Solsken Limited improved from Inadequate to Good across all five key questions following a short-notice announced inspection in November–December 2022, successfully exiting special measures after addressing eight prior regulatory breaches. Minor gaps remained around risk register dating, duty of candour tracking, an outdated complaints policy copy, and contingency plan signature clarity, but no breaches of regulation were identified at this inspection.
Concerns (4)
minorGovernance: “there were no dates on the risk register, for initial risk rating, target dates or review dates.”
minorIncident learning: “the services incident reporting tracker did not indicate when duty of candour letters was sent following an incident.”
minorRecord keeping: “the copy we saw in a client's home was due to be reviewed in October 2022 and needed to be replaced with the most up to date version.”
minorConsent / capacity: “there was not a specific section for a relative or carer signature so it was unclear as to whether it was the client or relatives signature.”
Strengths
· Mandatory training compliance was 96% overall, with bespoke client-specific training provided to all staff.
· Safeguarding referral processes were robust; 24 referrals made between March and November 2022 with a full log maintained.
· Infection control measures were well-managed including weekly PPE stock checks and spot check visits to client homes.
· Staffing levels were sufficient with low vacancy rates and a contingency team recruited to cover short-notice absences.
· Medicines management was safe with less than 1% error rate across the review period and competency-checked administration.
Quality-Statement breakdown (29)
safe: Mandatory trainingGood
safe: SafeguardingGood
safe: Cleanliness, infection control and hygieneGood
safe: Environment and equipmentGood
safe: Assessing and responding to client riskGood
safe: StaffingGood
safe: RecordsGood
safe: MedicinesGood
safe: IncidentsGood
effective: Evidence-based care and treatmentGood
effective: Nutrition and hydrationGood
effective: Pain reliefGood
effective: Client outcomesGood
effective: Competent staffGood
effective: Multidisciplinary workingGood
effective: Consent, Mental Capacity Act and Deprivation of Liberty SafeguardsGood
caring: Compassionate careGood
caring: Emotional supportGood
caring: Understanding and involvement of clients and those close to themGood
responsive: Service planning and delivery to meet the needs of local peopleGood
responsive: Meeting people's individual needsGood
responsive: Access and flowGood
responsive: Learning from complaints and concernsGood
well-led: LeadershipGood
well-led: Vision and strategyGood
well-led: CultureGood
well-led: GovernanceGood
well-led: Management of risk, issues and performanceGood
Solsken Limited remained Inadequate overall after insufficient improvements since the July 2021 inspection, with critical concerns around staff shortages, excessive working hours, unfilled shifts covered by family members, unsafe medicines management and weak governance. Despite compassionate frontline care, the service remained in special measures due to ineffective leadership, poor culture, and breaches of Regulations 12, 16, 17 and 18.
Concerns (14)
criticalStaffing levels: “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”
criticalStaffing levels: “working hours in one week totalled 60 and 78 hours respectively... two staff members on the same package of care had worked 30 and 36 hour shifts respectively”
criticalMissed or late visits: “between 19 December 2021 and 14 February 2022 there were multiple missed shifts each week with the main reason given as staff sickness”
criticalGovernance: “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”
criticalLeadership: “Leaders did not have the skills and abilities to run the service. Leaders had not taken timely action to address the need for significant improvement since our last inspection.”
criticalMedication management: “13 occasions in December where medicines were identified as 'missed' but no rationale was given, and no actions taken”
criticalMedication management: “asked by managers to go against original pack dispensing advice for two patients when medicines were not stored in their original packaging or liquid medicines were combined”
moderateStaff training: “clinicians did not have any qualifications in teaching others and that the service did not have a system to record how clinicians maintained their clinical skills”
moderateStaff competency: “of the 18 members of staff enrolled on apprenticeships, eight were 20-40% behind target and four were over 40% behind target”
moderateComplaints handling: “four of the families we spoke with still told us they had not received a response or resolution to a concern raised. One family told us that they received an abusive response from managers”
moderateCommunication with families: “managers could be difficult to contact and didn't always respond when queries or concerns were raised with them”
moderateRecord keeping: “records were not always up to date. It was unclear how important patient information was handed over when family members were providing care”
moderateIncident learning: “it was unclear how lessons learned were cascaded amongst all staff following incidents”
moderateSafeguarding: “service had not put into place additional safeguarding measures to protect patients and staff who were employed to care for their own family members... not measured the risk of the development of closed cultures”
Strengths
· Care records were holistic and personal to each individual patient
· Support staff treated patients with compassion and kindness, respected their privacy and dignity
· Mandatory training provided in key skills with high overall compliance (94% support staff)
· Staff understood how to protect patients from abuse and worked well with other agencies
· Staff controlled infection risk well and used PPE appropriately
Quality-Statement breakdown (5)
safe: Community health services for adults - SafeInadequate
effective: Community health services for adults - EffectiveRequires improvement
caring: Community health services for adults - CaringRequires improvement
responsive: Community health services for adults - ResponsiveRequires improvement
well-led: Community health services for adults - Well-ledInadequate