• About the service: InVent Healthcare Ltd is a domiciliary care agency supporting adults and children with very complex and life limiting conditions. At the time of the inspection the service was supporting 47 people across the East and South of England.

People’s experience of using this service:

•The registered manager was based in a Norfolk office. The service was managed from three locations across the South and East of England. Governance systems had not been developed to allow the registered manager to have oversight of the whole service provided.

•Quality audits and monitoring records were not used effectively to drive improvement and identify where change was required. A system of effective quality assurance was yet to be developed.

•Medicine management was not as robust as required, specifically around the management of controlled drugs. Audits identified some issues but not all and they did not serve to drive improvement in this area.

•People’s care records and monitoring information were not contemporaneous records of the service provided. Some care plans were missing from people’s files and reviews that resulted in changes to support provided, whilst implemented were not routinely recorded on people’s care plans and assessments. When we looked at files in people’s homes we found additional information was available. We have made two recommendations about this.

•Team meetings did not happen as frequently as the service’s policy required. The provider had identified this but appropriate action had not been taken. We have made a recommendation about this.

•Staff told us key information was shared at team meetings for the team supporting specific individuals and we saw daily records contained comprehensive information on how to support people. Staff told us the daily records kept them updated of any changes to people’s needs and staff were available on the phone for support if required.

• 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. Consent was acquired as appropriate.

•Family and people, we spoke with being supported by the service told us it was excellent and they had confidence in the staff to keep them or their family member safe.

•The service included the relevant people and professionals in reviews of people’s care. The service worked well with other specialist services ensuring the care delivered was safe and effective in meeting people’s needs.

•Safeguarding procedures were available at the service and had been developed and agreed for each person.

•Staff were safely recruited and received specialist training for the people they supported.

•Support people received was clinically complex and life sustaining treatment was provided routinely to the people supported.

Rating at last inspection: Good (report published 6 March 2016).

Why we inspected: This inspection was completed as part of our planned programme of comprehensive inspections.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: Any action we agree is required will be monitored to ensure it is taken.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk