Superb Healthcare was rated Requires Improvement overall at its May 2023 inspection, with four regulatory breaches identified covering staffing (Reg 18), consent (Reg 11), person-centred care planning (Reg 9) and good governance (Reg 17). Caring was rated Good, reflecting strong compassionate relationships between staff and people, but failures in care plan quality, MCA compliance and oversight had persisted since the previous inspection.
Concerns (7)
criticalStaffing levels: “The provider was unable to demonstrate that enough suitably competent and experienced staff were deployed to make sure people's care and treatment needs were met safely.”
criticalConsent / capacity: “Consent to care and treatment was not always sought or recorded in accordance with the MCA. This was a breach of Regulation 11 (Need for Consent).”
criticalCare planning: “Care plans still contained none of the required equality and diversity information related to people's personal history, lifestyle choices, cultural, religious, emotional, spiritual and sexuality needs.”
criticalGovernance: “The registered manager had failed to identify and address breaches of regulation in relation to staffing, the need for consent and person-centred care planning.”
moderatePerson-centred care: “Support plans did not always use respectful person-centred language. For example, support plans did not refer to people by their preferred name but used the impersonal term 'the client.'”
moderateRecord keeping: “People's daily notes did not always record the times of their visits... all requested staff rota information had not been provided.”
moderateMissed or late visits: “One person told us, 'They're never on time and they do not let me know if they are running late... I will often cancel as I know that if I have to wait for them I won't make my appointment.'”
Strengths
· People experienced caring, meaningful relationships with staff who treated them with kindness and compassion, with staff going above and beyond such as staying with people during medical emergencies.
· Medicines management was well-structured with a detailed policy, trained staff, competency assessments and accurate MAR records.
· Effective infection prevention and control practices, with staff using PPE appropriately and completing food hygiene training.
· Strong multi-agency working with occupational therapists, hospital discharge teams, social workers and other care providers.
· Accidents and incidents were recorded, analysed and used to update risk assessments and drive learning.
Quality-Statement breakdown (25)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
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
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: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
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 staffRequires improvement
well-led: Continuous learning and improving careRequires improvement
Superb Healthcare Ltd was rated overall Good at its first inspection in July 2018, with Good ratings across four of five domains. The Requires Improvement rating for Safe reflected variable risk assessment detail, incomplete employment history records, and insufficient clarity around medicines prompting responsibilities.
Concerns (6)
moderateRecord keeping: “three of the four reviewed did not contain enough detail to show a complete history of their employment since leaving full time education”
moderateGovernance: “missed or late calls were therefore, reported to the service... the care co-ordinator told us they called care staff every day to check they had completed their calls. However, this was not recorded.”
minorCare planning: “some elements which would enable staff to provide more person-centred care were not recorded. These included areas such as people's history, personal information about them and their likes and preferences.”
minorIncident learning: “it was clear actions were taken to minimise the risk of recurrence, the actions taken were not always recorded”
minorMedication management: “the responsibility the service took regarding people's medicines was not always clear”
minorPerson-centred care: “People's diverse emotional and spiritual needs were not always recorded in care plans. People's religious, cultural and lifestyle choices were not noted.”
Strengths
· Staff trained in safeguarding and understood how to protect people from abuse; no safeguarding incidents or referrals since registration
· Sufficient staffing levels maintained with ongoing recruitment campaign to meet care package requirements
· Effective quality assurance systems including monthly audits reduced late calls from 23% to less than 5%
· Staff well supported through regular supervisions, spot checks, competency assessments and annual appraisals
· People supported by consistent care staff teams enabling positive relationships and person-centred delivery
Quality-Statement breakdown (13)
safe: Risk assessments completed but variable in detail; some lacked sufficient information to guide staff safelyRequires improvement
safe: Recruitment checks in place but employment history gaps not always recorded on application formsRequires improvement
safe: Safeguarding training embedded in induction and ongoing supervision; no safeguarding referrals since registrationGood
safe: Adequate staffing levels maintained; business continuity policy in place though individual risks during emergencies not addressedGood
effective: Staff received appropriate induction, mandatory training, regular supervisions and annual appraisalsGood
effective: Service worked with external health professionals; people involved in assessment and care planningGood
effective: Mental Capacity Act understood; care plans signed by people with capacity; no DoLS restrictions requiredGood
caring: Staff treated people with respect, dignity and maintained consistent relationships through allocated care teamsGood
caring: People encouraged to be independent; equality and diversity policy in place with zero tolerance to discriminationGood
responsive: Care plans reviewed at least every six months and updated when needs changed; complaints handled appropriatelyGood
responsive: Care plans not sufficiently person-centred; recommendation made to seek guidance on individualised care planningGood
well-led: Effective quality assurance and audit systems with evidence of action taken; staff and people consulted regularlyGood
well-led: Registered manager experienced, qualified and up-to-date with legislation; records mostly accurate and accessibleGood