Solution2care Services Limited

About the service

Solution2Care is a domiciliary care agency providing personal and nursing care to people living in their own homes. The service provides support to children and adults with complex healthcare needs, as well as people living with dementia and people with learning disabilities and or autism. At the time of our inspection there were 84 people using the service including 14 children.

People’s experience of using this service and what we found

Right Support

At our last inspection we found 1 person was having inappropriate restrictive interventions. At this inspection the service had introduced a clear policy of no physically restrictive practice. At our last inspection some incidents which needed to be shared with the local authority safeguarding team and CQC had not been recognised as safeguarding concerns. At this inspection although we saw much improvement, we found 1 incident which had not been recognised as requiring a safeguarding alert to the local authority safeguarding team. Some care files lacked detailed guidance for staff on how to support people with specific care needs. Staff we spoke with were, however, knowledgeable about people’s care needs. People were supported by enough staff. Where possible care calls were made by the same staff to enable them to develop a good knowledge of how the person wished to be supported.

Right Care:

People’s care records showed varying levels of detail about their cultural needs, some contained basic details, some contained more information about people’s needs. At our last inspection, 2 people we spoke with did not know they had care plans. At this inspection we found steps had been taken to address this. People who could not read their care plans had the option of having them read out to them. Staff received training in safeguarding adults and children and policies and procedures were in place. Systems to safeguard people from the risk of harm were improved but had not enabled the management team to identify the need to escalate 1 safeguarding concern to the local authority safeguarding team.

Right Culture:

Systems to investigate and analyse incidents were much improved but still required further improvement to ensure safeguarding concerns were fully explored and responded to appropriately. This meant people were benefitting from better protection from harm, but there was still risk not all incidents would be investigated and shared appropriately. Systems to ensure risk assessments were robust had not identified some areas where guidance for staff was insufficient. In some care files guidance for staff was improved, showing improvement of care files was a work in progress. People and relatives told us they knew how to make complaints and share concerns. We found that recording, investigating, and learning from complaints and concerns was much improved. This meant people and relatives felt they were listened to and had more confidence concerns would be addressed.

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 supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 September 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found whilst improvements had been made, the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service was subject to safeguarding risks. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the systems in place to manage risk of safeguarding concerns. This inspection examined those risks.

This inspection was also carried out to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We have found evidence that the provider needs to make improvements to how safeguarding concerns are identified. Please see the well led section of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service remains ‘requires improvement’ based on the findings at this inspection.

Enforcement and Recommendations

We have identified breaches in relation to the governance systems in place to monitor and manage risks at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Solution2Care is a domiciliary care agency providing personal and nursing care to people living in their own homes. The service provides support to children and adults with complex healthcare needs, as well as people living with dementia and people with learning disabilities and or autism. At the time of our inspection there were 62 people using the service including 14 children.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support

One person was having restrictive interventions used without adequate assessment or training. This left the person at risk of inappropriate restraint. Some incidents and concerns which needed to be communicated to the local safeguarding authority and CQC had not been recognised as safeguarding concerns. Therefore, they had not been communicated to other agencies appropriately and not always fully investigated. Some risk assessments lacked detailed guidance for staff on how to support people with specific care needs. Staff we spoke with were, however, knowledgeable about people’s care needs. People were supported by adequate numbers of staff. Where possible care calls were made by the same staff to enable them to develop a detailed knowledge of how the person wanted to be supported.

Right Care

Some people’s care records did not contain much information about their cultural needs. However, the staff we spoke with knew people well. Two people told us they did not know they had care plans. One said they would need assistance to read the care plan, and this had not been offered. Staff had received training in safeguarding adults and children and policies and procedures were in place. These were not always followed. This meant the management team could not demonstrate they had done everything they could to ensure people were protected from the risk of abuse and future risk.

Right Culture

Systems to investigate and analyse incidents for learning opportunities were not always effective. Some incidents were not being recorded and analysed. This meant learning to prevent future risk and improve care was limited. Systems to investigate and address complaints had not always done so effectively. Some complaints had not been formally investigated. Formal apologies to people and relatives had not always been made when things had gone wrong. This meant opportunities to learn from complaints could have been lost and the learning culture was not as open as it could be. Staff told us they felt supported by the management team and they felt the induction was helpful in preparing them for their role.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 good (published 03 August 2022).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of neglect. This inspection examined those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. At this inspection we found the provider was in breach of regulations.

You can see what action we have asked the provider to take at the end of this full report. The provider has agreed to review policies and procedures to ensure practice is effective and in line with regulatory requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Solution2care Limited on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the systems in place to protect people and ensure safe treatment and care, how complaints were investigated and responded to and the oversight and management of governance systems at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Solutions2care services limited provides personal care and support to adults and children living in their own homes. The services supports some children and adults who have complex clinical needs. The support provided can include 24-hour care and support for children to access education. At the time of our inspection there were 27 people using the service. This included 13 adults and 14 children.

People’s experience of using this service and what we found

People were supported by staff that understood their individual needs. They had been trained and understood how to protect people from abuse. People received their medicines when they needed them, and staff worked closely with healthcare professionals to ensure people’s healthcare needs were monitored and met. Systems were in place to reduce the risk of infection, and to review any incident and accidents to see if there were any lessons to learn from these.

People received a consistent and reliable service from staff who were described as caring, competent and supportive. Staff felt supported and had access to information to guide them in their role. People and relatives told us they were happy with the service provided, and they knew who to contact if they had any concerns. Feedback was actively sought about the quality of the care being provided.

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 supported this practice.

Systems were in place to monitor the delivery of the service and to drive improvement. The registered manager was responsive to our feedback and made changes to their practices where required to ensure safe systems were in place.

Rating at last inspection the last rating for this service was good (published 28 February 2019).

Why we inspected

We received concerns in relation to how risks to people’s safety were being maintained and the competencies and training of staff providing clinical support to people. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained as good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, and effective sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Solutions2care services limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We gave the provider 24 hours' notice to ensure someone would be available at the office.

This was the first rated inspection of Solution2care Services since it was registered in 2017.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to children and older adults. At the time of inspection 24 children and five adults were using the service.

A registered manager was in place. 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 2008 and associated Regulations about how the service is run.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. There were other opportunities for staff to receive training to meet people’s care needs. A system was in place for staff to receive supervision and appraisal and there were appropriate recruitment processes being used when staff were employed.

People, relatives and staff told us they felt safe with the service. They trusted the workers who supported them. They thought there were enough staff to provide safe care to people. However, not all people said they received a reliable and consistent service. We have made a recommendation that best practice guidelines are followed when planning staff rosters.

Risk assessments were in place and they identified risks to the person as well as ways for staff to minimise or appropriately manage those risks. Care plans were in place that provide some guidance about how people wished to be supported. Staff knew the needs of the people they supported to provide individual care. Care was provided with kindness and people’s dignity was respected.

People were involved in decisions about their care. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

People were supported to access health care professionals, if needed, to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People had food and drink to meet their needs.

Care was provided with kindness and people’s privacy and dignity were respected. Communication was effective to ensure staff and relatives were kept up-to-date about any changes in people’s care and support needs and the running of the service.

A complaints procedure was available. People told us they would feel confident to speak to the registered manager and staff if they needed to.

A range of systems were in place to monitor and review the quality and effectiveness of the service. However, they needed to be more robust to ensure people received a reliable and consistent service. People had the opportunity to give their views about the service. There was regular consultation with people and their views were used to improve the service.