Superhealthcare received an Inadequate overall rating following a focused inspection in July 2022, with continued breaches of Regulations 12, 17, and 19 relating to unsafe medication management, unsafe recruitment practices, and ineffective governance arrangements. The service remained in special measures for a fourth consecutive inspection cycle with insufficient improvement made since the previous rating of Inadequate in January 2022.
Concerns (11)
criticalMedication management: “Not all staff who administered people's medication had received training or had their competency assessed through direct observation to ensure their practice was safe.”
criticalMedication management: “MAR forms for two people recorded one member of staff had administered two people's medicines on 12 occasions but they were not appropriately trained.”
criticalRecord keeping: “Unexplained gaps on the MAR forms for two people, giving no indication of whether they had received their medicines or not, and if not, the reason why was not recorded.”
criticalStaff training: “No records of induction available for eight members of staff. There was no evidence of training for four members of staff.”
criticalStaff competency: “Recruitment practices remained unsafe and lessons had not been learned to make the required improvements. No recruitment files were available for three members of staff.”
criticalSafeguarding: “No Disclosure and Barring Service [DBS] checks were completed for these staff... A risk assessment was not completed or considered to assess and manage the risks.”
criticalGovernance: “Quality assurance and governance arrangements in place were not effective in identifying shortfalls in the service or making the required improvements.”
criticalIncident learning: “There was no analysis, follow up, or investigation to identify the potential causes of injuries sustained by people using the service. For example, unexplained bruises identified on body maps.”
moderateSupervision / appraisal: “Not all newly appointed staff had received supervision or 'spot visit' checks... One member of staff told us they had not received any supervisions or spot visit checks since commencing in post in December 2021.”
moderateConsent / capacity: “Where restrictions were in place, the reason for the restriction was not recorded to evidence these had been agreed as part of 'best interest' procedures.”
moderateInfection control: “We were not assured all members of staff employed at the service had received appropriate training relating to infection, prevention and control, COVID-19 or 'donning' and 'doffing' training.”
Strengths
· People confirmed they had not experienced any missed calls and felt safe with staff visits.
· Staff understood safeguarding responsibilities and knew how to escalate concerns to the registered manager and external agencies.
· Risks to people were assessed, recorded and managed to enable people to live in their own homes safely.
· Staff had access to adequate PPE supplies and were undertaking COVID-19 testing in line with government guidance.
· Customer satisfaction surveys showed all areas marked as 'good' or 'outstanding' by people using the service.
Superhealthcare improved from Requires Improvement to Good overall following a focused inspection on Safe, Effective, and Well-led, with previous breaches of Regulations 12 and 17 remediated. The service exited Special Measures, with people and relatives reporting high satisfaction and no missed calls recorded since the introduction of electronic call monitoring.
Concerns (2)
minorGovernance: “Improvements were needed to make sure completed audits were less generalised and more focused on individuals who used the service and staff.”
minorCare planning: “The registered manager should consider assessing people's environmental risks.”
Strengths
· No missed or late calls recorded since introduction of electronic call monitoring system; relatives confirmed accuracy
· People and relatives consistently praised staff caring attitudes and continuity of care
· Medication audits completed regularly with no corrective actions required
· Staff received formal supervision, spot visits, and appraisals since last inspection
· Governance improved from Inadequate to Good; provider no longer in breach of Regulation 17
Superhealthcare improved from Inadequate to Requires Improvement overall following a July 2022 inspection, with continued breaches of Regulation 17 (Good Governance) for a fifth consecutive time and Regulation 19 (Fit and Proper Persons), resulting in special measures. While caring and responsive practice was rated Good and some safety improvements were embedded, persistent failures in recruitment checks, call monitoring, medicines management, and quality assurance oversight undermined confidence in sustainable compliance.
Concerns (6)
criticalGovernance: “Effective arrangements are not in place to assess and monitor the quality of care provided...This was a continued breach of Regulation 17 [Good governance]...breached for a fifth consecutive time.”
criticalRecord keeping: “Not all recruitment checks had been completed...only 1 written reference was evident...A written record was not completed or retained for 1 member of staff.”
moderateStaff training: “There was no evidence of a completed induction for 1 member of staff who was newly employed at Superhealthcare since our previous inspection in July 2022.”
moderateSupervision / appraisal: “Where issues were highlighted, no information was recorded detailing how this was to be monitored, followed up and addressed.”
moderateMedication management: “A person did not receive their medication as prescribed. The prescriber's instructions stated one of their medicines should be given 30 to 60 minutes prior to food and all other medication.”
moderateMissed or late visits: “The current arrangement of staff notifying the provider through an instant messaging platform...was ineffective and inconsistent.”
Strengths
· Relatives reported family members felt 100% safe and staff were kind, caring, and consistent
· Staff completed mandatory and specialist training including Care Certificate since last inspection
· Risks to people were assessed, recorded, and managed effectively including manual handling and medication
· People received personalised, responsive care with support plans covering all individual circumstances
· No safeguarding concerns raised since last inspection and staff understood escalation procedures
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
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 wrongRequires improvement
effective: Staff support: induction, training, skills, and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
Superhealthcare remained rated Inadequate and in special measures, with continued breaches of regulations 12, 13, 17 and 19 covering risk assessment, safeguarding reporting, governance and safe recruitment. CQC imposed urgent conditions after finding no care plans, unassessed risks, unsafe COVID-19 testing, missing DBS/references and a registered manager without effective oversight.
Concerns (13)
criticalCare planning: “the registered manager had still not put care plans in place for people. However, they had created a 'routine' for staff to follow.”
criticalCare planning: “Risks to peoples' safety and well-being had not been assessed... eight of the 10 people receiving care had risks associated with their health and wellbeing”
criticalStaff training: “Two members of staff said their training was out of date. One said, 'Our training has expired. We've done safeguarding training. They [the provider] are getting it sorted now.'”
criticalStaff competency: “the registered manager failed to provide evidence of staff training and competence and stated they had not carried out any competency assessments with staff.”
criticalSafeguarding: “The provider had failed to record or report the incident which was a breach of regulation 13”
criticalInfection control: “The registered manager had failed to follow current government guidelines for undertaking COVID-19 testing. Staff had been provided with weekly rapid Lateral Flow Devices [LFT] instead of the recommended PCR test.”
criticalGovernance: “The registered manager did not have systems in place to have effective oversight of the service or assess and monitor the quality of care. This was a continued breach of Regulation 17”
criticalLeadership: “there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalRecord keeping: “One person said they had reported an incident of abuse but there was no record of this.”
criticalIncident learning: “Lessons had not been learned since the last inspection. At this inspection we found the registered manager had failed to make the necessary improvements to the service.”
criticalOther: “the registered manager had not obtained references or Disclosure and Barring Service [DBS] checks prior to staff starting work at the service.”
moderateMedication management: “the provider was unable to evidence they had additional documentation in place to help staff know when and how to administer certain medicines such as 'when required' [PRN] protocols.”
moderateSupervision / appraisal: “The registered manager said they were not carrying our formal supervisions or competency checks”
Strengths
· People and relatives reported feeling safe with care staff: '[Relative] is safe with the care staff. Staff know [relative] really well.'
· There were enough staff to meet people's needs and rotas included travel time between calls.
· People and staff were positive about the registered manager being approachable and easy to talk to.
· Weekly feedback surveys were issued to people and analysed by the registered manager.
· A support manager (registered nurse and experienced registered manager) had been employed to help improve the service.
Quality-Statement breakdown (6)
safe: Assessing risk, safety monitoring and management; Preventing and controlling infection; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Using medicines safelyInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; duty of candour; Continuous learning and improving careInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering; Engaging and involving people, public and staff; Working in partnership with othersInadequate