Preheat oven to 375 degrees. Spray a 9×13 inch casserole dish lightly.
Roughly chop the head of cauliflower or 2 lb bag of cauliflower (recommended) into smaller bite-size pieces. Add and even out into casserole dish.
Brown the sausage in a large skillet under medium to high heat. Drain grease.
Whisk together the cream of chicken soup, water, heavy whipping cream, onion powder, crushed red pepper, salt and pepper in a bowl.
Add an even layer of sausage on top of the chopped cauliflower. Then pour the soup mixture on top of the sausage. Spread evenly with a spatula. Cover with foil and bake for 45 minutes.
Remove foil and top with sharp shredded cheddar cheese. Return to oven 5 more minutes to melt the cheese, then serve.