Top4Care Services Ltd

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this newly registered service. This key question has been rated good.

This meant people’s needs were met through good organisation and delivery.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people were at the centre of decisions about their care and treatment and worked in partnership with them when responding to changes in their needs. Staff demonstrated a good understanding of people’s preferences, routines and what mattered to them. Care was shaped around the person’s daily choices, such as food preferences, personal care routines and how they wished to spend their time.

Relatives provided examples of how staff took a person centred approach to promoting independence. Relatives told us, “At first the staff went with them on public transport to college. They go alone now” and “They have taught [person] to cook using an air fryer and clean.”

People described how staff engaged in conversations about their day, interests and wellbeing. We observed interactions which reflected a person-centred approach, with staff respecting how people wished tasks to be completed and adapting support.

The provider understood the diverse health and care needs of people, so care was joined-up, flexible and supported choice and continuity.

Care plans included information about involvement from family members, including legal arrangements such as appointees. An appointee is a person or organisation formally appointed to manage a person's finances when the person is unable to manage this independently.

Before people moved into the service, assessments were completed in partnership with professionals to gain an understanding of people’s health and support needs. For example, we found records contained a detailed assessment involving nursing staff from the previous placement. This focused on how staff supported the person when distressed. This supported a smooth transition from a care home placement into the service.

Relatives told us they were kept informed about changes in their family member's care and were involved in reviews where appropriate. Staff also worked with family members to support people in attending healthcare appointments, such as providing transport or ordering medicines for when people returned home from visiting family.

The provider provided appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Policies and procedures demonstrated a commitment to the Accessible Information Standard. The provider had systems to ensure information could be adapted, including the use of simple language, easy-read formats and communication tools, such as pictures.

Care plans recorded communication needs and preferences. These also included literacy skills and support people required when receiving written information or completing forms.

People had access to information about their care, support and wellbeing in formats they could understand. For example, people showed us their easy read care plans and were able to explain aspects of their care, support and personal goals.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People were involved in decisions about their care and support. They were encouraged to express their views during key worker sessions. Key workers were responsible for reviewing people’s support needs and ensuring people’s goals, preferences and wellbeing were reflected in their care plans. Staff recognised that there were occasions when people did not wish to engage in planned sessions and revisited discussions later when people felt ready and able to engage.

The provider responded appropriately to feedback, concerns and complaints. Records showed that issues were investigated and outcomes communicated with people and relatives. Relatives told us they felt confident raising concerns and believed they would be listened to. One relative told us, “I was not looking forward to having [person] over Christmas and was worried in case he absconded. [The registered manager] offered for a person to come home with him.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Staff and leaders supported people to attend appointments with healthcare professionals. Care plans reflected people’s communication preferences and protected characteristics. Staff demonstrated a good understanding of how to adapt their approach to support people, such as using picture boards.

People were supported to access education, social activities and healthcare services that were important to them. The provider recognised the challenges people sometimes experienced when accessing services and took an active role in helping them overcome these barriers. One staff member told us, “We identify bespoke support that suits the person.”

Leaders shared responsibly for on-call arrangements, ensuring people and relatives could always access support. Relatives told us the registered manager was contactable at any time.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Care plans contained information about people’s backgrounds, cultural preferences, health needs and aspirations. For example, we found one person’s religious beliefs meant they avoided specific foods. Staff were aware and respected these dietary requirements. This helped the person maintain their cultural and religious identity and experience care that respected their protected characteristics.

Staff used this information to support people to access services, activities and opportunities. People told us they felt listened to, respected and involved in planning their support.

The provider recognised that some people may face barriers in achieving positive outcomes and worked in partnership with families and external professionals. People’s experiences were regularly reviewed and care plans updated when their needs changed.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider had not established effective systems to ensure people were supported to discuss and record their future care preferences whilst they had capacity to do so. Care records did not contain information about people’s wishes, preferences and choices for the future, including how they wished to be supported if their health deteriorated. Information relating to advance care planning, end of life wishes and other significant life decisions was absent or incomplete. This meant people were at risk of not receiving personalised care that reflected what mattered to them.

At the time of this assessment no one was receiving end of life care. However, the provider recognised that advance care planning required further development. Since the assessment, leaders have engaged in discussions with people about their wishes and preferences for the future.