CQC report explained · a residential care home
What the CQC found at Four Acres
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found people were protected from avoidable harm, with better risk guidance, suitable staffing on the inspection day, safe recruitment and good infection control. They noted that medicine patches did not always have evidence of being rotated in line with guidance.
- Effective?
- Good
- Staff were trained and supported, worked with health professionals and helped people maintain a balanced diet. Mental capacity records and support for consent had improved.
- Caring?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward to calculate the overall rating.
- Responsive?
- Good
- This key question was not inspected during this focused visit. Its previous rating was carried forward to calculate the overall rating.
- Well-led?
- Good
- Inspectors found stronger governance, organised audits and clear oversight of improvement work. The home was no longer in breach of Regulation 17, although some care records still needed improvement.
What inspectors found, June 2022
Four Acres rated Good; inspectors found safer, effective and well-managed care, with some records and medicines practice still needing attention.
This was an unannounced focused inspection on 25 May 2022. Inspectors spoke with people, relatives, staff and a visiting professional. They observed care and checked care records, medicines records, staff recruitment files, accident records and quality checks.
The home was rated Good overall. Safe, Effective and Well-led were each rated Good. Inspectors found improvements in risk guidance, staffing arrangements, medicines management, staff training, mental capacity records and quality monitoring.
The last rating was Requires Improvement, published in June 2021. The home had previously breached Regulation 17 about good governance. Inspectors found the home had improved and was no longer in breach.
This was a focused inspection. Caring and Responsive were not inspected during this visit, so their previous ratings were used when calculating the overall rating.
Clearer risk support
Staff had better guidance about people's risks and how to support people experiencing anxiety or distress. Changes in risks were shared between shifts.
“Improvements had been made to ensure staff had the guidance they needed to minimise people's identified risks.” from the report
Health and nutrition support
Staff worked with health professionals and used advice about nutrition. The chef knew about people's preferences, allergies and dietary needs.
“Staff worked with other professionals to ensure people's health needs were met effectively and in a timely manner.” from the report
Improved management
The home had organised quality checks and an action plan. Inspectors found that the earlier governance breach had been resolved.
“At this inspection we found improvements and the provider was no longer in breach of regulation 17.” from the report
Learning from incidents
The home reviewed accidents and incidents and shared lessons with staff to help prevent them happening again.
“Learning from incidents was shared with staff to prevent reoccurrence and generate improvements within the service.” from the report
Medicine patch rotation
needs fixingRecords showed patches were removed and replaced, but the home still needed to make sure they were rotated as the manufacturer advised. This was to reduce the risk of skin irritation.
“However, the provider needed to ensure patches were always rotated in line with the manufacturer's guidance to reduce risks of skin irritation.” from the report
Staff cover during absence
needs fixingStaff said staffing was usually adequate, but it could be difficult to maintain cover when someone was unexpectedly absent.
“The only time it is a struggle is if someone calls in sick and we are not able to cover it with our staff or agency staff.” from the report
Incomplete monitoring records
needs fixingSome records, including fluid input and output charts, needed improvement so managers could monitor care effectively. The manager was addressing this through electronic care-plan checks and supervision.
“We found some improvements were required in the records staff completed to enable effective monitoring to take place, for example fluid input and output charts.” from the report
- 01How do you now check that medicine patches are rotated in line with the manufacturer's guidance?
- 02What happens if a member of staff is unexpectedly absent and the planned cover cannot be arranged?
- 03How are fluid input and output records checked, and what action is taken when they are incomplete?
- 04What were the previous ratings for Caring and Responsive, which were not inspected during this visit?
- 05How do you check that improvements from the previous Regulation 17 breach remain in place?
This was an unannounced focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 30 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2021
Rated Requires Improvement; inspectors found gaps in risk management, staffing oversight and governance, although medicines and infection control had improved.
This was a focused inspection on 25 May 2021. Inspectors looked only at Safe and Well-led because concerns had been raised about risk management, emotional wellbeing and record keeping. They spoke with people, relatives and staff, and checked care, medicines and management records.
The home was not consistently safe. Staff did not always have enough information about catheter care, skin damage and pressure relief. Some pressure-relieving mattresses were set incorrectly, and records did not show that two people had been repositioned regularly. Staff also raised concerns about staffing levels on units where people had more complex needs.
There were positive findings. The home was clean, infection control measures were in place, medicines were mostly managed safely and staff were recruited safely. However, the provider's checks had not found several important problems, including two safeguarding incidents that were not referred promptly.
The overall rating remained Requires Improvement, as did Safe and Well-led. The provider had to submit an action plan, and CQC said it would monitor progress and return for another inspection.
Clean and infection control
Inspectors found the home clean and tidy. They were assured that infection prevention measures, PPE, testing and safe admissions were in place.
“The home was clean and tidy and infection control practices minimised the risks of infections spreading.” from the report
Safe recruitment
The home completed character and background checks before employing staff.
“Staff were recruited safely, pre-employment checks on staff's character and background were completed.” from the report
Action after feedback
The provider responded quickly during and after the inspection and put an action plan in place. Further training and healthcare professional support were arranged.
“The provider responded immediately to our feedback both during and after the inspection and implemented an action plan” from the report
Family involvement
Relatives were invited to regular care reviews and monthly meetings. Inspectors reported that most people and relatives were positive about the service and staff.
“Relatives were invited to regular reviews of their family member's care so they could ensure it met people's personal needs and preferences.” from the report
Incomplete risk information
seriousStaff did not have a clear catheter care plan. Risk assessments for skin damage and wounds were not always detailed enough, and repositioning records had significant gaps.
“There was no clear catheter care plan in place to tell staff how they should support the person with the catheter” from the report
Pressure-relieving mattresses
seriousSeveral mattresses were set for the wrong body weight. This could reduce their ability to protect people from pressure damage.
“We identified several mattresses which were not on the correct setting.” from the report
Staffing concerns
needs fixingStaff said staffing levels did not always reflect people's individual needs, particularly on units where people had more complex needs. The provider said levels were reviewed and increased after the inspection.
“Some staff particularly raised concerns about staffing levels on the two units on the first floor of the home where people had more complex needs.” from the report
Safeguarding referrals
seriousTwo incidents that should have been considered safeguarding matters had not been referred as required. They were referred after inspectors asked about them.
“However, we identified two episodes of behaviours which should have been considered as safeguarding incidents and had not been referred as required.” from the report
Weak quality checks
seriousThe provider's audits and governance systems did not identify several problems with staffing, incidents and care records. This was a breach of Regulation 17.
“The provider failed to operate effective systems and processes to assess, monitor and improve the quality and safety of the service.” from the report
Creams not fully recorded
needs fixingStaff recorded that creams had been applied but did not record which creams were used. Inspectors could not be sure that prescribed topical medicines had been given.
“This meant we could not be assured people received prescribed topical medicines.” from the report
- 01What has been done to make sure catheter care plans and skin damage risk assessments contain all the information staff need?
- 02How are pressure-relieving mattresses now checked every day, and who checks that the settings match each person's weight?
- 03What are the current staffing levels on each unit, especially the units caring for people with more complex needs?
- 04How are safeguarding incidents now identified, referred and reviewed?
- 05How are topical creams recorded so the home can show exactly which prescribed medicines were given?
This was a focused inspection of Safe and Well-led only; the other key question ratings came from previous comprehensive inspections. This explanation was written from the published report of 30 June 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Four Acres
4 rated inspections over 7 years: the service has held its Good rating throughout.
- June 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- December 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- September 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- December 2012
Registered with the Care Quality Commission on 10 December 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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