This inspection took place on 10 and 13 June 2016 and 16,17, 20 and 22 July 2016 . On 13 June 2016 we visited the office of Care by Us North Hertfordshire, Essex and North London and then contacted people and relatives for feedback about the service they received. We also visited people in their own homes during the inspection.

Care by Us is a large organisation which offers different types of services in East, West and North Hertfordshire, Essex and North London operated from two main locations. This inspection covered the services provided in West Hertfordshire and North London reaching out to approximately 600 people.

The services the provider offered to people included, domiciliary care, flexi care scheme, live in type of services, specialist care from home services, respite care, parent support and supported living. The provider also provided a `Local Links` service which offered specialised transport with staff support for people with mobility difficulties to access the community. This service was free of charge and run through the provider`s own charity organisation.

The provider had specialist staff teams trained to offer a wide range of care and support for people with complex health and social care needs. These included, end of life care, people with behaviour which could challenge other, people living with learning disabilities, dementia and other illnesses which required staff to be knowledgeable about, such as epilepsy, diabetes and eating disorders.

There was a long standing registered manager in post who was also one of the owners of the company. 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.

People were involved in developing their own care plan based on their needs and wishes. Before people started using the service staff met them for an initial personal and risk assessment where they decided and agreed their care and support plan. Staff captured in care plan people`s wishes, what dignity and respect meant for people and gave people choices and control over the support they required and wanted. People gave their written consent to the care and support delivered by staff and participated in regular reviews about their care needs.

People told us staff were respectful and offered care and support in a caring and compassionate way. The care and support offered to people met their needs and made people feel safe. Staff showed a caring attitude when talking about people and were able to tell us how they delivered individualised care which met people`s needs.

People told us they felt staff were knowledgeable and knew how to deliver care and support in an effective and safe way. They praised staff responsiveness to their needs and the provider`s approach to provide equipment, mobility aids and specialist support to enable them to live independently in their own homes for as long as possible.

Staff had comprehensive induction training when they started working for the provider and they attended regular refresher training sessions. The registered manager identified and offered specialist training for staff to develop and take on the roles of champions in the areas of their interest. The champions held the highest qualification in their subject areas and actively trained and coached staff. As a result staff acquired knowledge and skills to meet people`s needs effectively.

The provider created opportunities for staff to progress in their career within the company which led to a high retention of permanently employed staff group. People benefitted from consistent care and support from staff who were long standing and knowledgeable in how to meet peoples` needs effectively. The provider had a robust call monitoring system in