During an assessment under our new approach
Date of assessment: 18 November 2025 to 5 December 2025. Sambhana Care provides care and support to adults living in their own home. Sambhana Care Ltd had been rated Inadequate at the previous inspection and we undertook this assessment to follow up on enforcement action issued after our last assessment. At our last inspection we identified 8 breaches of regulation relating to the culture of the service, risk management, staffing, recruitment, safeguarding, governance, consent, and maintaining people’s dignity. We found there was a closed culture within the service, the provider was not open and transparent about incidents that had happened. At this inspection, significant improvements had been made, and the service was no longer in breach of any regulation. The provider had stepped back from day-to-day operations and had employed a new registered manager and new office staff, including supervisors and care co-ordinators. The service was also being over seen by a new operations manager who also is the Nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
At this inspection, we found that the service had made meaningful progress across most areas, particularly in culture, communication, training, care planning and staff supervision. People and families consistently told us they experienced kinder, more reliable care, and staff described clearer expectations under the new registered manager and nominated individual.
Despite this progress, improvements had not been yet fully embedded due to time. Governance systems—introduced only recently—had not consistently identified issues, and in some cases, inspectors identified concerns that internal audits had missed. This meant leaders could not yet fully assure themselves, at time of inspection, that care was safe and consistently managed.
Medicines management and risk assessment remained an area of concern. Although the registered manager had taken steps to improve practice, there were still gaps in MAR charts, incomplete audits and insufficiently detailed risk assessments. Some risks, such as the use of flammable creams, had not been appropriately assessed until raised during inspection. Once raised, these were remedied immediately.
Overall, the service is moving in the right direction, and many improvements have had a positive impact on people’s experiences. The registered manager and nominated individual had created a more open, supportive and responsive culture. Governance, medicines and risk management require further time to fully demonstrate appropriate oversight and consistency.
Feedback given to the registered manager and the nominated individual was accepted and acted upon immediately.
This service has been in Special Measures since 16 April 2025. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a time frame within which providers must improve the quality of the care they provide.
The registered manager demonstrated improvements that have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.