We carried out a review of the data available to us about SweetTree Home Care Services on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about SweetTree Home Care Services, you can give feedback on this service.
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.
Follow up
We will continue to monitor information we receive about the service. If we receive any concerning information we may inspect sooner.
This inspection took place on 9 and 10 October 2017 and was announced. At the last inspection on 24 August 2015 we found the service was rated 'Good' in all key questions and overall. At this inspection, we found the service was Outstanding in the Responsive and Well-Led domains.
SweetTree is a domiciliary care agency which provides home and live in care across London. At the time of our inspection, the agency provided support to a range of people. These included elderly and people living with dementia, people with brain injuries and neurological conditions and people with learning disabilities. Each area of the service provision had its own specific care team led by a member of the management team.
At the time of our inspection there was no registered manager appointed. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The previous registered manager had left in September 2017 and the agency had planned to appoint three new managers for each area of the service provision. This was to ensure that section of the service would be managed by a skilled and experienced manager. Following the inspection, the Director on Operations informed us, that three new managers were appointed and they would be submitting their individual applications for registration with the Care Quality Commission (CQC).
Although there was no registered manager at the time of our inspection, the agency continued to deliver seamless and professional care. This was due to the senior management team, including both managing directors and respective service directors and managers, having an exceptional understanding of all the matters related to providing care to people who used the agency. Our conversations with members of the senior management team confirmed that they knew the service very well and they were able to manage it to the high standard. Therefore, we were reassured that the exceptional service would not be affected even if the registered manager was not in post at the time of our visit.
At the time of our inspection, SweetTree provided the registered activity of personal care to approximately 380 people and employed approximately 500 staff members including 64 members of the office team.
The agency was exceptionally well led. There was strong leadership at all levels. The senior management team had been actively involved in all aspects of service provision and had very good knowledge about the business needs of the service provided and the satisfaction level of people who used it. This had been achieved through a variety of robust quality monitoring systems. These included internal and external quality audits and quality questionnaires completed by staff, people who used the service and their relatives.
Staff told us they were well supported by the management team and they thought they could approach them with any issues related to their professional roles and responsibilities. The senior management team had recognised staff efforts and their positive contribution to the quality of the service. They had introduced “The Jairo Medina Award”, to honour the memory of an ex-employee who had tragically lost his life in August 2016. Monthly Sweet Awards, a staff good practice recognition rewards scheme, were presented to staff to acknowledge positive feedback given to staff by people they supported and their family members.
There were a number of partnership initiatives. The aim was to continuously improve the positive experience of people who used the service and their families and increase awareness of the challenges and positive outcomes when working with people who need the support of others. This included the development of a National Dementia Carers Day in partnership with the Alzheimer’s Society and Dementia UK. In addition, the development of a series of training workshops for those professionals who wished to increase their knowledge and understanding on care related subjects. The agency had also worked with the University College of London (UCL) on implementing Cognitive Stimulation Therapy (CST) that aimed at the reduction of the cognitive decline of people with mild to moderate dementia. Since the beginning of 2017, the agency had also started hosting quarterly Registered Managers Forums where representatives of various agencies in the area could share their experience and good practice of service delivery.
The agency provided exceptional, all-round support to people who used the service as well as their family members. A matching process was used so that people received support from the most appropriate staff member. Common interests, culture, gender or languages spoken were taken into consideration. This meant that positive relationships could be developed between staff and people who used the service.
People’s care needs had been thoroughly assessed and they formed comprehensive care plans that took into consideration people’s care needs and cultural and religious preferences. People were involved in planning and reviewing their support and they said they felt in charge of care provided to them.
Relatives had been supported by a specially appointed Admiral Nurse whose role was to provide practical, clinical and emotional support to families living with dementia. Additionally, the agency had been working on a research project aiming at better understanding of the experience of families having a support staff living in their home. This meant, the agency had been aware of the impact of a person’s complex care needs on the whole family.
People using the service and their relatives uniformly gave us positive feedback about the support they received and the staff who supported them. They told us they were usually supported by the same staff who knew their needs and preferences well. They also thought the staff were very well trained to care for them effectively and they felt safe when they received support.
The agency had appropriate policies and procedures in place to ensure people received safe care. Robust recruitment procedures ensured only suitable staff were employed to work with people. Any risks to people’s health and wellbeing had been well documented and staff had comprehensive guidelines on how to manage and minimise identified risks. Staff knew what to do if they thought people were at risk of harm and abuse. They also knew how to manage people’s medicines safely and what actions to take in case of an emergency.
There were sufficient staff deployed to ensure all scheduled calls had taken place as agreed. The agency’s monitoring systems ensured that any staff absences were covered and people were informed in good time if any changes had to be made.
The agency had its own Training Academy that provided Continuing Professional Development (CPD) accredited training to all staff members employed by the agency. Therefore, staff had received in-depth training that had been tailored to the needs of people they supported. Staff also received regular support in the form of quarterly monthly one to one meetings in which they discussed their professional role, work satisfaction, training needs and opportunities and the support provided to people.
The agency had worked within the requirements of the Mental Capacity Act (2005), there was evidence of best interest meetings and other appropriate consultations taking place to ensure people’s human rights had been respected and protected.
People were supported to have a nutritious diet, which was appropriate to their needs and personal preferences. Staff had been provided with necessary guidelines on how to support people safely. Staff also supported people in having access to health care professionals when required.
Staff spoke kindly about people and said they enjoyed their work. Evidence showed that staff respected people’s privacy and dignity at all times and people said they felt comfortable with staff when receiving care.
The agency had a complaints procedure in place. The majority of people told us they never had to complain, and those who had complained said the agency had dealt with complaints immediately and to their satisfaction.
SweetTree is a home care agency based in North London which provides domiciliary and live in care predominantly across London.
At the time of our inspection the provider employed a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
The provider took the appropriate steps to ensure that staff were safe and suitable people to provide care and support. Keeping people safe was important to the service and people we spoke with had confidence in the ability of the service to keep them safe and to respond to any concerns if they arose.
We looked at the training records of eight staff. We saw that in all cases essential training had been undertaken and the type of specialised training they required was tailored to the needs of the people they were supporting. We found that staff supervision was provided using a system called facilitations which combined staff supervision with on-going appraisal.
People’s human rights were protected and the service was diligent with ensuring that the requirements of the Mental Capacity Act (2005) were complied with. Proper consideration and consultation took place to protect people’s human rights.
People who used the service had a variety of support needs, in some cases highly complex needs, and from the nine care plans we looked at we found that the information and guidance provided to staff was clear. Any risks associated with people’s care needs were assessed, and the action needed to minimise risks was recorded. We found that risk assessments were updated regularly.
During our review of care plans we found that these were tailored to people’s individual needs. Communication, methods of providing care and support with the appropriate guidance for each person’s needs were in place and consent to care was obtained.
We found that staff respected people’s privacy and dignity and worked in ways that demonstrated there was diligence at ensuring this. From the conversations we had with people, our observations and records we looked at, we found that people’s preferences had been recorded and that staff worked very well to ensure these preferences were respected.
From the discussions we had with people using the service, relatives and other stakeholders we found that people were usually highly satisfied with the way the service worked with people. There was confidence about contacting all staff at the service to discuss anything they wished.
Records which we viewed showed that people were able to complain and felt able to do so if needed. People could therefore feel confident that any concerns they had would be listened to and the service was open about action taken and changes made as a result.
People's needs were assessed and reviewed regularly. We noted that staff arrived on time and completed all the tasks before they left. The agency had a sufficient number of staff to ensure that shifts were covered and people's needs were met.
The agency had systems in place to ensure that people who used the service were protected from harm. People told us that staff were "not patronising" or "condescending". They told us they felt "safe" using the service. People and their relatives told us that they knew how to make a complaint if they were not happy about the service.
We saw that care workers were aware of safeguarding policies and that they were able to identify concerns and take appropriate action as necessary. One care worker told us that 'the training is really good'. Care workers we spoke with felt supported and felt able to raise concerns with their managers when necessary. There were regular opportunities for the people who used the service, their relatives and care workers to feed information back to the service. There were robust complaints procedures and complaints had been dealt with well.
People we spoke with confirmed that a care plan file is kept in their home and that care workers make a record of the visit.
People we spoke with said that if they had a concern or a complaint they would feel confident to raise this with the staff that work with them or report this to a manager. People indicated that they were satisfied with the response of the service.