Day and Nite Services (Kingston)

Day and Nite Services (Kingston) is a domiciliary care agency providing personal care to older people in their own homes.

At the time of the inspection, there were 58 people using the service who were receiving help with 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

The provider operated safe recruitment procedures and had implemented an electronic call monitoring system to monitor care worker visit times. People and their relatives told us they felt safe in the presence of care workers and said that generally their care visits were on time and they were kept informed if care workers were running late. The provider took steps to assess and manage risks to people which helped to keep them safe from harm. People received appropriate support with regards to their medicines.

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.

Feedback from people was that the service was well-led and both the quality of service and communication with the office staff had improved since the last inspection. The management team had taken feedback from the previous inspection on board to improve the frequency of staff supervision, implement digital care planning and more robust monitoring and gathering feedback form people.

However, the governance and quality assurance process were still not fully embedded and there was a lack of analysis in relation to care worker visit times. We identified some issues with the care planning and medicines records, which although the provider acted upon when we raised these with them, were not picked up by the provider’s own audits.

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 inadequate (published 14 May 2022) and there were breaches of regulation in relation to safe care and treatment, staffing, notifications and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made in relation to the breach in relation to safe care and treatment, staffing and notifications and the provider was no longer in breach of these regulations. However, the provider remained in breach of good governance.

At our last inspection, we made a recommendation to the provider to review how it captures, records and follows up the concerns and complaints received in a more responsive manner. At this inspection we found the provider had acted on these recommendations and had made improvements.

Why we inspected

This inspection was carried out to look at improvements against the breaches found at the previous inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led only and also targeted to look at staffing in the key question effective and complaints management in the key question responsive.

For those key questions 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 inadequate to requires improvement based on the findings of this inspection.

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 breaches in relation to good governance 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Day and Nite Services (Kingston) on our website at www.cqc.org.uk

Day and Nite Services (Kingston) is a domiciliary care agency. Not everyone who used the service received personal care. 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. At the time of our inspection they were providing personal care to 51 older people living in their own homes in Kingston, Sutton and Surrey.

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

People using the service were generally satisfied with the support and the quality of care they received from their individual care workers, including their prescribed medicines. They also told us they felt safe in the presence of care workers.

The provider had made some improvements in relation to some areas of concern we found last time including recruitment checks for new staff. However, not enough improvement had been made in relation to risk assessments, staffing, statutory notifications and governance.

Risks to people were not always recorded accurately so they could be managed effectively, people’s risk assessments contained conflicting information to their care plans.

Although the provider had implemented a new call monitoring system, we received mixed feedback from people regarding call visit times and of poor communication from the office when care workers were running late, especially at weekends. We discussed this staffing issue with the managers at the time of our inspection who were aware this system needed further improvement. The provider had an call monitoring system in place, however it was not being used effectively and there was no data available for the provider to accurately record information related to care worker visits.

The provider failed to submit statutory notifications when safeguarding allegations were made. Governance procedures were not effective in identifying the areas of concern we found during this inspection. Audits to review care plans, risk assessments and medicines records were not in place. The provider was not able to produce contemporaneous records to evidence that action had been taken in response to service concerns or safeguarding allegations.

People told us that the care workers who supported them respected their privacy and dignity and gave us examples of how they promoted and encouraged them to maintain their independence. They said their dietary and nutritional needs were being met.

Despite the above positive feedback, people and their relatives said the communication with the office staff was mixed.

Audits identified some of the issues we found during this inspection, but these were not always addressed and/ or followed up in a timely manner.

We have made a recommendation to the provider in relation to complaints management.

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 1 April 2021) and there were breaches of regulation in relation to fit and proper persons employed, notifications and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made and the provider was not in breach of regulation in relation to fit and proper persons employed. However, we found some new breaches in relation to staffing and safe care and treatment. We also found the provider remained in continued breach in relation to notifications and good governance.

The service has deteriorated to inadequate.

Why we inspected

This inspection was prompted in part by a review of the information we held about this service. There were also ongoing concerns from the local authority and feedback received from whistle-blowers. A decision was made for us to inspect and examine those risks.

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

You can see 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 Day and Nite Services (Kingston) on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, notifications and good governance at this inspection.

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.

Since the last inspection we recognised that the provider had failed to submit statutory notifications. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

21 additional people who used the service received help with tasks that were not related to personal care including, shopping, cleaning and welfare checks. The Care Quality Commission (CQC) only inspects where people receive personal care. Where they do, we also consider any wider social care provided.

People’s experience of using this service

Most people told us they were satisfied with the standard of care and support provided by this domiciliary care agency. People typically described the staff as “caring”. However, we found evidence during our inspection of multiple breaches of regulation and the need for this provider to make improvements.

The provider’s recruitment procedures to check the suitability and fitness of new staff for their role were not consistently or safely applied. This meant people using the service had been placed at unnecessary risk of harm of receiving personal care and support from staff who were not properly vetted and therefore might not be ‘fit’ for their role.

The provider had failed to always notify the CQC without delay about 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.

The provider had established governance systems in place to assess and monitor the quality and safety of the care people received however, we found these processes were not always operated effectively. This is because they had failed to pick up a number of issues we identified during our inspection.

In addition, we have made a recommendation about staff being entitled to sufficient uninterpreted time off without working between their scheduled visits and/or shifts.

We also received mixed feedback from people about staff time keeping, with approximately a third expressing dissatisfaction with staff arrival times and missed visits. We discussed this staffing issue with the managers at the time of our inspection who were aware this was something they needed to improve. Managers confirmed they were in the process of introducing a new electronic call monitoring (ECM) system to replace their existing one, which they were confident would significantly improve how they monitored and managed staff punctuality and attendance.

Despite our findings, we found people continued to receive personal care and support from staff who knew how to manage risks and keep them safe. Staff followed relevant current best practice guidelines regarding the prevention and control of infection. People continued to receive their prescribed medicines as and when they should.

The provider ensured staff had the right levels of training and support they needed to deliver effective home care to people.

The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives and staff. The provider worked in partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support.

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 good (published 27 August 2019).

Why we inspected

We received concerns in relation to the management of staff recruitment. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We also used a targeted approach to look at specific concerns we had about staff training and support under the Key Question of Effective. As we only looked at part of Effective, we have not changed the rating from the previous inspection for this Key Question.

We reviewed all the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for the key questions of Effective, Caring and Responsive were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement because we found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified three breaches in relation to staff recruitment, notifications the provider has a legal obligation to send the CQC and their governance systems. This was because the provider failed to ensure they always consistently checked the suitability and fitness of all new staff for their role, to always notify the CQC without delay about the occurrence of incidents that adversely affected the health, safety and well-being of people using the service, and did not always operate their established governance systems effectively.

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 the relevant local authorities to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Day and Nite services (Kingston) is a domiciliary care agency. At the time of our inspection they were providing personal care and support to 68 mainly older people living in their own homes. One person using the service received 24-hour care from live-in staff.

66 out of the 68 people currently using the service received 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

People told us the service had significantly improved in the last 12 months. Most people said they were much happier with the standard of home care and support this agency provided them. A quote we received from a relative summed up how people now felt about this home care agency, “I think staff time keeping and the way the managers in office run Day and Nite is a lot better than it was…I would now recommend them to anyone who needed help at home.”

People were cared for and supported by staff who knew how to manage risk and keep people safe. The punctuality of staff regarding their scheduled visits and the way the provider monitored their visit times had improved. Appropriate staff recruitment checks still took place before new staff started working for the agency. People received they medicines as they were prescribed. The services arrangements for controlling infection remained robust.

The training and support staff received had improved in the last six months, which meant it was now relevant to their roles and responsibilities. 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 this, people were supported to maintain a nutritionally well-balanced diet. People continued to be supported to stay healthy and well and had access to the relevant health care professionals as required.

Staff continued to treat people with dignity and respect. People were treated equally and had their human rights and diversity respected, including their spiritual and cultural needs and wishes. People were encouraged and supported to develop their independent living skills. Assessments of people’s support needs were carried out before they started using the service.

Care plans were more personalised, which ensured people received personal care that was tailored to meet their individual needs and wishes. Managers now understood the Accessible Information Standard and ensured people were given information in a way they could understand. People were satisfied with the way the provider dealt with their concerns and complaints. People’s end of life care wishes were recorded in their care plan.

The provider had improved their governance systems to ensure they could effectively assess and monitor the quality and safety of the service people received. The provider now worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support. People, their relatives and staff all spoke positively about the way the office-based managers now ran the agency. The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives and staff.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 15 October 2018) and there were multiple 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

This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Day and Nite (Kingston) 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 180 mainly older people, four younger adults and two children living in the south London Boroughs of Kingston-upon-Thames, Wandsworth, Merton and Sutton. Most people using the service were living with dementia, while some people also had physical disabilities or complex health care needs associated with old age or mental ill health. Both the children using the service had a learning disability or autistic spectrum disorder. In addition, five people received a 24-hour home care service from this agency and had live-in care staff.

Approximately fifteen percent of the 180 people currently using the service did not receive a regulated activity from Day and Nite (Kingston). The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service continues to have a registered manager/owner in post, although this individual was no longer in operational day-to-day charge of the agency following the appointment of a new manager in January 2018. The new manager has not yet applied to the CQC for us to consider registering them as the service’s new manager. 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 CQC inspection, which we carried out in July 2017, we found the provider had improved the way they notified us about incidents involving people using the service. We rated the service ‘Good’ overall, although we had also received some mixed feedback from people about staff sometimes missing their scheduled visits or being late.

At this comprehensive inspection although we continued to rate the agency ‘Good’ for the key question, ‘Is the service caring?’, we found some aspects of practice had deteriorated. Consequently, the overall rating for the service and the three key questions, ‘Is the service safe, effective and responsive?’ have been downgraded from ‘Good’ to ‘Requires improvement’, while the key question, ‘Is the service well-led?’ remains ‘Requires improvement’.

This was partly because the risk management plans that were in place to help staff take the appropriate action and prevent or deal with risks people might face were not always sufficiently detailed. This meant the provider had not done all that they could to mitigate identified risks and keep people safe.

Staff did not have all the right knowledge and skills to effectively carry out their roles and responsibilities. For example, staff who supported children had not received any child protection (safeguarding) or learning disability/autism awareness training. In addition, staff who supported adults living with dementia, mental ill health or behaviours that challenged the service had also not completed relevant awareness training in the areas outlined above.

Furthermore, although governance systems were in place to monitor the quality and safety of the service provided; we found they were not always operated effectively. For example, essential information obtained through these governance processes was always evaluated. This meant the provider did not always reflect on their practice to learn lessons and consider how they might improve the home care service they provided.

These shortfalls represent three 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.

In addition to the breaches described above, we found other issues of concern during our inspection.

The provider did not always work in partnership with other external agencies and professional bodies. Community social care professionals told us in the last 12 months the registered manager/owner had not always worked in a collaborative or cooperative manner with them. However, people receiving a home care service from this agency, their relatives and external health and social care professionals all spoke positively about the leadership style of the new manager and were confident they could work collaboratively with them.

We continued to receive mixed feedback from people, their relatives and professional representatives about staff not always turning up on time for their scheduled visits. The new manager confirmed that as discussed at the service’s last inspection the provider had recently installed an electronic call monitoring (ECM) system. The system logged the exact time staff started and finished their scheduled visits and automatically flagged up when staff were late, left early or missed a call. The new manager was confident the ECM system would help them address the ongoing issue regarding staff’s time keeping.

Staff had opportunities to review and develop their working practices, although most staff appraisals of their overall work performance in the last 12 months were well-overdue.

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 children or adults with learning disabilities. This meant children and adults with a learning disability might not always be able to understand the information, which could limit their opportunities to be actively involved in making decisions about the home care and support they received.

Each person had been given a copy of their care plan, although the information they contained could be made more person centred and provide clear guidance for staff about people’s individual needs, strengths and preferences.

The negative comments made above notwithstanding, we found the provider had improved their arrangements for notifying us without delay about incidents involving people using the service, which we identified as an issue at their last inspection. The new manager demonstrated a good understanding of their incident reporting responsibilities.

Staff continued to treat people with dignity. Most people and their relatives typically described the staff who worked for Day and Nite (Kingston) as “kind” and “respectful”. During our inspection we observed staff on scheduled visits interact extremely well with people they were supporting. People received continuity of care and support from staff who were familiar with their needs and preferences. People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives.

The provider also continued to have robust systems in place to identify, report and act on signs or allegations of abuse or neglect. Most people felt their family members were safe with the staff who visited them at home. Staff recruitment procedures remained safe and continued to minimise the risk of people being cared for by unsuitable staff. Where the service was responsible for this, medicines continued to be managed safely. People remained protected by the prevention and control of infection.

The manager and staff continued to adhere to the Mental Capacity Act (2005) code of practice. Staff also took account of people’s food and drink preferences when they prepared meals.

Since our last inspection we also received information from people using the service, relatives and staff concerned about the way the agency recruited, trained and supported staff. A number of people also expressed concern that staff did not always turn up on time for their scheduled visits.

This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focused inspections, by selecting the 'all reports' link for ‘Day and Nite Services (Kingston)’ on our website at www.cqc.org.uk.

Day and Nite Services (Kingston) is a domiciliary care agency that provides personal care and support to people living in their own homes mainly in the London Boroughs of Wandsworth, Merton and Sutton. At the time of our inspection 101 people received care and support from this agency. Three of these people had 24 hour live-in care workers and another person who lived in a nursing home regularly received one-to-one support from the agency. People using the service were mainly older adults living with a range of health care needs and conditions, including dementia.

Since our last inspection the service has a new registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC). Registered managers like registered providers 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 new manager was registered with us in April 2017, replacing the previous registered manager/owner, who was now the Company Director.

During this focused inspection, we found that the provider had followed their action plan and now met legal requirements and fundamental standards. Specifically, the provider had improved the way they kept the CQC informed about the occurrence of any incidents and events that adversely affected the health, safety and welfare of people using the service.

We received some mixed comments from people using the service and their relatives regarding staff turning up for their scheduled visits on time, although most people told us they did not have any major concerns about their regular care worker’s punctuality. In response to concerns raised by a few people about their care workers’ time keeping the provider had introduced a new 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 workers’ scheduled visits more effectively.

We saw staff recruitment procedures continued to prevent people from being cared for by unsuitable staff.

Staff also continued to be suitably trained and support by the providers management team to ensure they had the right knowledge and skills to effectively meet people’s needs. Managers monitored staff training to ensure their existing knowledge and skills remained up to date. Managers and senior staff were also in regular contact with the staff team to check they were clear about their duties and responsibilities to the people they cared for.

Day and Nite Services (Kingston) is a domiciliary care agency that provides personal care and support to people living in their own homes. At the time of our inspection 49 people received a service from the agency, which included four people who had live-in care workers. People using the service were mostly older adults who had a wide range of health care needs and conditions. Most people receiving a service were living with dementia.

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.

Providers are required to inform the CQC when there are significant events in a service, including any allegations of abuse. These are called statutory notifications. We found the provider had not notified us about a safeguarding incident involving a person who received a service from the agency.

We identified a breach of the Care Quality Commission (Registration) Regulations 2009 during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

People were satisfied with the overall standard of personal care and support they received from this provider. People told us staff that provided their care and support were kind and caring.

People felt safe with the care and support they received from staff working for the agency. Staff were supported to take appropriate action to ensure people were protected if they suspected they were at risk of abuse or being harmed by discriminatory behaviour or practices. Risk of injury or harm posed to people by their specific health care needs and home environment had been assessed .However guidance for staff on how to ensure these risks were minimised needed to be improved.

People were supported by staff that were suitable and fit to work for the service. Employment and criminal records checks were carried out on all staff before they started work. 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 be met at all times.

Staff received training to meet people’s needs. Training was in areas and topics relevant to their work. Managers and senior staff monitored training to ensure staff skills and knowledge were kept up to date. Staff received regular supervision (one to one meetings) and appraisal so that they were appropriately supported to care for people. They felt well supported by managers who they said were approachable.

Staff were knowledgeable about the people they supported. This included their preferences, routines and their support needs. Staff provided people with the support they required in line with their care plans. Staff regularly discussed people’s needs to identify if the level of support they required had changed, and care plans were updated accordingly.

People were involved in discussions about the care and support needed. Each person had a care plan which set out their specific needs and preferences, and how they wanted these met by staff. People said staff met their needs. People’s right to privacy and to be treated with dignity was maintained by staff, particularly when receiving personal care. People were encouraged to do as much as they could and wanted to do for themselves to retain control and independence.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff received training in the MCA so they were aware of their responsibilities in relation to the Act. Records showed people’s capacity to make decisions about aspects of their care was considered when planning their support. Where people lacked capacity to make specific decisions there was involvement of their relatives or representatives and relevant care professionals to make these decisions in people’s best interests.

People were supported to stay healthy and well. Staff were knowledgeable about the signs and symptoms to look out for that indicated a person’s health may be deteriorating. If staff had any concerns about a person’s health, appropriate professional advice and support was sought. People were supported to eat healthily, where the agency was responsible for this. Staff also took account of people’s food and drink preferences when they prepared meals. People received their medicines as prescribed and safe medicines management processes were followed.

People knew how to make a complaint if needed. The provider also routinely sought the views and experiences of people about the quality of care and support provided and how this could be improved. They used this information along with other checks to assess and review the quality of service people experienced. Where there were any shortfalls or gaps identified through these checks senior staff took action to address these.

Managers communicated a strong ethos focusing on person centred care and ensuring people received a good quality service from the agency. Managers regularly met with staff and checked they were clear about their duties and responsibilities to the people they cared for. Staff told us they felt valued and appreciated for the work they did by the agency’s management team.

Managers monitored the quality of service delivery. A range of regular audits were undertaken, and information was gathered about key aspects of service delivery. Where it was identified that improvements were required these were undertaken promptly by the provider. The provider also used external scrutiny and challenge to ensure people received appropriate care and support from the agency.