The assessment was carried out due to an aged rating and took place from 9 December 2025 to 16 January 2026. Bespoke Care and Support Services is a domiciliary care service providing personal care to people living in their own homes. At the time of our assessment the service was supporting 77 people with the regulated activity of personal care. We identified 4 breaches of the legal regulations during this assessment. The breaches were in relation to safeguarding, good governance, staffing, and fit and proper persons. We found although safeguarding concerns were investigated, they were not always escalated to the local authority, and the required statutory notifications were not sent to the Commission. Staff were not up to date with required training and had not always been recruited safely. The governance of the service was not always robust enough to identify the areas for improvement we found during this assessment. The registered manager provided assurance that improvements to some of the issues we found at this assessment would be addressed promptly. People and their relatives were involved in their care planning, although some care plans lacked risk assessments. Some records required more detail to help guide staff in how to recognise and escalate concerns. People felt safe and told us staff understood and met their needs. Staff supported people kindly, with dignity and respect. Staff encouraged people to be independent and have choice over their care where they were able to. People and their relatives provided mainly positive feedback about the service, but we identified some concerns around the timing and length of calls. Staff worked in partnership with other professionals to ensure people’s needs were met. The service was not currently supporting anyone with care at the end of their life and had not recorded people’s future wishes. We have asked the provider for an action plan in response to the concerns found at this assessment.
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Bespoke Care & Support Services received an overall rating of Requires Improvement at its September 2017 inspection, with regulatory breaches found in staff training, supervision and appraisal (Regulation 18) and good governance including absent mental capacity records (Regulation 17). The service was rated Good for caring and responsive, reflecting strong person-centred practice and positive feedback from people and relatives.
Concerns (9)
criticalSupervision / appraisal: “Staff had not received supervision, appraisal and training to make sure competence is maintained and to acquire skills to carry out their roles.”
criticalStaff training: “The registered provider was not meeting this standard in relation to supervision and appraisal...not all staff told us they had their competency to administer medicines checked.”
criticalGovernance: “Systems and processes had not been robust in identifying gaps in service provision and improving practice.”
criticalConsent / capacity: “We found two stage capacity assessments in some of the care files we looked at but they were absent in others, when the information indicated the person did not have capacity.”
criticalRecord keeping: “Records such as mental capacity assessments and best interest decisions were not in evidence.”
moderateStaff competency: “Not all staff told us they had an assessment of their competency to move people safely and they had highlighted they required further training in this area.”
moderateMedication management: “The record did not always contain information to advise what the medicines were for and when they should be administered.”
moderateSafeguarding: “One person had started work three weeks before their DBS had been returned...there was no risk assessment in relation to this.”
minorComplaints handling: “Complaints or concerns...were not compiled and the registered provider was unable to show how they had analysed and responded to information gathered.”
Strengths
· People and relatives spoke highly of care staff, describing them as caring, respectful and person-centred.
· Staff demonstrated good understanding of safeguarding and how to report concerns.
· Electronic monitoring system provided real-time oversight of staff attendance and medicines administration.
· Detailed, outcome-focused care plans supported person-centred and independence-promoting care.
· Positive workplace culture; staff motivated and supported by colleagues and management.
Quality-Statement breakdown (17)
safe: SafeguardingGood
safe: RecruitmentRequires improvement
safe: Medicines managementRequires improvement
safe: Risk assessmentGood
effective: Staff training and competencyRequires improvement
effective: Supervision and appraisalRequires improvement
Bespoke Care & Support Services received a Good rating across all five key questions at its April 2015 inspection, with 16 people receiving care that was consistently described as respectful, person-centred and responsive. Minor gaps included transferred staff lacking written references and an overall service audit not yet completed, but neither constituted a regulatory breach.
Concerns (2)
minorRecord keeping: “new staff were required to have two references but the staff that had transferred over from the previous agency did not have two references”
minorGovernance: “The service had not yet completed a whole service audit which they had planned to do in June 2015 but individual audits were undertaken”
Strengths
· Staff demonstrated strong safeguarding knowledge and could describe actions to take if abuse was suspected
· Detailed, person-centred risk assessments and care plans that were regularly reviewed
· Staffing levels maintained to high standards; provider turned down packages rather than compromise quality
· Comprehensive staff training programme including workbooks, online tests, supervision and spot checks
· Highly positive feedback from people using the service and relatives about caring, respectful staff
Bespoke Care & Support Services improved from Requires Improvement to Good overall following a previous breach of regulations around training, supervision and governance, with all areas now meeting requirements except Effective. The sole remaining weakness is inconsistent application and recording of Mental Capacity Act best interest decisions, with a recommendation issued to the provider to implement best practice guidance and strengthen staff knowledge.
Concerns (3)
moderateConsent / capacity: “The provider was completing mental capacity assessments and best interest decisions but these were not always recorded separately for each specific decision.”
moderateRecord keeping: “Staff's understanding around this area required improvement. We recommended the provider researches and implements best practice guidance to ensure specific decisions made in people's best interest are appropriately recorded.”
moderateStaff competency: “Staff confirmed they had received training in this area however their knowledge on how to apply the MCA to their work was not robust.”
Strengths
· Medicines were safely managed using an electronic medicines management system with regular auditing and competency assessments
· Safe recruitment procedures in place including DBS checks and employment history verification
· Staff received ongoing training, supervisions, appraisals and competency observations
· People and relatives consistently praised staff as kind, caring, compassionate and respectful
· Person-centred care plans were detailed and regularly reviewed with people's involvement
Quality-Statement breakdown (23)
safe: Risk assessment and managementGood
safe: Medicines managementGood
safe: SafeguardingGood
safe: Safe recruitmentGood
safe: Staffing levelsGood
safe: Infection controlGood
effective: Mental Capacity Act compliance and best interest recordingRequires improvement
effective: Staff training and inductionGood
caring: Involvement in care
Good
responsive: Person-centred care planningGood
responsive: Complaints handlingGood
well-led: Leadership and cultureGood
well-led: Governance and quality monitoringGood
effective: Supervision and appraisal
Good
effective: Nutrition and hydration supportGood
effective: Access to healthcare servicesGood
caring: Kindness, compassion and dignityGood
caring: People's involvement in careGood
caring: Privacy and dignityGood
caring: Equality, diversity and human rightsGood
responsive: Person-centred care planningGood
responsive: Consistency of care workersGood
responsive: Complaints handlingGood
responsive: Accessible information and communicationGood
well-led: Quality assurance and governanceGood
well-led: Leadership and cultureGood
well-led: Staff engagement and communicationGood
well-led: External partnerships and collaborationGood