Identifying and sharing knowledge about what works and what’s new is essential in domiciliary services. I feel that the main challenge within the service is following our procedures when a tenant has a fall or in need of hospital admission. If a tenant has a fall and cannot get up, it is procedure to contact paramedics and staff are not allowed to try and lift a person up, for the tenant’s safety and the staff member. On several occasions the paramedics have said that it is not an emergency and why doesn’t your staff get them off the floor. There needs to be a better understanding of different service settings within the NHS. Poor discharges from the hospital’s due to lack of beds. In our extra care setting it can show a challenge with lack of involvement and communication between Occupational therapist’s, District nurses and GP’s when visiting. We are not always told of visits etc and this prevents us from keeping support plans up to date and being aware of any further health needs, equipment being placed, medication changes. This then has an impact on us meeting requirements in our service and also our CQC inspection.Rota’s can be a big challenge, in meeting tenants required times allocated and tenants not being flexible to time changes in the event of emergencies. Sometimes rota times need to be prioritised to individual’s that have health appointments, medication changes, family visits, which then has an impact on other tenants time of calls. Staff shortage or if agency staff were used have a impact to the service, not only to find cover but also the lack of knowledge agency staff would have regarding the tenants and their care needs. In the past I have found that the challenges I have faced when using agency staff, medication errors, tenant feedback negative, not fulfilling all health & safety checks.Time restraints on the commissioned care is not always enough time to meet the long term needs to the individual and this then adds pressure to the care staff. Meeting all the regulations and requirements to be compliant within a service has become more challenging year after year. The paperwork involved has added extra stresses to anybody who works in the care sector.