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. 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 Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches relate to person-centred care (Regulation 9), safe care and treatment of people using the service (Regulation 12), good governance of the service (Regulation 17) and staffing (Regulation 18). You can see what action we told the provider to take at the back of the full version of this report.