Four Acres

Four Acres is a purpose-built residential home registered to provide accommodation and personal care for up to 67 people, including people living with dementia. At the time of our inspection visit there were 55 people living at the home. Care is provided across two floors. Communal lounge and dining areas were located on both floors. People’s bedrooms were en-suite and there were further communal bathroom facilities located on each floor.

People's experience of using this service and what we found

Improvements had been made to ensure staff had the guidance they needed to minimise people's identified risks and support them at times of anxiety or distress. Information was shared with staff, so they understood the support people required to keep them safe. Staff understood their responsibility to report any concerns about people’s health and well-being.

On the day of our inspection there were enough staff available to maintain people’s safety and respond to their requests for support. Staff received regular training and support and told us managers were available to give guidance when needed.

Staff worked with other professionals to ensure people's health needs were met effectively and in a timely manner and supported people to maintain a healthy diet. Medicines were stored, managed and administered in line with good practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Improvements had been made in governance systems. The registered manager’s approach to governance ensured people’s experience of living in the home was central to assuring the quality of care provided. Learning from incidents was shared with staff to prevent reoccurrence and generate improvements within the home.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 June 2021).

At our last inspection we found a breach of the regulations in relation to good governance of the service. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting this regulation.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 May 2021. A breach of legal requirements was found in relation to Good Governance. This inspection was prompted by a review of the information we held about this service and to check if the provider had made improvements and were now meeting the legal requirements.

This report only covers our findings in relation to the key questions Safe, Effective and Well-led. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Four Acres on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect

Four Acres is a purpose-built residential home registered to provide accommodation and personal care for up to 66 people, including people living with dementia. At the time of our inspection visit there were 58 people living at the home. Care is provided across two floors. Communal lounge and dining areas were located on both floors. People’s bedrooms were en-suite and there were further communal bathroom facilities located on each floor.

People's experience of using this service

At our last inspection we found improvements were needed in the management of some risks. At this inspection we found further improvements were still required to ensure staff had the information they required to manage risks associated with catheter care and people at risk of skin damage.

Some people’s health could impact on their emotional and mental wellbeing causing them to become distressed or agitated with themselves or others. The provider was providing extra guidance and training to support staff in meeting those people’s needs.

Staff were not confident that staffing levels accurately reflected the level of care and supervision some people required, especially on the units where people with more complex needs lived. Following feedback at our inspection visit, the provider confirmed staffing levels had been reviewed and had been increased to ensure people’s individual needs were consistently and safely met.

The home was clean and tidy and infection control practices minimised the risks of infections spreading.

The provider had processes in place to assess and monitor the quality of care provided at Four Acres. However, these were not consistent in identifying areas where improvements were required to ensure good outcomes for people.

The provider responded immediately to our feedback both during and after the inspection and implemented an action plan to address those areas we had identified as requiring improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 4 December 2019).

Why we inspected

The inspection was prompted in part due to information received about the management of risks, particularly those associated with people’s emotional and mental wellbeing and record keeping within the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Four Acres on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Four Acres is a purpose-built residential home registered to provide accommodation and personal care for up to 67 people, including people living with dementia. At the time of our inspection visit there were 40 people living at the home. Care is provided across two floors. Communal lounge and dining areas were located on both floors. People’s bedrooms were ensuite and there were further communal bathroom facilities located on each floor. Four Acres reopened in October 2018 following a total refurbishment. This is the first inspection of this service since it reopened.

People’s experience of using this service and what we found

Since the last inspection visit, people and staff had relocated to other services whilst the home was being redeveloped. Four Acres had been reopened for 12 months and people who lived at Four Acres previously, new admissions and staff had settled into their new environment. Since the home reopened the registered manager and deputy manager had left the service and other senior management changes had also taken place. The provider’s systems and processes to ensure people continued to receive good care outcomes during this time were not always effective. Some audits and checks had been completed, however a lack of effective oversight and scrutiny meant some standards fell short of the manager’s expectations.

Individual risk assessments described people’s risks and staff knew how to keep people safe from those risks. However, records that recorded how the assessed risks were managed by staff were not always kept up to date. People’s dietary needs, preferences and nutritional needs were assessed and known by staff. However, the recording of what people had eaten and drunk was not always accurate. This meant it was not obvious to identify what foods and fluids people enjoyed so they could be encouraged to have more of the same. If other healthcare professionals were involved, records would not clearly show what worked well and what did not.

Care plan records were reviewed but, in some cases, needed ‘the small’ more personalised information for staff to provide person-centred care, the management team told us about. People received their medicines from trained and competent staff. Some medicines were not always given safely and in line with manufacturers guidance or prescribing advice.

People were supported by staff who routinely promoted privacy and dignity. Staff had a good understanding of people, their likes and dislikes. People were supported by staff who had a good knowledge of how to protect them from abuse and harm. People were encouraged to live as they wanted to. Staff encouraged independence in people. People who required end life care were supported by staff who demonstrated kindness and compassion.

People, relatives and staff said the new manager was visible and approachable. Staff said changes particularly over the last two months were for the better. Staff felt they worked well together which helped ensure people received good and consistent care, but recognised time was still needed for all staff to come together and perform as one team. The manager had plans to improve upon the changes already made and they had already identified some of the shortfalls we found at this visit.

There were enough numbers of care staff on duty to keep people safe. People told us they were happy living at Four Acres and they received support from kind, caring and thoughtful staff. Staff were quick to offer reassurance and support people which helped reduce people’s anxiety.

Staff had training in relevant subjects and they knew their roles and responsibilities, such as safeguarding people from poor practice.

People continued to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People pursued opportunities to engage in activities and interests that kept them stimulated and involved in what they enjoyed. Plans to improve this were being completed.

Rating at last inspection

The last rating for this service was Good (published 9 September 2015).

Why we inspected

This was a planned inspection based on the rating at the last inspection. The previous ‘good’ service provided to people had deteriorated. The overall rating has changed to requires improvement. We found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Below is a summary of what we found. This summary is based on our observations and evidence we found during the inspection. We were able to speak with five people and a relative of a person who lived at the home.

Is the service safe?

We inspected this service previously in May 2013 and identified improvements were required in several different areas. These included the safe care and welfare of people, how the service monitored and assessed the quality of its service and records that supported the care people needed. We found the provider had made changes following our previous inspection and improvements had been made in all these areas.

People told us they felt safe living at the home. People told us the staff were kind and friendly towards them and provided the care and support they needed. One person said: "The staff are lovely here".

People told us they were involved in their day to day care decisions and staff helped them to maintain their own levels of independence. One person said: "I can do most things myself but need a little help now and again".

People’s records had been completed at the required intervals and people’s care records matched their individual care needs. We found people had appropriate risk assessments in place that made sure people were not placed at additional risk. We found people had appropriate risk assessments in place that made sure any risks were managed.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We were told that no DoLS applications had been made. We saw records that showed some staff had received training in the Mental Capacity Act. The registered manager told us that they were arranging further training for staff in the Mental Capacity Act in light of the recent High Court judgement around MCA and DoLS.

Is the service effective?

People’s health and care needs were assessed and people had been involved in planning the care they received. We found care plans had been reviewed regularly and matched the care people required. We found care plans supported staff to deliver care and support to meet people’s needs.

People were involved in how their care was delivered. Staff asked people for their consent before any care or treatment was provided. People’s mobility and other needs were taken into account in relation to their environment. This enabled people to move around freely and safely and with the level of support that met their needs.

We found the provider had an effective recruitment system in place that made sure the staff employed were suitable and qualified to support people.

Is the service caring?

Staff were attentive to people’s needs throughout our inspection. We saw staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived at Four Acres. People told us that staff respected their choices and staff helped them to promote their own independence as much as possible. One person said: “I want to be able to do as much for myself as I can and the staff help me to do this”.

We found people’s preferences were supported. People were free to make their own choices about food, drinks, bedtimes, personal care, clothes they wanted to wear and where they wanted to spend their time in the home. People told us they did not have to wait long when they needed help or support. People told us the staff were very supportive and friendly.

Visitors we spoke with confirmed they were able to see people in private and that they could visit their relatives whenever they wanted.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors and podiatrists. People were supported to participate in activities inside and outside of the service that were personal to them.

People told us that they were asked for their views about the service they received. All of the people we spoke with were satisfied with the service they received.

Is the service well led?

The service worked with other health professionals and community services to make sure people received the appropriate levels of care they needed. We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service that people received. People told us they were able to speak with staff and managers and felt able to raise any issues or concerns they had.

People who lived at the home and their relatives told us, 'I like living here, everything is perfect' and 'Always nice atmosphere when we walk in.'

We saw staff were kind and attentive when delivering care. We looked at four people's care plans and saw their care and welfare needs were not always met due to the lack of information available for care staff.

We saw that people were provided with a good choice of food. Some people told us they were not always happy with the choices available to them.

People told us they felt safe, but one visitor raised concerns about their relative's care.

Care staff had received training to enable them to look after people safely. Care staff had not been given the opportunity to meet with the manager on a one to one basis, but we saw regular staff meetings took place.

We saw the home met with people to enable them to give their views about their care. However, the provider did not always listen to the concerns of care staff and relatives.

We saw records and documentation were incomplete for people who lived at Four Acres. This meant there was not enough information to direct care staff on how to look after people safely.