The inspection took place on 23 July 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 of the service was on 8 August 2017 when re rated the service requires improvement. Following this, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of ''Is the service safe?'', ''Is the service responsive?'' and ''Is the service well-led?'' to at least ‘good’. We had rated the key questions, ''Is the service effective?'' and ''Is the service caring?'' as good. The provider told us they would make all the necessary improvements by 30 April 2018. At this inspection of 23 July 2018, we found the necessary improvements had been made and have rated the service as good for all key questions and overall.

Avant Healthcare (Hillingdon) 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 older adults and adults under the age of 65 with a disability or mental health needs living in the London Borough of Hillingdon. At the time of the inspection 62 people were using the service. The service is one of three locations managed by the provider, a private limited company.

There was not a registered manager in post. There was a branch manager in charge of the day to day running of the service and they were supported by an operations manager. The branch manager planned to apply for registration in the future. In the meantime, the operations manager had applied to be registered for the service. This application had been submitted to the Care Quality Commission but had not been processed at the time of our inspection. 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 generally happy with the service, they liked their care workers and felt that their needs were being met. Some people said that care visits did not always take place at the planned time. The provider had systems to audit and respond to any visits which were late or did not take place as planned. People told us that they were involved in planning and reviewing their care. They said that the agency responded to changes in their needs or request for changes to the care package. The staff were kind, polite and caring.

The staff felt supported. They had access to a range of training and took part in regular individual and group meetings to discuss their work and the service. They were able to feedback their opinions to the managers and good practice was praised and rewarded.

Risks to people's safety and wellbeing had been assessed and planned for. The provider had procedures designed to safeguard people from abuse and to investigate any accidents, incidents or complaints. People received their medicines in a safe way and as prescribed. People had consented to their care and the provider had acted in accordance with the Mental Capacity Act 2005.

The provider had effective systems for monitoring the quality of the service and making improvements. These included a range of audits and asking people using the service and other stakeholders for their views and ideas. The managers worked closely to reflect on their practice and look at ways improvements could be made. People were able to make complaints. These were investigated and appropriately responded to. The records used by the provider were accurate, up to date and complete.

We undertook an announced inspection of Avant (Hillingdon) Healthcare Services Limited 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 (Hillingdon) Healthcare Services Limited provides a range of services to adults in their own home including personal care in the London Borough of Hillingdon. At the time of our inspection approximately 90 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 the service did not have a registered manager was in post. A branch manager had been appointed for the service and would be applying as 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 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. The care plans and risk assessments had not been reviewed and updated if required following the incident.

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.

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. Th