Date of Assessment: 29 to 30 September 2025. Bikur Cholim Ltd is a homecare agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection there were 60 people using the service. At this assessment the rating has changed to requires improvement. We found breaches of 3 regulations in relation to safe care and treatment, staffing and good governance. The service did not always have a proactive and positive culture of safety. They did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. Staff did not always assess risks to people's health and safety or mitigate them where identified. There were no robust and safe recruitment practices in place to make sure all staff, including agency staff, were suitably experienced, competent, and able to carry out their role. The service did not always make sure staff received effective support, supervision and development. The service did not ensure that medicines were managed safely. The provider did not always make sure people’s care and treatment were effective. People did not always have care plans to guide safe practice. Governance systems and audits were not effective in identifying or addressing areas for improvement. However, people knew how to give feedback, and staff told us they felt supported and encouraged to speak up. The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The service worked with people and staff to ensure there was continuity of care. The provider cared about and promoted the wellbeing of their staff. The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.
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Bikur Cholim Ltd was rated Good overall at its April 2018 inspection, demonstrating improvements in medicines management since a previous breach identified in 2016. Minor recommendations were made regarding more detailed risk assessments and fuller application of the Mental Capacity Act 2005, and the service was operating without a registered manager at the time of inspection.
Concerns (4)
moderateConsent / capacity — “Where people lacked capacity to consent to their care the provider had not followed the principles of the Mental Capacity Act (MCA) 2005.”
minorCare planning — “Some risk assessments lacked some detail about how to mitigate risks. For example, one person was at risk of malnutrition. The risk assessment gave minimal guidance.”
minorRecord keeping — “The provider had a mental capacity assessment template with the MCA policy however they were not using this template.”
minorStaff training — “We noted first aid training had not been offered for the period of 2016 to 2017.”
Strengths
· Medicines were managed safely with accurate, up-to-date records and monthly checks by senior staff.
· Staff demonstrated a good understanding of safeguarding adults and whistleblowing responsibilities.
· Safe recruitment practices in place with DBS checks, references and identity verification completed before staff worked unsupervised.
· People's cultural and religious needs were respected, with a bespoke guide for carers supporting the Orthodox Jewish community.
· Care plans were person-centred and detailed, covering health, social and personal care needs.
Bikur Cholim Ltd was rated Requires Improvement overall following a November 2016 inspection, with one regulatory breach (Regulation 12) identified due to inadequate risk assessments and unsafe medicines recording practices. The service demonstrated genuine strengths in culturally sensitive, caring support for the Orthodox Jewish community, but required improvement in medicines management, MCA training, risk assessment, supervision frequency, and audit effectiveness.
Concerns (7)
criticalMedication management — “staff were not always completing the medicine administration records (MAR's) correctly as there were a number of gaps where staff had failed to sign the MAR”
criticalCare planning — “risks that had not been fully assessed and some risk assessments had not been completed correctly to show how these risks could be reduced”
moderateStaff competency — “regular medicines competency checks had not been completed to ensure that staff were safely supporting people with their medicines”
moderateConsent / capacity — “staff had not received training in MCA therefore we could not be assured that staff fully understood the principles in relation to the Act”
moderateGovernance — “although some of the areas we checked had been identified through the provider's audit processes, these did not pick up the concerns relating to risks and medicines”
minorSupervision / appraisal — “frequency of this varied from once to twice a year...in one staff file we found their appraisal had not been completed”
minorRecord keeping — “daily records and care plans needed to be more person centred in respect of people's individual preferences and what support they received”
Strengths
· Staff were kind, caring and treated people with dignity and respect; relatives shared consistently positive feedback about care quality.
· People received visits at requested times with continuity of care from the same staff members.
· The service provided additional funded support hours through its charitable status to fully meet people's needs.
· Staff had a culturally specific 'guide for carers' and training to meet the needs of the Orthodox Jewish community.
· Safeguarding procedures and training were in place; staff could identify and report suspected abuse.
Quality-Statement breakdown (15)
safe: Medicines managementRequires improvement
safe: Risk assessmentRequires improvement
safe: SafeguardingGood
safe: Staffing and visit punctualityGood
effective: Staff training and developmentRequires improvement