure people were getting the care they needed. People who were supported at mealtimes, and those who were supported by care workers undertaking shopping, were happy with this support.

People had consented to their care and treatment. For people who lacked the mental capacity to make decisions the provider had liaised with the person's representatives to make sure decisions about their care and support were made in their best interests.

The procedures for recruiting staff were suitable and were designed to make sure the staff had the skills, attitude, qualifications and experiences which reflected the provider's values. There was an appropriate level of training and support for all staff so that they had the information they needed to care for people safely and appropriately. The staff felt supported. They were able to speak with the registered manager and other managers whenever they needed. They felt listened to and told us they had the guidance they needed.

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We undertook an announced inspection of Avant (Ealing) on 1, 2, 3, 4 and 8 August 2017. We told the provider two 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 and we wanted to be sure someone would be available to assist with the inspection.

Avant (Ealing) provides a range of services to adults in their own home including personal care in the London Borough of Ealing. At the time of our inspection approximately 150 people were receiving personal care in their home. The care had either been funded by their local authority or people were paying for their own care.

At the time of the inspection a registered manager was 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.

Risk assessments were not developed to ensure specific risks related to each person were identified and guidance was not provided as to how to reduce identified risks.

Care workers used a telephone based system to record their arrival and departure times to monitor the visits but some care workers did not have travel times included in their rota for some visits and therefore did not always arrive or leave on time.

Care plans described the tasks required during each visit but did not identify how the person wished their care to be provided.

The provider had a range of audits in place but some of them did not provide appropriate information to enable them to identify any issues with the service and take action to make improvement.

Records relating to care and people using the service did not provide an accurate and complete picture of their support needs.

The provider had a process in place for the administration of medicines but at the time of the inspection this was not in line with guidance from the National Institute for Health and Care Excellence.

There was a process in place for the recording and investigation of incidents and accidents.

The provider had an effective recruitment process in place. Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for the person using the service as well as regular supervision with their line manager and annual appraisal.

The provider had procedures in place in relation to the Mental Capacity Act 2005. The process in place to assess a person’s capacity to make decisions relating to their care was being reviewed by the provider.

Care plans identified if the person required support from the care worker to prepare and/or eat their meal.

The provider would contact the relevant healthcare professional and the person’s relatives if they identified a change in their health.

People felt the care workers were kind and caring as well as respecting their privacy and dignity when they provided support.

The care plan identified the person’s religious and cultural needs as well as their preference in the gender for their care worker.

The provider had a complaints process in place and people receiving support from the service or relatives of people using the service knew how to raise a concern if they needed to.

The governance arrangements in place were not effective as they did not provide information identifying areas requiring improvement. There were positive comments from people using the service and staff when asked if they thought the service was well-led. There were equally many negative comments, which meant they did not think the service was always well-led. This meant a consistent quality of service was not being provided for all the people using the service.

We found a number of breaches of The Health and