Sambhana Care Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 4 quality statements at this assessment and found they had deteriorated. We found 4 breaches of regulation. We found new people using the service had not had potential risks to their health and welfare assessed. There was no guidance for staff about how to mitigate the risk. There were no effective systems in place to recognise and report safeguarding concerns to the local authority. Staff had not been recruited safely, the required checks, had not been completed. Staff had not received the training and supervision to make sure they had the skills and knowledge to complete their roles.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not acknowledge there had been ineffective processes to report, identify and investigate safeguarding concerns. The provider confirmed safeguarding concerns had not always been reported to the local authority safeguarding team. These included concerns raised about rough support provided during personal care. Staff could tell us what the potential types of abuse a person may be subjected to however, most staff we spoke to did not have a good understanding about reporting concerns around people’s safety. They told us they would tell the office, but they did not mention whistle blowing processes if they were worried about how concerns were being dealt with internally. Staff did not tell us about other organisations they could report concerns to such as the local authority, CQC or police.

People were not protected from allegations of abuse and unsafe care. The provider did not have robust systems in place to make sure incidents of potential abuse were reported, recorded and investigated. This meant we could not be assured that incidences of alleged abuse were being reported to the relevant local authority. Staff had been dismissed due to a number of allegations of poor care and unsafe practice. The provider had not raised the incidents with the local safeguarding authority. This meant the incidents had not been investigated by the appropriate authorities and CQC had not been made aware of the allegations and action taken. As the incidents had not been properly investigated, a decision had not been made if it was appropriate to refer the dismissed staff to the relevant disclosure and barring authority.

The provider and manager could not tell us which risk assessments had been reviewed or if they had been updated. The provider stated that the manager was responsible for this but the manager told us they had not looked at the risk assessment system since being in post as they were moving to another system in October 2024. The manager told us that the care plans were “terrible”, yet no action had been taken to improve these and ensure staff knew what would be needed to mitigate risks. Not all staff understood what we meant by the term risk assessment. Some told us they found people’s assessments on their phones, some told us they were in paper copies in people’s homes and the office but none were able to tell us about specific risks we asked. Staff told us the supervisors often tell them what needs doing but did not confirm to us that the supervisors had identified all risks present to people and staff supporting them. Staff told us they are “all active on a WhatsApp group and if there’s anything wrong or something needs an update we know about it.” There was a risk staff would not know or recognise risks or changes to people's support placing people at risk.

The provider had not ensured people’s individual risks had been identified and assessed nor did staff have the guidance necessary to mitigate any risk to people receiving care. Out of the 37 people the provider delivered care to in their own homes, only 13 people had risk assessments in place. One person’s care plan said they ‘struggled breathing’ but there was no further information about this or the reasons why. The person had no risk assessments in place. Their daily record evidenced they had oxygen in place within their home and staff had recorded they had turned up the oxygen to provide more oxygen to the person. Without the correct guidance available for staff to refer to this could cause damage to a person’s health. No risk assessments were in place to provide guidance to staff in relation to the risks of oxygen in the home, what the signs of the person’s deterioration were and what action they needed to take if they had concerns for the person’s health. The person also needed support with eating their food as they had difficulty swallowing and needed pressure area care. No information or risk assessment was recorded for staff to follow about either of these individual risks. Another person’s care plan recorded they were incontinent and had difficulty eating and needed staff support to eat their meals. When they were discharged from hospital in January 2024, their hospital discharge records stated they were at high risk of pressure sores according to a nationally recognised risk scoring tool. The provider had been providing care to the person since January 2024 and they had not completed any risk assessments since then, despite the known risks.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider told us they do not have any issues recruiting staff. Staff told us they felt supported by the provider, manager and supervisors and they felt there was enough of them to be able to meet people’s needs. The manager told us spot checks and supervisions were completed by the care supervisor. However we found no documentation or evidence to demonstrate these had been completed. Staff told us they had a meeting with the new manager a month ago but had not received a supervision.

Staff had not had the training and support to ensure they were able to provide people’s care safely. Although there were sufficient numbers of staff to provide the care, as there were no concerns around missed or late calls, staff were not trained sufficiently to carry out the care tasks allocated. Staff had completed online moving and handling theory training, however, this had not been backed up with practical training, to make sure they knew how to safely use equipment such as hoists. Staff had not had their competence checked through spot checks and observations to make sure they were moving people safely. Less than half the 28 staff had completed safeguarding of adults training, there was no assurance all staff knew their responsibilities in keeping people safe and how to report concerns. Staff had not had 1:1 supervision meetings to check their progress in their role, discuss concerns and manage staff performance and competency. Staff recruitment practices did not evidence a safe approach to making sure only suitable staff who were of good character were employed to provide people’s personal care. We looked at 4 staff recruitment records. These records did not demonstrate that safe and effective processes were in place when recruiting new staff. We found evidence of people not explaining gaps in their work history and evidence of previous conduct in role had not been sought. We found evidence of one person not having a disclosure and barring service check (DBS) before working alone, and not having satisfactory references to check whether they were of good character. Without an established safe recruitment system to ensure staff had the right skills and character, people were placed at risk of harm.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The manager and provider did not know how many people were being supported to take their medicines. They did not know if people's medicines records were accurate. We asked the office staff who showed us the records. Staff told us their electronic app told them who required support with their medicines and they administered this from the instructions included. The app listed medicine administration as a task to be completed and staff recorded when medicines had been given from the pharmacy supplied dosette box. The app did not include specific instructions about the medicines given or how they should be given.

Where people were supported by staff to take their prescribed medicines, we found no concerns with the management of this. Staff recorded on a system on their mobile phone when they had completed the task. We did not find any gaps in the records. People had their medicines dispensed into a dosette box at the pharmacy so staff gave people their medicines from this. There was no specific information about each medicine, for example if there were side effects that staff should be aware of, or if there was particular guidance for a medicine, such as to take before or after food, or if people needed to sit up while taking it. For example, some people received medicines which thinned their blood, there was no guidance for staff about the risks of excessive bleeding, bruising and the extra precautions to be taken if the person fell. This placed people at risk of harm.