Brown the sausage. Heat oil in a skillet over medium. Add sausage, breaking it into crumbles.
Cook until browned and no longer pink, 6–8 minutes. Drain excess fat if needed.
Sauté aromatics. In the same pan, add the onion and cook 3–4 minutes until softened. Stir in garlic for 30 seconds until fragrant.
This step builds big flavor.
Load the crockpot. Add browned sausage, onion, garlic, chicken broth, diced tomatoes, cauliflower, Italian seasoning, and red pepper flakes to the slow cooker. Stir to combine.
Slow cook. Cover and cook on Low for 6–7 hours or High for 3–4 hours, until the cauliflower is tender but not mushy.
Finish creamy. Stir in heavy cream (and cream cheese if using) and Parmesan. Add spinach and let it wilt for 5–10 minutes.
Taste and season with salt and black pepper.
Serve. Ladle into bowls and top with more Parmesan and chopped parsley if you like. The soup should be velvety, with a slight kick from the sausage and red pepper flakes.