Four Acres

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.

At our last assessment we rated this key question good. At this assessment the rating has remained 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 did not always make sure people were at the centre of their care and treatment choices, and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Some people and relatives feedback was that they did not feel at the centre of their care. Comments included, “Sometimes I do not think that they know what they are doing. Sometimes I have to wait until 12.00pm to get showered, I don’t like that” and “In the main I think they are trained but would like [Relative] to be supported more with promised exercises.” Regarding their mobility, a further person said, “They do not encourage me to walk.” One relative told us staff did not always communicate well enough with their family member. This relative said, “The lack of communication with some of the care staff leaves [Person] frustrated. Some care staff do not allow [Person] enough time to speak and express themselves.” Other people who were more independent and less reliant on staff, were happy with their support.

Staff told us they provided person centred care. Staff told us information about changes in people’s needs and preferences was shared in handover meetings which helped care to be adjusted, if needed, to continue to meet people’s needs. Activities staff adjusted the activities provided to ensure all people could participate. The activities manager told us, “We look at care plans to see what is suitable for them (people).” Staff told us if people were cared for in bed, they could provide activities on a 1-1 basis.

Care plans detailed people’s preferences and how they preferred their care to be provided. For example, in 1 care plan it stated, “Medication: [Name] likes it 1 at a time on a spoon with water.” People had sleeping care plans that recorded their preferences. One care plan stated, “2 pillows and a blanket or sheet rather than a quilt, curtains closed, door half closed.” We saw the person had a blanket rather than a quilt.

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

Staff understood the needs of the people they cared for and what other services were available to support them. We saw timely and appropriate referrals were made to other health professionals including mental health teams and dieticians.

Staff said they had the information they needed to support people’s choices and maintain as much continuity as possible in their lives. One staff member said, “Like everything else, that information (cultural and religious needs) will be in staff hand devices. At present some people enjoy attending the church services mainly Christian, we don’t have other cultural needs.”

People had access to a secure outdoor area with seating. Staff said some people had previously enjoyed garden tasks, and they were encouraged to continue doing them.People were encouraged to maintain their community and social links. A Summer Fete was planned where members of the public were invited. One person said, “We have a summer fete soon and I am looking forward to helping with that.” Activities planned included singers, local community groups and pet therapy. We saw people had family members visit them and although staff encouraged protected mealtimes, family members could still visit if they wished.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There were notice boards around the home to inform people and visitors about important and celebratory events at the home. People were provided with a written schedule of activities planned for each week so they could choose if they wished to attend. Menus were on display in each communal dining room, so people knew what choices were available to them at mealtimes.

Pictorial versions of menus were given to everyone prior to their meal to assist them to choose. We saw staff gave some people a smaller plated option so they could make a visual and sensory choice.

Sensory information was recorded in people’s care plans, so staff knew if people needed glasses or hearing aids to aid communication. One person confirmed they had plenty of hearing aid batteries so they could always hear what was going in.

Staff knew people’s individual communication needs. One staff member said, “All care plans have people’s communication needs. Some people are hard of hearing so it’s important to face them when talking and to speak slowly. We make sure people have their hearing aids in so they can hear better.” One staff member told us what they would do if they felt a person who was not able to tell them was in pain or discomfort. This staff member said, “If a person was in pain, I think staff know. We all know the people here and would know if something was not right and would report to a senior.”

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.

Overall, people we spoke with were satisfied with their support. People and relatives knew who to raise any concerns with and how to raise them. One relative told us they had shared some feedback to staff. They said, “[Person]s only been there a few months, yet they have got their head around it and [Person], in the early days there were initially teething problems like they were putting them to bed too late. We just said can you change that, their usual bedtime at home was 8:30pm and they did.” Other relatives felt involved and were consulted when they needed to be. However, we had mixed feedback from 2 relatives about whether they felt listened to when they raised concerns. People and relatives overall did feel able to share feedback.

Staff told us feedback was shared with them. A staff member said, “We would hear about any complaints or falls from our team leaders.” This helped to ensure staff knew how to adapt how they cared for people and people’s views were listened to by the whole team. Other staff told us about residents’ meetings, where menu options were discussed, so people were able to influence what meals were made available.

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

People’s needs were reviewed to ensure they had access to the care and support they required. People’s protected characteristics were understood by staff who supported them to access care from other health and social care professionals. For example, appointments for their physical and mental health.

Staff had a good understanding of people’s health and well-being needs and provided opportunities for people to live their lives as they wished at the home. For some people, this meant considering how they could safely have access to items which brought them comfort. For other people it was about ensuring their physical needs were addressed, but they were given opportunities to be as independent as possible.

The home environment was spacious and accessible, supporting people to move independently around the home and outdoor space. There were accessible communal areas available, as well as areas for people to make their own drinks and eat snacks to remain as independent as possible.

Staff and leaders did actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was tailored in response to this.

Staff carefully considered feedback from people and their representatives when considering the safest way to accommodate their wishes. This included careful consideration of the layout of people’s rooms so their equality and sensory needs would be safely met. People’s religious and cultural needs were considered. People in the home were given opportunities to participate in day trips and events at the home. One staff member told us people recently went out for a pub meal which they enjoyed. They explained how 1 person who spent time on their own was encouraged to attend, which they did, and they had a good time. We also heard from 1 person who had previously spent most of their time in their own room but now felt encouraged to come out during the day, into communal areas of the home. For people who did spend time in their own room or who did not respond well to group sessions, 1:1 engagement with staff helped keep people involved socially.

People were supported to plan for future care including care at the end of their life.

People’s care plans showed people had considered some important decisions in the event their health deteriorated. For example, systems to ensure do not attempt resuscitation (DNACPR) and Recommended Summary Plans for Emergency care and Treatment (ReSPECT) forms were available and known. Staff gave us 1 example showing how people had been appropriately supported at the end of their lives. This included staff marking their respect when people made their final journey from the care home. However, we found further development was required in relation to people's end of life care plans, to ensure people were fully supported and their preferences were comprehensively identified so they could be met at this key stage of care. The regional operations director said they and the deputy manager had enrolled on a training package to help identify and consider, how staff could build their confidence to ask important and sensitive questions about people’s preferences for their end of life care.