18 December 2020
As part of a pilot into virtual inspections of domiciliary and extra-care housing services, the Care Quality Commission conducted an inspection of this provider on 10, 11 and 12 November 2020. The inspection was carried out with the consent of the provider and was part of a pilot to gather information to inform CQC whether it might be possible to conduct inspections in a different way in the future. We completed this inspection using virtual methods and online tools such as electronic file sharing, video calls and phone calls to gather the information we rely on to form a judgement on the care and support provided. At no time did we visit the provider’s or location’s office as we usually would when conducting an inspection.
This inspection was carried out by two inspectors, one pharmacy inspector and six Experts by Experience. An Expert by Experience (ExE) is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the inspection
Before the inspection, we carried out telephone interviews with 17 people using the service and 57 family
members who gave their feedback on behalf of their relatives who could not do it themselves due to their health condition. We emailed and asked for feedback from care staff employed by the service and 15 staff responded. We received feedback from 20 external health and social care professionals. We reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed other information about the service such as satisfaction questionnaires that are sent to people using the service and their relatives prior to our visit and from notifications the provider is required to submit to the Care Quality Commission. Additionally, we requested that the provider uploaded on our online systems documents related to the service delivery so we could review them remotely.
During the inspection
During our visit, we spoke with the registered manager, the agency's founder, the chief executive officer (CEO) who was also the nominated individual and two members of the care staff team. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included 38 people’s care records and multiple medication records. We looked at 10 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
18 December 2020
This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the COVID-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the Provider.
About the service
SweetTree is a domiciliary care agency which provides personal care to people living in their own homes. At the time of our inspection, the agency provided support to a range of people including live-in-care. These included older people and people living with dementia, people with brain injuries and neurological conditions and people with learning disabilities. At the time of our inspection, the service was providing care to approximately 285 people. Each area of the service provision had its own specific care team led by a member of the management team. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
People using SweetTree and their relatives gave us excellent feedback about the service. They all said they would recommend the service to others. People using the service, their relatives, staff and external health and social care professionals all said that SweetTree dealt admirably with challenges posed by the pandemic and were able to provide a high quality of care.
We found that SweetTree had built on the previous high standards we had found. Since our last inspection SweetTree had launched a range of new initiatives to support people using the service, their families and the wider community. These included an upgraded internet website to respond to enquiries quicker. There was also an improved accidents, incident and complaints reporting system allowing staff and people to have instant access to the information and the support of managers when needed.
We found that SweetTree had responded to the Covid-19 pandemic in a systematic and well thought out way. There was a range of good practice which resulted in positive outcomes for people. These included the corporate pre-planning work to address the challenges of care provision during the pandemic. It also included the successful procurement of enough appropriate personal equipment planning. The individualised COVID-19 risk assessment of all people using the service and staff. The regular and current infection control training and emotional and practical support for people, their families and staff.
SweetTree’s mission, vision, values and ethics were at the heart of all decisions made by the senior management team. Anchored to that, thoughtful consideration of the service needs and bold and quick implementation of new ways of working meant that the service could provide the best care during the most challenging times.
The governance of the service was outstanding. Managerial responsibilities were allocated with consideration of specific roles as well as individual skills, experience, interests and talents of each manager. This meant the governance of the service was highly effective. The senior management team promoted career development within the service. They introduced a leadership and management framework to help to develop future leader and managers within the service.
Staff knew what was expected of them. Their roles were clearly defined through individual role descriptions for specific departments within the service. Staff skills were regularly improved through a range of training available from the service’s training academy. Staff were also regularly monitored through managerial checks of their direct work with people as well as regular supervision.
Staff were extremely caring for people who used the service and their families. All people and relatives spoke highly of staff who supported them. They said that although the COVID-19 pandemic affected the intensity of the support provided, staff still did all they could to reduce the impact of the pandemic on people. Staff contribution had been recognised by the service through the yearly Sweet Awards for the best care staff. Nominations for these awards were given by people who used the service.
Staff supported people to reach their full potential despite their health condition and wellbeing. There were detailed and personalised care plans formulated as a result of a collaboration between people using the service, their relatives and professionals. This meant that people were receiving care they needed and wanted. The individualised care was enhanced by skilful matching of care staff with people according to their interests, staff skills and experience.
Medicines were managed safely. People were protected from abuse by safely recruited and appropriately trained staff. Risks to people’s health and wellbeing had been assessed and staff had detailed guidelines about supporting people safely.
People told us they had lots of opportunities to provide feedback about the service. This was done through regular reviews and frequent contact with members of the management team. People and relatives told us that when issues arose, these had been dealt with quickly and to their satisfaction.
SweetTree had a range of community initiatives. They acted to support the local community and the general public by running webinars about later life, dementia and coronavirus to increase awareness about these topics. They also collaborated with the Skills for Care Charity and chaired the London Central registered manager network which supported registered manager from other services in London during the COVID-19 pandemic.
We received feedback from 20 external health and social care professionals who all gave a positive view of the service. They commended the service for a high level of training, the positive and caring attitude of staff towards people and their relatives and the excellent management of the service.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care maximised people’s choice, control and, independence. Care was person-centred and promoted people’s dignity, privacy and human Rights. Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection The last rating for this service was outstanding (published 08 January 2018).
Why we inspected
This was a planned pilot virtual inspection. The report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the COVID-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the Provider.
The pilot inspection considered the key questions of safe and well-led and provide a rating for those key questions. Only parts of the effective, caring and responsive key questions were considered, and therefore the ratings for these key questions are those awarded at the last inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for SweetTree Home Care on our website at www.cqc.org.uk.
We will continue to monitor information we receive about the service. If we receive any concerning information we may inspect sooner.