Enterprise Care Support Limited

Enterprise Care Support Limited is a domiciliary care agency providing personal care to older people living in their own homes. At the time of our inspection 70 people were receiving personal care at home from this provider. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People using the service and their relatives told us they were satisfied with the overall standard of care and support they received from this home care agency. People typically described staff as “kind”. One person said, “They’re very kind and are doing what they are supposed to. I’m happy with the service I receive, and I’d give them ten out of ten.” A relative added, “They [staff] know how to do a good job and have the skills to do what my [family member] needs. Overall, I’m quite pleased with the level of care provided.”

At our last inspection we found the provider had failed to always ensure people were not placed at risk of harm because of the way they supervised and supported staff, managed complaints, operated their governance systems, coordinated and monitored staffing, and maintained medicine’s records.

At this inspection we saw enough improvement had been made by the provider in relation to the way they now supervised and supported staff, managed complaints, operated their governance systems, coordinated staffs scheduled call visits and monitored their time keeping, and maintained medicine’s records.

People were kept safe and protected against the risk of avoidable harm and abuse. People received consistently good-quality and safe personal care from the same group of staff who were familiar with their needs and preferences. The fitness and suitability of staff to work in adult social care had been thoroughly assessed as part of the providers robust recruitment procedures. Staff followed current best practice guidelines regarding the prevention and control of infection, including those associated with COVID-19. People continued to receive their prescribed medicines as and when they should.

Staff had the right mix of knowledge and skills to deliver good-quality, safe care. People's care plans were person-centred, which helped staff provide them with the individualised care at home they needed. Staff ensured they communicated and shared information with people in a way they could easily understand. People were encouraged to make decisions about the care and support they received at home and staff respected their informed choices. Where appropriate, people's end of life wishes, and contacts were known and recorded for staff to refer to.

People were all complimentary about the way the registered manager and office-based staff ran the service, and how approachable they were. The managers promoted an open and inclusive culture which sought the views of people, their relatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people's packages of care at home.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 May 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, responsive and well-led which contain those requirements.

For the key question caring, which was not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

At our last inspection the key question of effective was rated good. We have not changed the rating as we have not looked at all of the effective key question at this inspection. The purpose of this inspection was to check if the provider had addressed a concern, we had about staff support. We will assess the whole key question at the next comprehensive inspection of the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Enterprise Care Support Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information, we may inspect sooner.

At the time of our inspection 80 people were receiving a personal care at home service from this provider and ten others did not receive any personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People's experience of using this service and what we found

Most people receiving a care at home service from this agency and their relatives told us they were generally happy with the overall standard of the service they or their loved one received from Enterprise Care Support Limited.

However, we found evidence during our inspection of multiple breaches of regulation and the need for this provider to make improvements.

The service was not always safe. This was because the provider did not always ensure people's medicines were always managed appropriately and we found numerous errors with documentation.

In addition, we received mixed feedback from people about staff time keeping, with a number of peoples’ relatives and community social care professional’s expressing dissatisfaction with staff arrival times and missed visits. We discussed this staffing issue with the provider at the time of our inspection who assured us they had plans to address this ongoing issue by introducing an electronic call monitoring system by June 2022, which would help improve how they coordinated and monitored staffs’ scheduled call visits. Progress made by the provider to achieve this aim will be monitored by the CQC.

The service was not always responsive. People’s complaints and concerns raised about the standard of care they or their relatives received from this provider were not always well-managed. For example, we found the provider did not always investigate, respond well or learn lessons when complaints were raised. This meant people had been placed at unnecessary risk of being harmed.

The service was not always well-managed. The provider had failed to always notify the CQC without delay of the occurrence of incidents that had adversely affected the health, safety and well-being of people using the service. This placed people at risk of harm because the CQC was not aware of how the provider had managed such incidents and were keeping people safe.

Furthermore, the provider did not always operate their governance systems effectively because they had failed to identify and/or take appropriate action to address a number of unsafe practices and issues we found during this inspection.

People were kept safe from abuse and risks they might face were suitably assessed and managed. People received continuity of care from a regular group of staff who were familiar with their personal needs and wishes, and whose fitness to work in adult social care had been thoroughly assessed. Staff followed current best practice guidelines regarding the prevention and control of infection, including those associated with COVID-19.

Assessments of people’s support needs and wishes were carried out before they started receiving any support from this provider. People received personal care from staff who had the right mix of knowledge, skills and support to perform their roles and responsibilities well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Where staff were responsible for preparing people’s meals and/or assisting them to eat and drink, people were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and well, and to access relevant community health and social care services as and when required.

People's care plans were person-centred, which helped staff provide them with the individualised home care and support they needed. Staff ensured they communicated and shared information with people in a way they could easily understand. People were encouraged to make decisions about the care and support they received at home and staff respected their informed choices. Where appropriate, people's end of life wishes and contacts were known and recorded for staff to refer to.

Most people receiving a care at home service, their relatives and staff were complimentary about the way the registered manager/owner ran the service, and how approachable they were. The registered manager promoted an open and inclusive culture which sought the views of people, their relatives and staff. The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of home care.

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

Rating at last inspection

The last rating for this service was good (published 26 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We received concerns in relation to staff missing or being late for their scheduled visits, staff training and poor record keeping. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

When we inspected we also found there was a concern with how the provider managed complaints and concerns, so we widened the scope of the inspection to include the key question of responsive.

For the key question of caring, which was not inspected, we used the rating awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the relevant key question sections and what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Enterprise Care Support Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified two breaches in relation to how this provider manages complaints, their governance systems and record keeping at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Enterprise Care Support Limited is a home care agency. It provides personal care to people living in their own homes in the community. At the time of our inspection this agency was providing a home care service to approximately 90 older people living in the London Boroughs of Camden, Merton, Wandsworth and Lambeth, as well as the home county of Surrey. People receiving a home care service from this agency had a range of personal and health care needs. The agency also specialised in providing a home care service, although not exclusively, to people who spoke a range of Asian languages.

The service continued to have a registered manager in post who was also the owner. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

At the service’s last two CQC inspections, which we carried out in November 2016 and 2017, we found staff had failed to follow best practice guidelines for the recording of the administration of medicines. This meant it was unclear if people had received their medicines and if they had, who had administered them. This repeated failure to identify and address these on-going medicines recording issues also indicated the provider’s management oversight and scrutiny arrangements were not being operated effectively. Consequently, we rated the service ‘Requires Improvement’ overall and for the key questions, Is the service safe and well-led?

At this inspection we found the provider had made improvements and now met the regulations and fundamental standards. We have therefore rated them 'Good' overall and for all five key questions, Is the service safe, effective, caring, responsive and well-led? This was because the provider had improved its governance systems. Quality assurance records showed field supervisors now routinely assessed staff’s medicines recording practice as part of their bi-monthly spot checks on staff during their scheduled visits. Consequently, we found no gaps or omissions on medicine's administration records (MAR) sheets we looked at. This meant we could also be assured people received their medicines as prescribed.

Staff continued to receive appropriate training and support to ensure they had the right knowledge and skills to effectively meet most people's needs. However, records showed staff who regularly supported people with a learning disability or mental ill health needs had not received any additional training in understanding how to meet these individual’s specific needs. This meant some staff might not have the right mix of competencies to effectively perform their roles and responsibilities. We have made a recommendation for staff training about people living with a learning disability or autism and mental ill health.

Furthermore, although people had been given essential information about the service, we found the service users’ guide, the provider’s complaints procedure and people’s care plans were not always available in easy to understand pictorial formats for people with learning disabilities or sensory impairments. This meant some people might not be able to understand all the information they were given about the agency, which could limit their opportunities to be actively involved in making decisions about the home care and support they received. We discussed this issue with the registered manager/owner who agreed where appropriate easy to understand pictorial, large print and audio versions of these documents should be available for people with specific communication needs. Progress made by the provider to achieve this stated aim will be assessed at their next inspection.

The comments above notwithstanding, people and their relatives told us they remained happy with the standard of the home care service they or their family members received from Enterprise Care Support. People felt their regular care workers were friendly and kind. Staff knew the people they regularly supported well and had clearly built up good working relationships with these people and their families. This was confirmed by discussions we had with people and their relatives.

People continued to feel safe with the staff who regularly provided their home care and support. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people's safety in a way that considered their individual needs. Staff recruitment procedures were designed to prevent people from being cared for by unsuitable staff.

People did not have major concerns about staff turning up late or missing a scheduled visit. This indicated there were sufficient numbers of staff available to support people. Staffing levels were continuously monitored by managers and senior staff to ensure people experienced consistency and continuity in their care and that their needs could always be met.

Managers and senior staff were in regular contact with the staff team to check they were clear about their duties and responsibilities to the people they cared for. Staff adhered to the Mental Capacity Act 2005 Code of Practice. People were supported to eat healthily, where the agency was responsible for this. People received the support they needed to stay healthy and to access healthcare services.

Staff were caring and continued to treat people with dignity and respect. They ensured people's privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. When people were nearing the end of their life, they received compassionate and supportive care.

People continued to receive personalised support that was responsive to their individual needs. People were involved in planning the care and support they received. Each person had an up to date, personalised care plan, which set out how their specific care and support needs should be met by staff. Staff regularly discussed people's needs to identify if the level of support they required had changed, and care plans were updated accordingly. The provider operated an effective service user and staff matching process. People received continuity of care from a small group of designated staff who were familiar with their needs, daily routines and preferences. Staff communicated with people in appropriate and accessible ways. The staff team spoke a variety of different languages, which meant staff could be suitably matched with people whose first language they understood.

Managers and senior staff provided good leadership. The provider had an open and transparent culture. People felt comfortable raising any issues they had about the provider. The service had arrangements in place to deal appropriately with people's concerns and complaints. The provider also routinely gathered feedback from people using the service, their relatives and staff. This feedback alongside the provider's own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided. Staff felt supported by their line managers.

The service had a registered manager in post who was also the owner. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

When we completed our previous comprehensive inspection of the service on 1 November 2016 we found concerns relating to the provider not appropriately maintaining medicines administration record (MAR) charts and not displaying their most recent Care Quality Commission (CQC) performance assessment (known as performance rating). At this time these topic areas were included under the key questions of safe and well-led. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these topic areas remain included under the key questions of safe and well-led.

We carried out a follow-up focused inspection on 27 April 2017 to check the provider had improved their arrangements for displaying their previous CQC report and rating in order to comply with their legal requirements. At the time of our focused inspection we found the provider had resolved the aforementioned issue and now met the regulations and fundamental standards. This meant people now had a much fuller picture of the service prior to requesting care from them. However, we continued to rate them 'requires improvement' overall because we needed to see the service could consistently maintain this improvement over time.

At this comprehensive inspection we found the provider continued to conspicuously display their most recent CQC report and rating both at their offices and on their website. However, we have continued to rate the service 'requires improvement’ overall and for the two key questions is the service ‘safe’ and ‘well-led?’ This is because we found two new issues in relation to medicines record keeping and management oversight. This will be the third consecutive time the service has been rated ‘requires improvement’.

More specifically, during this inspection we found the provider was still not following best practice guidelines for the recording of the administration of medicines. This meant it was unclear if people had received their medicines and if they had, who had administered them.

Furthermore, although we saw the provider had established some good governance systems to assess and monitor the quality and safety of the care and support people received; we found these measures were not always operated effectively. For example, as described above we identified large numbers of omissions on MAR charts where care workers had failed to sign for medicines they had administered. This meant the provider had either failed to pick this issue up as part of their quality monitoring audits and spot checks on care worker practices during scheduled visits, or if they had identified this trend, failed to take appropriate and timely action to resolve this on-going problem. This indicates the provider was not always sufficiently monitoring or improving all aspects of the service so that people experienced good quality, safe care.

These failings represent two new breaches of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We also received some mixed comments from community professionals we contacted about care workers being late or missing scheduled visits. Specifically, they were concerned about second care workers that were needed to safely use mobile hoists were often running late or missing visits all together. The provider told us they were in the process of introducing a new centralised electronic system that would allow the care coordinators to closely monitor staff punctuality and length of their stay. This would help the provider plan care worker’s scheduled visits more effectively.

The negative points described above notwithstanding people felt safe using the service and with their regular care workers. There were robust procedures in place to safeguard people from harm and abuse. Care workers were familiar with how to recognise and report abuse. The provider had assessments and management plans in place to minimise possible risks to people, which included infection control and safe food handling measures. Staff recruitment procedures continued to prevent people from being cared for by unsuitable care workers.

Care workers received appropriate training and support to ensure they had the right knowledge and skills to effectively meet people’s needs. Managers and care workers adhered to the Mental Capacity Act 2005 code of practice. People were supported to eat healthily, where the agency was responsible for this. Care workers also took account of people’s food and drink preferences when they prepared meals. People received the support they needed to stay healthy and to access healthcare services.

People and their relatives told us they were happy with the care and support provided by their regular carer workers. Care workers treated people with dignity and respect. They ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received personalised support that was responsive to their individual needs. People were involved in planning the care and support they received. Each person had an up to date support plan. People felt comfortable raising any issues they had about the provider. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

The provider had an open and transparent culture. They routinely gathered feedback from people using the service, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided. Care workers felt supported by the registered manager/owner and senior staff.

We also found at the November 2016 inspection, concerns that people’s medicines administration records were not being completed appropriately by care workers, to confirm people received their medicines as prescribed. Additionally, people told us care workers were often late for calls which meant there were risks their care needs were not fully met. We did not consider the provider had breached legislation but considered improvements could have been made. We therefore rated the service for the outcomes areas of ‘Is the service effective’ ‘Is the service responsive’ and Is the service well led?’ as Requires Improvement. We have not checked whether improvements have been made in these key questions and will do so at our next comprehensive inspection.

We undertook a focused inspection on 27 April 2017 to check the provider now met legal requirements. This inspection was announced and we gave the provider 24 hours’ notice as we needed to be sure of access to the providers’ offices.

This report only covers our findings in relation to the legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Enterprise Care Support on our website at www.cqc.org.uk

Enterprise Care Support Ltd provides personal care to people living in their own homes. At the time of the inspection they provided a service to 50 people who lived mainly in the London Boroughs of Camden, Merton and Lambeth and to people living in Middlesex and Surrey. The provider specialises in providing a service, although not exclusively, to people who speak a range of Asian languages.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our focused inspection we saw the provider had included a link on their website to include the CQC last inspection report completed on the 1 November 2016. They had also made a copy of the inspection report available in their office.

The provider had therefore taken adequate steps to meet the legal requirement to display their performance rating.

This has not changed the ratings for the outcomes areas of ‘Is the service effective’ ‘Is the service responsive’ and Is the service well led?’ These will remain as ‘Requires Improvement’ until the next full comprehensive inspection when the services’ rating will be reviewed.

Enterprise Care Support Ltd provides personal care to people living in their own homes. They currently provide a service to 47 people who live mainly in the London Boroughs of Camden, Merton and Lambeth and to people in Middlesex and Surrey. The provider specialises in providing a service, although not exclusively, to people who speak a range of Asian languages.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

During the inspection we found the provider was not following best practice guidelines for the recording of the administration of medicines. This meant it was unclear if people had received their medicines and if they had, who had administered them.

A number of people we spoke with told us care workers were often late for their calls. We were told that as a consequence care workers were often rushed in completing tasks. People also told us they sometimes felt care workers did not understand their needs. People said if they raised the issue with office staff they were not confident they would be listened to.

Additionally the provider was not displaying their CQC rating from an inspection completed in August 2015 at their premises or on their website, according to legal requirements. This meant people may have not had a full picture of the service prior to requesting care.

We identified a breach of the Health and Social Care (Regulated Activities) Regulations 2014 during our inspection. This was in relation to the provider was not displaying their previous rating. You can see what action we told the provider to take at the back of the full version of this report.

The provider tried to match people’s preferences for care workers with staff they had working for them to enable caring relationships to develop between them, but on some occasions this did not work very well. Once matched, the provider tried to ensure people had continuity with their care worker. Where the matching process worked people felt care workers understood their needs.

The provider completed recruitment checks to ensure only suitable people were employed. There were policies and procedures in place to safeguard adults at risk of abuse or harm. Staff were familiar with these and had received training and their knowledge was refreshed regularly to make sure they knew how to keep people safe.

Possible risks to people’s health were identified and there were guidelines to care workers outlining what action should be taken to minimise risks, this included infection control measures. People were encouraged to do as much as they could for themselves, in this way their skills were maintained.

People’s health was monitored. This included contacting healthcare professionals when it was necessary and making sure people had enough to eat and drink.

Care workers received support from the provider to ensure they had suitable skills to complete their work through training which was refreshed regularly. In addition, care workers were supported by their managers and peers to share information and discuss issues affecting their work practice.

Care plans were specific to the person which meant people received care that was individualised and met their needs. People told us care workers sought their permission before providing care, in this way care was generally in line with their wishes.

People told us care workers knew how to maintain their rights to privacy. This included making sure people’s confidentiality was maintained when required.

The provider undertook some measures to ensure the quality of the service. This included the use of spot checks on carers and the use of an annual survey to people who used the service.

Following the inspection the provider sent us an action plan on 7 July 2014 setting out the steps they would take to make the necessary improvements.

This visit was carried out by an inspector who helped to answer one of our five questions: Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our examination of three sets of information about people who use the service and with talking with the registered manager.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider operates an effective recruitment procedure to ensure care workers that they employ are of good character and have the qualifications and experience needed. This includes completing all the necessary checks with other agencies and taking up appropriate references.

The manager has an understanding of significant or untoward events that they must inform the Care Quality Commission of. This is outlined in the regulations of the Health and Social Care Act (2008). We require the agency to do this so that we can track incidents and monitor whether the service has made the correct decisions when dealing with events that could put people at risk of harm.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

Staff had undertaken some training regarding safeguarding vulnerable adults and how to respond to signs of abuse. However, the provider had not informed us of untoward incidents which related to safeguarding adults and so could be putting people who use the service at possible risk. We have therefore asked the provider to make improvements in this made a compliance action which requires the provider to take action and we will make sure that this is done.

The provider's staff recruitment and selection processes were not robust. References taken up were not adequate for the provider to assure themselves of the suitability of the candidate. This could mean that people who use the service were not protected from unsuitable staff. We have made a compliance action which requires the provider to take action and we will make sure that this is done by completing a follow up inspection in the near future.

Is the service caring?

People we spoke with were positive about the care provided by care workers. Comments included, 'I can go to work and don't have to worry'. People who used the service told us they were supported by kind and compassionate staff. Staff treated the people who used the service with respect and dignity.

Is the service responsive?

We found the provider continually monitored the service people were receiving and on occasions sought advice from social care professionals so that people received care that was appropriate to their needs.

The service had a complaints policy and procedure. People we spoke with told us they knew how to make a complaint if there was something that they were unhappy with. However, the complaints policy was not in an accessible format that could be understood by the people who lived at the service.

Is the service effective?

Care plans had details of people's needs and the action to take to meet these. These plans were regularly reviewed and updated so that they were meeting people's current needs. Any risks were assessed and reviewed regularly to ensure people's individual needs were being met safely.

People received effective assistance from staff who in turn were supported by their manager.

Is the service well-led?

The service had a registered manager. The manager had a range of quality assurance systems in place, which included spot checks of care workers. An annual survey was completed by people who used the service or their relatives. The results were used to identify any areas for improvement.

Regular audits of the care plans and risk assessments were carried out to help ensure that people received good quality care.

All relevant policies and procedures that would be expected of a domiciliary care agency were well documented and readily available, including information on safeguarding, whistle blowing, complaints and recruitment policy.

The people we spoke to told us that they were happy with the standard and continuity of care that was provided and considered that their individual needs and wishes were taken into account. They felt that the care provided was reliable, and that there was a good collaborative working relationship with staff.

People were aware of a complaints procedure and were confident that they could relay any concerns about the service if they needed to do so.

Staff felt well supported and suitably trained and there was a clear and rigorous selection process in operation.

People told us that they felt safe with their care workers and that they enjoyed the continuity they got from having the same care workers visit them.

People said that they felt their care workers were suitably qualified to help them and they said they knew how to make a complaint about the service if they wanted to do so.