• Community
  • Community healthcare service

Solsken Limited

Overall: Good read more about inspection ratings

23-25 Market Street, Crewe, CW1 2EW 07399 076011

Provided and run by:
Solsken Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

Wednesday 30 November to Friday 02 December

During an inspection looking at part of the service

We carried out this short notice announced inspection of this service because at our last inspection in February 2022 we rated the service overall as inadequate and the service remained in special measures. We gave the service short notice the day before the inspection visit because it supports people across a large area, and we needed to be sure that the registered manager would be available.

Our rating of this location improved. We rated it as good because:

  • The service had made a number of improvements since our last inspection to improve the quality and safety of the service.
  • The service had enough staff to care for clients and keep them safe. Staff had training in key skills, understood how to protect clients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to clients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
  • Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of clients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated clients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to clients, families and carers.
  • The service planned care to meet the needs of local people, took account of clients individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of clients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with clients and the community to plan and manage services and all staff were committed to improving services continually.
  • We found the provider was embedding a supervision process that sought to meet the needs of the staff as a priority. The supervision process focused on points of contact for staff which included clinical and managerial supervision but also included more focused and individualised sessions in terms of probation meetings, welfare checks, spot checks, themed supervisions, team meetings and appraisals.
  • We found the providers use of information technology in the community was maintaining good quality records and managing effective communication between staff and managers. There was good governance, audit and oversight of this.

01-02 February and 9-10 February 2022

During a routine inspection

We carried out this short notice announced inspection of this service because at our last inspection in July 2021 we rated the service overall as inadequate and issued the service with a Section 29 warning notice indicating areas requiring significant improvement. We gave the service short notice the day before the inspection visit because it supports people across a large area, and we needed to be sure that the registered manager would be available.

This was a full inspection of the service whereby we reviewed all the key lines of enquiry within all domains.

Our rating of this service stayed the same. We rated the service as Inadequate because;

  • At the last inspection, we issued a Section 29 warning notice to the service. It stated that improvements must be made to ensure people were protected from the risk of harm. At this inspection, we found that there were remaining areas of concern which had not been entirely addressed by the service.
  • Substantial and frequent staff shortages posed increased risks to people who use the service. The service did not have enough staff to keep patients safe from avoidable harm and to provide care and treatment. There were not enough staff to cover all shifts meaning that family members often had to provide care for patients. Staff were working excessive hours and were unable to take breaks. The service continued to have a high turnover of staff which impacted on consistency of care.
  • Staff did not feel respected, supported and valued and feedback from staff and families of patients was that managers were not always visible or approachable within the service.
  • Managers did not ensure that staff responsible for training others within the service were competent, trained and appropriately qualified to do so, and did not ensure all staff had undertaken required competency training. Following our last inspection managers had enrolled senior support staff on adult care apprenticeships to support their development and role responsibilities but were not monitoring progress with this and we found a number of staff were behind expected targets.
  • The delivery of high-quality care is not assured by the leadership, governance or culture. The service did not have an organisational risk register, or similar, to identify and mitigate risks to the service. There was no policy, procedure or oversight of staffing concerns including gaps in care provision and staff working excessive hours, effectiveness of contingency plans, sleep in shifts, and overall wellbeing of staff.
  • There was little understanding of the importance of culture. There were low levels of staff satisfaction, high levels of stress and work overload. Staff did not feel respected, valued, supported or appreciated.
  • The service used a combination of electronic and paper records and we found that records were not always up to date. It was unclear how important patient information was handed over when family members were providing care and it was unclear how lessons learned were cascaded amongst all staff following incidents.
  • Whilst the service had made some improvements to their complaints process since our last inspection, some families still told us they had not received a response or resolution to a concern raised. The provider did not make it clear how complainants could escalate concerns beyond the service if they were dissatisfied with an outcome.
  • Over half of the families we spoke with raised concerns with regards to staffing and told us they were regularly covering shifts due to lack of staff, and that this was having a detrimental effect on their own physical and mental health.

However:

  • Care records were holistic, and personal to each individual patient.
  • Patients and their families told us, and we observed, that support staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. They were focused on the needs of patients receiving care.
  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Staff controlled infection risk well. They used equipment and control measures to protect patients, themselves and others from infection. Staff managed clinical waste well.
  • Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

Letter from the Chief Inspector of Hospitals

This service was placed in special measures in July 2021.

Insufficient improvements have been made such that there remains a rating of inadequate for any core service, key question or overall.

We will add full information about our regulatory response to the concerns we have described to a final version of this report, which we will publish in due course.

14 July 2021 to 23 July 2021

During a routine inspection

Our rating of this location is inadequate because:

  • Immediately following this inspection we took enforcement action and issued a Section 29 warning notice to the provider. This was to tell them that they needed to make significant improvements to the safety and governance of the service. We were concerned that people were at risk of avoidable harm.
  • We had concerns about the safety of the service because staff had not undertaken the training required to ensure they could perform their roles safely. There were not always enough staff available and this meant that some staff were working excessive hours, were unable to attend training and could not take annual leave. The service had a high turnover of staff which impacted on the consistency of care delivered to people.
  • The service did not keep track of incidents within the service to ensure learning and improvement.
  • During our inspection we observed that staff did not always wear personal protective equipment.
  • Staff did not receive regular and effective supervision and appraisal.
  • Although staff delivering care were kind and compassionate and conscientious in their roles, we could not be assured that all service users received kind and compassionate care. This was because the service did not monitor this. Not all patients and carers were receiving person centred care. Two relatives raised concerns about the treatment received.
  • There was mixed feedback from carers and inconsistency in experiences with the service. Some carers told us they found it difficult to contact managers, that they felt communication was poor and they did not know the process to complain.
  • The service was not well led. Senior health care assistants were not adequately prepared to undertake their management roles. There was limited oversight of the service as a whole and a lack of governance systems or processes to monitor risks and provide assurance. The service had no risk register or similar process to identify and highlight risks to the service and plan mitigations, for example, relating to staffing recruitment and retention. There were few systems to track actions and monitor progress, for example in relation to safeguarding, and incidents. Where systems were in place these were not effective because actions were not always taken to address concerns.
  • There was no process to review key items such as the strategy, values, objectives, plans or the governance framework.

However:

  • Some carers gave positive feedback about the core staff who delivered care to their loved ones. They told us that managers were easily contactable, they received feedback regularly and that they were aware of how to raise concerns.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • We reviewed five care and treatment records. Care plans were well written and reflected good practice guidance.

Letter from the Chief Inspector of Hospitals

I am placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.