Sambhana Care Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question inadequate. At this assessment the rating has remained inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care. The service was in breach of legal regulations in relation to duty of candour and good governance.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. There was a closed culture within the service. The provider had not been open and transparent when incidents happened, they had not provided accurate information to other professionals. For example, when a serious incident happened, the provider had not informed health professionals, the local safeguarding team or CQC. The provider told us they had coerced staff to alter records and to be dishonest about what had happened because they had panicked. Staff told us they had felt pressurised to do this for fear of losing their job and sponsorship status. CQC had been informed about serious incidents. When CQC asked the provider to report the incidents, they had not provided accurate information. The provider had not been open and transparent with the relatives of people involved, about the circumstances of the incident. During our assessment the provider had continued to be defensive about their actions and those of the staff. The provider’s actions showed they did not have people at the centre of the service.

The provider and leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty. There was no effective leadership of the service and there had been no improvement since our last assessment. The provider and manager had not displayed leadership skills or acted with integrity when incidents happened. They had not been open and honest with staff, people or other professionals. Staff had been placed in situations where they had to do things they were not happy about. The provider had acted without consideration for people in their care. The actions the provider initiated following an incident showed they had little regard for people’s wellbeing and had not put their needs as a priority. The provider lacked the experience and skills to deliver the regulated activity of personal care. The provider had relied on senior staff to lead the service, but they had not shown the skills or knowledge needed to operate the service and promote good care. The manager had not provided guidance or supervision to staff. Senior members of staff who were responsible for monitoring the quality of the service had not given the provider accurate information about the progress to improve the service since the last assessment.

The provider and manager did not promote a positive culture within the service. During our assessment staff told us they felt confident to speak up and raise concerns with the management team. we found this had not been the case. Following our on site assessment visit, other staff contacted us to reveal they had been asked to complete documents retrospectively. Staff were distraught at their actions but had felt they had no choice as they needed their job or were dependent on the provider for their employment sponsorship. Staff had not received regular supervision or been invited to attend general staff meetings. They had not been given the opportunity to speak up and provide feedback about their experience of working at the service.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff were positive about the provider being inclusive and treating them equally. Most staff were of different ethnic backgrounds, including staff who were employed under the sponsorship scheme and English was not their first language. During our contact with staff, we found many staff had difficulty responding to our questions and their English was quite poor. Staff had not been given the opportunity to improve their English skills. There was a risk staff would not understand training and policies to support equality and diversity including how to protect people from discrimination and abuse.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The provider had told us they had completed all the actions required after our last assessment. However, we found the management and oversight of the service had not improved. The provider had relied on the manager to complete an action plan to rectify the shortfalls, however, the manager had not completed these actions. The provider had not had oversight of the manager and had not understood their responsibility to check the action was being taken. There were no effective systems or processes in place to monitor the quality of the service, staff practice or to drive improvement. The provider and manager showed a lack of understanding and knowledge about their legal responsibilities to keep people safe and provide a safe service.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement. There were no effective processes in place to work with healthcare partners. The provider had not shared information of concern with other agencies when required until prompted by CQC We received a copy of the information the provider shared with the local authority, this had not been a full and accurate account of what had happened, and the action taken.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. The quality of the service, management and culture of the service had deteriorated since our last assessment. There had been no improvements to the care plans, supervision or training of staff. The provider and manager had not acted to rectify shortfalls and had not identified concerns and issues we found during this assessment.