Solution2Care Services Limited retains an overall rating of Requires Improvement following its December 2023 inspection, with a continued breach of Regulation 17 (good governance) due to failure to identify and escalate a safeguarding concern to the local authority, despite notable improvements in complaints handling, restraint policy, infection control, and medicines management since the previous inspection. The service is rated Good for effective and caring domains, but weaknesses in care plan detail, communication needs, end-of-life planning, and governance oversight continue to present risk.
Concerns (8)
criticalSafeguarding: “1 incident which had not been recognised as requiring a safeguarding alert to the local authority safeguarding team.”
criticalGovernance: “Systems to ensure the quality of performance and compliance with regulatory requirements had not consistently enabled the registered manager and provider to identify failings.”
moderateIncident learning: “Systems in place to address, investigate and learn from when things go wrong were much improved. However, they had not identified an incident which needed to be shared with the local authority safeguarding team.”
moderateCare planning: “Some care files lacked detailed guidance for staff on how to support people with specific care needs.”
moderateCommunication with families: “Two people told us they had had difficulty in communicating with staff. One person told us they felt 1 carer was not able to speak English at all.”
moderateEnd-of-life care: “A care plan for a person receiving end of life care was very basic and did not contain much detail about the person's needs and wishes.”
moderateRecord keeping: “Guidance on catheter care was not always sufficiently detailed and the positioning of a person during percutaneous endoscopic gastronomy (PEG) feeds was not addressed.”
minorMedication management: “Systems had failed to enable staff to seek medical advice about a possible missed medication in a timely way.”
Strengths
· No restraint policy introduced and embedded across the service following previous breach of regulation 12.
· Robust staff recruitment processes including DBS checks and visa verification for overseas staff.
· Staff demonstrated strong knowledge of individual people's care needs despite gaps in written care plans.
· Complaints handling significantly improved; people and relatives felt heard and responded to.
· Medicines management safe with electronic system being introduced and PRN/cream guidance clear.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink; working with other agencies; accessing healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Meeting people's communication needsRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Duty of candour; continuous learning and improving careGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
Solution2care Services Limited received an overall rating of Requires Improvement following a focused inspection of Safe and Well-led, with Well-led rated Inadequate due to breaches of Regulations 12, 16, and 17 relating to unsafe risk assessment of restrictive interventions, failure to investigate complaints, and inadequate governance systems. The inspection was prompted by a notifiable incident involving a person's death, and enforcement warning notices were served in relation to safe care and good governance.
Concerns (11)
criticalSafeguarding: “Some incidents which required investigation to determine whether abuse had occurred had not been shared with the local authority safeguarding team.”
criticalSafeguarding: “A risk assessment had failed to identify the inappropriate use of restrictive intervention for 1 person...left the person at risk of avoidable harm.”
criticalGovernance: “Systems to ensure the quality of performance and compliance with regulatory requirements had not consistently enabled the registered manager and provider to identify failings.”
criticalComplaints handling: “Systems to investigate and act upon complaints were not robust. This meant complaints were not always fully investigated and people did not always receive clear outcomes.”
criticalLeadership: “The registered manager and provider had failed in their legal duty to notify CQC of some notifiable incidents.”
moderateIncident learning: “Incidents were not always recorded and analysed effectively...Opportunities to learn were missed because the information gathered to feed into the systems was insufficient.”
moderateRecord keeping: “1 person's file lacked guidance for staff on how to support a person's mobility needs. Another file lacked guidance on percutaneous endoscopic gastrostomy (PEG) care.”
moderateCare planning: “Two people told us they did not know they had a care plan. One person commented due to a disability, they would need help to read the care plan, but this help had not been offered.”
minorCultural competency: “Some people's care records contained limited information about how the needs defined by their equality characteristics could be met...limited or no information about people's religious or spiritual needs.”
minorConsent / capacity: “Documentation about people's ability to make decisions for themselves was not always very clear.”
minorInfection control: “Some people told us carers had been running out of gloves. One person told us they had been giving carers gloves from their own supply.”
Strengths
· People were supported by sufficient numbers of staff, with consistent carers assigned where possible.
· Staff recruitment processes were robust, including DBS checks and visa verification for overseas staff.
· Staff induction was effective and tailored to the needs of people being supported.
· Medicines were managed safely with electronic medicines management being introduced and staff competency assessed via spot checks.
· Staff were knowledgeable about people's care needs and knew them well.
Solution2care Services Limited received a Good rating across all five key questions at its first rated inspection in February 2019, with staff demonstrating kind, person-centred care and robust safeguarding and recruitment practices. Minor concerns were noted around consistency of care workers, gaps in behavioural care planning, and the need for more robust quality monitoring to ensure reliable and consistent service delivery.
Concerns (5)
moderateStaffing levels: “We don't always get two staff at the calls when [Name] has been assessed as needing two support workers four times a day.”
moderateCare planning: “A behavioural care plan was not in place to provide guidance for staff to follow when the person became distressed.”
minorPerson-centred care: “[Name] has the same care workers 40% of the time. Don't always get to know if someone different coming”
minorCare planning: “They provided some detail but did not give instructions for frequency of interventions and what staff needed to do to deliver the care in the way the person wanted.”
minorGovernance: “Discussion took place with the registered manager to ensure effective monitoring and audits captured people's comments about any lateness of calls or changes in workers'.”
Strengths
· Staff received safeguarding training for both children and adults and could describe appropriate steps to take if concerned about safety.
· Robust recruitment processes including DBS checks and employment references before staff commenced work.
· Staff received regular supervision every two to three months and opportunities for further training including specialist and end-of-life care training.
· Care plans were person-centred with detailed communication profiles including gestures and facial expressions for non-verbal individuals.
· Positive feedback from external agencies including children's disabilities and Looked After children's teams.
Solution2care Services Limited, a domiciliary care agency supporting 27 adults and children with complex needs, retained its overall Good rating following a focused inspection of safe, effective and well-led domains triggered by concerns about risk management and staff competency. No evidence of harm was found; minor record-keeping and care plan gaps were identified and promptly addressed by the registered manager during the inspection.
Concerns (3)
minorRecord keeping: “physical evidence of their full employment with gaps explored and explained was not initially available for three of the four staff files we reviewed”
minorCare planning: “We found for one person their care plan had not been updated to reflect their current needs. The registered manager agreed to address this.”
minorGovernance: “audits of medication records were completed only a sample of these were reviewed each month...a couple of gaps had not been explored and the rationale provided”
Strengths
· People received support from a consistent core team of staff with rotas including travelling time provided in advance
· Staff received enhanced training for specific medical conditions and clinical procedures, with competency observed by the clinical lead
· Electronic systems monitored delivery of care including call times and durations, enabling proactive management of late visits
· Strong multi-agency working with occupational therapists, dieticians, district nurses, hospital specialists and children's disability teams
· Registered manager demonstrated duty of candour awareness and was responsive to inspection feedback, making immediate practice changes
Quality-Statement breakdown (16)
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood