Continuity Health Care Services PVT Limited

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• 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

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. This is the first assessment for this service. This key question has been rated 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 regulation in relation to good governance

This service scored 36 (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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The service did not have a consistently shared direction or culture which supported the delivery of high‑quality home care. Although leaders described a clear vision focused on person‑centred, reliable support, this was not fully understood or embedded across all staff teams. Some care workers told us they were unsure about the provider’s priorities or how expected standards should be applied during home visits, particularly when working alone in the community.

Communication between office staff and care workers was inconsistent, and the systems used did not always support a shared direction or cohesive culture. Much of the day‑to‑day information was shared through a WhatsApp group, which staff told us was not always reliable or well‑managed. Important updates could be missed, and there was no structured process to ensure all staff received and understood key information.

The provider’s communication approach tended to focus on responding to immediate issues, such as changes to visits or complaints, rather than offering proactive organisational updates or involving staff in wider service improvement. Care workers told us they did not always feel informed about the provider’s priorities or any planned developments, which limited their ability to contribute to a positive, unified culture.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leaders said they were committed to providing a caring and supportive service, but they did not always demonstrate the capability or consistency needed to ensure effective oversight. Roles and responsibilities within the management and office team were not clearly defined or consistently understood, which led to gaps in monitoring, communication and decision‑making. Staff told us they were sometimes unsure who to approach for specific guidance, and this contributed to delays in resolving issues and inconsistent follow‑up on concerns.

People and their representatives also raised concerns about the leadership of the service. Several told us they were often unable to contact office staff, which made it difficult to make plans, request changes to their support, or ensure their social needs were met. Comments included, “Before 9.00am it can be a problem to contact the office. As it is out of office hours. There are a couple of numbers for out of office hours. They may go to the office machine. The problem is if you have an eight o’clock morning visit, you contact a closed office.” and “The agency needs more staff, and the office could be better. It takes 2-3 times of calling if I tell the office. It’s easier to tell the carers to tell the office.”

This lack of accessible and responsive leadership oversight affected people’s confidence in the service and limited opportunities to tailor care in a timely and person‑centred way.

Although leaders were described by staff as approachable and compassionate, the lack of clarity in leadership structure meant they were not always able to provide inclusive, proactive support to staff or ensure quality and safety processes were reliably implemented.

People did not always feel they could speak up and their voice would be heard.

The service did not have consistently effective systems to support a strong Freedom to Speak Up culture. Although people told us they felt happy to speak up and had raised issues or concerns in the past, the processes for responding to feedback were not always clear or reliable. Some concerns were not recorded or followed up in a timely way, and people were not always informed about the actions taken as a result of their feedback.

Staff told us they were willing to raise issues, but they were not always confident concerns would be addressed consistently or lead to meaningful improvement. There was limited evidence learning from concerns was shared across the staff team or used to strengthen the quality and safety of the service.

The provider had not ensured Freedom to Speak Up arrangements were well‑embedded or supported by clear policies, training and oversight. As a result, opportunities to use feedback to drive improvement were sometimes missed.

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.

Leaders modelled respectful and fair behaviours towards their workforce, and staff told us they felt treated equitably and supported regardless of their background or personal characteristics. Recruitment processes were fair and transparent, and staff said they felt confident raising concerns about discrimination, knowing these would be taken seriously and addressed promptly.

Equality and diversity training had been completed by most staff, but leaders did not routinely reinforce this learning or use it to shape decision‑making or organisational culture. The provider did not consistently monitor workforce data or staff feedback to identify inequalities or trends which could inform improvement.

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.

Governance and management arrangements were not effective, the provider had not established robust systems or processes to ensure the service was safe, well‑led or sustainable. Roles and responsibilities within the leadership and office team were unclear, which contributed to inconsistent oversight and gaps in quality monitoring. Audits of key areas such as daily notes, medicines, accidents, incidents and safeguarding were either not completed or were ineffective in identifying concerns or driving improvement.

The registered manager had a tracker in place to record incidents; however, this was not completed effectively and did not provide sufficient analysis or meaningful responses to concerns raised. This meant wider patterns, risks and learning were not identified or acted upon. We requested provider‑level audits to demonstrate oversight of the service and the effectiveness of governance systems. However, these were not submitted.

Leaders did not have the information they needed to understand the quality of care being delivered or to ensure people received safe, consistent and sustainable support. The lack of effective governance placed people at risk of harm and meant improvements were not identified or implemented in a timely way.

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.

The service did not work effectively in partnership with external professionals or community services to ensure people received safe and coordinated care. District nursing teams raised significant concerns about poor pressure care management, including failures to follow agreed care plans and delays in escalating deterioration. Several safeguarding referrals had been made due to avoidable declines in people’s skin integrity, indicating partnership working was not robust and risks were not being managed collaboratively.

Health professionals reported communication from the service was inconsistent and staff did not always respond to advice or share essential information in a timely way. This lack of effective joint working contributed to poor outcomes for people and undermined confidence in the provider’s ability to work as part of a wider health and social care system.

Leaders had not ensured partnership arrangements were clearly defined, monitored or embedded in practice, resulting in unsafe gaps in coordination and oversight.

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. They did not actively contribute to safe, effective practice and research.

The service did not have effective systems to support learning, improvement or innovation. Leaders did not demonstrate a clear understanding of the issues affecting quality and safety, and there was little evidence concerns, incidents or feedback were used to drive meaningful change. Where shortfalls had been identified such as missed visits, poor record‑keeping or concerns raised by external professionals, there was no structured approach to analysing what had gone wrong or implementing sustainable improvements.

There were no established forums for sharing good practice or reflecting on areas for development. Opportunities to embed wider learning from safeguarding incidents, complaints or audits were repeatedly missed, and the same issues continued to reoccur without effective action being taken.

The provider had not created an environment which encouraged innovation or continuous improvement. Systems to monitor quality were either absent or ineffective, and leaders did not demonstrate the capacity or capability to make the changes needed to ensure people received safe, high‑quality care. As a result, the service lacked the foundations required for sustained improvement.