Solsken Limited

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.