Four Acres

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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’s care and treatment was effective because they did check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed before they moved to the home. In some cases, assessments were completed in hospital by “trusted assessors”. Trusted assessors carried out holistic assessments to reduce duplication, speed up decision-making, and support timely discharge to a safe environment. In other cases, senior care staff from Four Acres completed people’s assessments. A staff member told us, “When we are assessing, we think about the dynamics back here, and if we can meet people’s needs, and make sure we are not putting them at risk. We think about what other teams, such as district nurses, will need to be involved in their care.”

Staff gave us examples showing how they reviewed people's assessments as they began to settle into the home. A staff member told us where people's needs changed when admitted to the home, this was discussed with senior staff, so appropriate plans would be put in place to meet people's emerging needs. Staff told us the manager had a positive approach to supporting people so their needs would be met and took time to explain how best to support new people coming to live at Four Acres, who may be anxious.

The provider did plan and deliver people’s care and treatment in line with legislation and current evidence-based good practice.

Recognised tools to monitor and evaluate people’s health conditions were used to determine the support people required to promote positive outcomes. Where people required regular assessing to monitor their likelihood of developing sore skin, we observed pressure relieving equipment in place for those who needed it. This helped make sure, people received the right support to maintain their overall health and wellbeing.

Staff understood the national recognised tool used to determine a person’s food and fluid consistency, so people could eat and drink in a safe way based on their individual needs. Staff described to us those people who needed thickener in their drinks, to reduce the risk of choking. Staff completed individual food and fluid charts; however, we told managers they needed to ensure, staff documented what people had eaten, rather than ‘ate meal’. The manager agreed to take action to address this.

Catering staff were provided with information on people’s dietary needs and gave examples showing how they ensured people requiring fortified food, or textured diets, were appropriately and safely supported to have enough to eat so they would remain well. Where staff had concerns, such as people may not be having enough to eat, advice was sought from other health and social care professionals. Staff gave us examples showing how this advice was followed. Records showed us, where people did not have any underling health conditions, they regained weight they had lost upon admission to the home.

The provider endeavoured to work well across teams to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People’s health and wellbeing needs were met by staff through working across teams and with other health and social care professionals, including dieticians, district nursing teams and through referrals to mental health teams. The manager told us the GP rarely visited, but community nurse teams did. The manager was seeking ways to improve people’s access to the GP within the home. When people required support from emergency services, staff did not have to wait for clearance from managers to contact paramedics. Staff knew what information paramedics needed. One staff member said, “They need to know our observations, how the [person] is presenting, what medicines the person is on and if a respect form is in place, and you let the family know.”

Staff told us what they did when a person was discharged back to them from hospital. They explained how they prepared the person’s room; ensured food was available for them and offered them personal care on their return. Staff checked and scanned in people’s hospital discharge letters, so they could be sure they had picked up on any changes in their care upon returning home. A staff member told us, “We would also let the GP or advance nurse practitioner know about any changes. The nurse practitioner comes in most weeks.”

Medical history of new admissions was obtained through GP connect (NHS England digital service that allows authorised health and care staff to safely share and view people’s GP records across different IT systems in real time). A staff member explained this meant they did not have to keep asking families for detailed information about people’s state of health or diagnosis, at times which may be stressful for relatives.

The provider did support people to manage their health and wellbeing, so people could maximise their independence, choice and control. Staff supported people to reduce their future needs for care and support.

People’s health and wellbeing needs were monitored, and referrals were made promptly to other health and social care professionals where concerns were identified. This helped to ensure people had access to the care they needed to manage their health and wellbeing.

During our visit, a visiting health professional was reviewing people’s health and welfare. We spoke with the visiting health professional who told us, “We are in the home daily and for most of the day, supporting people who are diabetic. We give insulin, scan and monitor blood sugar sensors.” The visiting health professional also told us, “Staff are good at reporting concerns to us or the GP and following instructions given.” Staff confirmed the input from visiting health professionals was excellent and that there was a positive working relationship to benefit the people who lived at the home.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We found no evidence people had come to harm, but where people required support with modified diets, records did not always show what they had consumed. For people we reviewed, staff recorded ‘ate meal, puree’ but not what they had eaten. Where snacks and desserts were given, records were not specific to say what these were. Accurate Information enables health professionals to have a better understanding to make more informed decisions to support improved outcomes.

During a mealtime on the first day of our visit, staff did not always recognise or consider, when people did not eat their main meal. We saw staff took 2 people’s uneaten meals without asking if they wanted anything else to eat. In a third example of a person not eating their meal, we asked staff if there was another choice. They asked this person if they wanted something else which they did, and they ate all of it. For others, there was limited vegetarian choices. In a further example, we saw a person was eating their meal from their knife. We told staff about this and their response was, “Oh well they have a fork and spoon.” We gave feedback to the manager and regional operations director who assured us they would address these issues.

The manager completed regular clinical checks and audits of incidents to make sure people received the right support. Through our conversations, the manager agreed to make more detailed reviews into the quality of records, so they had evidence people’s overall health and wellbeing was being monitored.

The provider did tell people about their rights around consent and always respected their rights when delivering care and treatment.

There was limited evidence of decision specific mental capacity assessments (MCA). For example, 1 person’s mental capacity had been assessed in relation to them living at the home and for staff to administer their medicines. No other MCA assessments had been done for this person. Where people needed an MCA, we saw they were completed, however, records of best interests’ decisions were inconsistent to show how the decisions were reached. The provider’s Mental Capacity Act assessments prompted staff to check people’s capacity to make their own decisions but did not require staff to provide details of how and when this had been done. It was not therefore always possible to understand how staff had worked with people to ensure they were offered the best chance to understand what was being assessed and to make their own decisions. The deputy manager agreed to review this to ensure people’s needs were considered.

Our observations showed people were asked what they wanted to drink, where they wanted to go or what they wanted to do. Staff sought people’s consent before assisting them, as well as seeking consent from people with limited understanding or communication. One staff member said, “Not all people have capacity at all times. People may have capacity some days and not others. Lots of people have been assessed by social services and have a DoLS. These are in place to keep people safe. I always ask for consent before I provide care. Some people say no so I leave them a short while and ask again.” Staff told us they always explained what they were doing and looked at people’s visual cues, expressions or what people said, to determine what the person wanted. People said they made their own choices and staff respected their decision. One person said, “I do my own personal care, but they support me with my shower.”