People with profound intellectual and multiple disabilities may not always be well supported to engage meaningfully in activity at home, an injustice impacting on well‐being and quality of life. Research sought better understanding of how occupational therapists work to improve the quality of this support, in particular, how they encourage support workers and managers to adopt recommendations. A single, purposively selected, case of supporting engagement in activity at home was investigated using a critical ethnographic case study methodology from an interpretivist and social constructionist stance. An occupational therapist worked with five people with severe and profound learning disabilities and their support workers over one year. Data were collected using ethnographic methods (participant observation, interviews and document analysis) and analyzed using an emergent systematic strategy (formal coding and categorisation, alongside intuitive and affective analysis) and NVivo qualitative data analysis software. Please contact the library to receive a copy of this article - http://bit.ly/1Xyazai