The inspection took place on 17 April 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 in the key questions of Safe, Responsive and Well-led. The overall rating of the service was Requires Improvement. 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 on 17 April 2018 we found that the necessary improvements had been made and have rated the service Good in all key questions and overall.

Avant Healthcare Services Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in the London Borough of Hounslow. It provides a service to older adults, younger adults with learning disabilities and people who have physical disabilities. At the time of the inspection approximately 200 people were using the service. The majority of people were older adults, some who were living with the experience of dementia. Some people were receiving end of life care. The provider owns two other branches which are located at the same postal address and provide care and support to people living in other London Boroughs.

The registered manager had stopped working at the service shortly before the inspection. The provider explained that they planned to advertise for a permanent manager. There was an acting manager in post. They had previously worked as the deputy manager at the service. 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 and support they received. They liked their care workers and were usually cared for by the same care workers. People felt their needs were being met and that they were able to discuss their individual needs and preferences.

The staff told us they felt well supported by the management and the provider. They had enough information and training to enable them to carry out their roles and responsibilities. They were invited to meetings where they could discuss how they felt and any concerns they had.

The risks people were exposed to had been assessed and planned for. The provider had procedures designed to safeguard people and protect them from abuse. People received their medicines in a safe way and as prescribed. People felt able to make complaints and felt these were responded to. The provider had systems to learn from mistakes and put things right when they went wrong.

The provider was acting within the principles of the Mental Capacity Act 2005 so that people had consented to their care, or decisions had been made in their best interest by those who knew them best.

People's needs were assessed and care plans had been created to reflect these needs. They were regularly reviewed and updated. People using the service, or their representatives, had been involved in creating and reviewing these plans. Care was provided in accordance with the plans, this included the staff arriving on time and carrying out all the required care and support for each person.

The provider had effective systems for monitoring and improving the quality of the service. These included involving people who used the service and other stakeholders in discussions about how they felt the service could be improved.

We undertook an announced inspection of Avant Healthcare 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 Healthcare Services Limited provides a range of services to people in their own home including personal care in the London Borough of Hounslow. At the time of our inspection approximately 250 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.

The provider had a process in place for the recording of incidents and accidents but information relating to any actions taken had not been noted in the relevant paperwork. Care plans and risk assessments had not been reviewed and updated if required following the incidents.

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. 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 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 to take action to make improvements.

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.

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