Accessible Information in Adult Social Care: Building Reasonable Adjustments That Actually Work

Accessible Information only improves care when it changes what staff do in real situations: referrals, assessments, consent, complaints, safeguarding, medication and discharge planning. Many services have “easy read” templates and still fail people because the adjustment is not matched to how the person understands and expresses themselves, or because staff are not consistent across shifts. This article sits within Communication, Accessible Information & Total Communication and reflects Core Principles & Values by focusing on practical, auditable reasonable adjustments.

What “accessible information” means operationally

In practice, accessible information is a service capability. It means staff can:

• identify a person’s communication needs early (not after something goes wrong)
• adapt how information is provided (format, pace, environment, language)
• adapt how decisions are made and evidenced (checking understanding, supported decision-making)
• carry those adjustments consistently across teams, partners and settings

For providers, the challenge is not producing resources; it is building a repeatable approach that survives shift changes, agency use, and multi-agency pressure.

Designing reasonable adjustments that are specific, not generic

Generic adjustments (“use pictures”, “keep it simple”) are rarely enough. Strong adjustments describe:

• Trigger points: when the adjustment must be used (medication changes, consent, refusals, incidents, discharge planning)
• Exact approach: how staff must communicate (one-step instructions, closed questions, key words written down, visual choices)
• Understanding check: what staff do to confirm the person has understood (teach-back, demonstration, structured choice)
• Recording rule: what must be recorded in daily notes and decision records

Operational Example 1: Hospital discharge information that prevents re-admission

Context: A person with ABI and executive function difficulties was discharged with written instructions about follow-up appointments and medication changes. They missed appointments, medication was inconsistent, and the service faced repeated crisis escalation.

Support approach: The provider created a discharge “accessible information bundle” matched to the person’s needs, then embedded it into the discharge checklist and first-week support plan.

Day-to-day delivery detail:

• A one-page “what happens next” sheet using simple headings: Today / This week / Next week, with times and locations.
• Appointments converted into a visual schedule placed in a consistent location at home, with staff prompts during each visit.
• Medication changes translated into a colour-coded prompt that matched the MAR and the blister pack labels.
• Staff used a structured “teach-back” check: the person explained the plan back using their own words; if not, staff rephrased and repeated once, then escalated for clinical clarification.

How effectiveness/change is evidenced: The service tracked missed appointments, medication errors and crisis contacts for 6 weeks before and after. The post-discharge period showed fewer missed contacts and fewer urgent calls, and records showed clear evidence of understanding checks.

Operational Example 2: Complaints and “service challenge” handled safely

Context: A supported living service received a complaint from a person with learning disability who felt ignored. Staff believed they had responded, but the person could not access the written response and became increasingly distressed, leading to repeated incidents and safeguarding referrals.

Support approach: The service built an accessible complaints pathway and made “accessible response format” a mandatory field in the complaint triage.

Day-to-day delivery detail:

• At complaint logging, staff recorded how the person wanted to receive updates: face-to-face with pictures, short written summary with symbols, or audio summary.
• The investigator used a “three-part” accessible outcome: (1) what you told us, (2) what we found, (3) what will change — each in plain language with a visual cue.
• A follow-up conversation was booked to check understanding and whether the person felt heard; staff recorded the person’s feedback in their own words.
• The service used supervision to test practice: staff had to describe how they adapted communication during the complaint meeting.

How effectiveness/change is evidenced: Complaint re-open rates fell, incident patterns reduced, and quality audits showed consistent recording of “format used” and “understanding check” for complaint responses.

Operational Example 3: Medication consent and refusal supported lawfully

Context: In homecare, a person repeatedly refused medication. Notes recorded “refused” with minimal detail. Family challenged the service, and staff felt pressured to “persuade” without clear guidance, increasing risk of coercion.

Support approach: The provider introduced an accessible medication explanation tool linked to the MAR refusal process, making communication steps part of medication governance.

Day-to-day delivery detail:

• A short, consistent script explained what the medication is for, what might happen if it is missed, and what alternatives exist (e.g. “take later” option).
• Staff offered a structured choice (now / in 30 minutes / discuss with nurse or GP) rather than repeated verbal prompting.
• Understanding was checked using a simple “why” question (“What is this tablet for?”) and recorded.
• Escalation thresholds were defined: two consecutive refusals triggered a clinical review request and family update, rather than staff improvisation.

How effectiveness/change is evidenced: MAR audits showed improved refusal recording quality, fewer repeated refusals without review, and clearer evidence that staff supported decision-making without coercion.

Commissioner expectation: accessible information must be embedded and evidenced

Commissioner expectation: Commissioners typically expect providers to demonstrate that reasonable adjustments are identified early, embedded into pathway steps (assessment, review, discharge, complaints, safeguarding) and evidenced through records and audits. They look for consistency across staff groups and a clear escalation process when communication needs create risk.

Regulator / Inspector expectation (CQC): communication adjustments reflected in real practice

Regulator / Inspector expectation (CQC): Inspectors will test whether people can understand information about their care and whether staff adapt communication consistently. Good services can show: individualised adjustments, staff awareness, and records that demonstrate understanding checks, consent practice and safe responses to refusals or distress.

Governance and assurance: making accessible information auditable

1) A single place where adjustments are recorded

Adjustments should be visible and easy to find: in the person’s profile, care plan front page, and any key documents used daily (MAR, risk summary, handover sheet).

2) A “when used” recording rule

Services should define when staff must record communication adjustments (capacity decisions, refusals, incidents, safeguarding conversations, complaint outcomes). This turns communication into evidence, not opinion.

3) Spot checks that test practice, not paperwork

Quality checks should include observing or discussing a real scenario: “How did you explain the change today?” and “How did you check understanding?” This is where weak practice is revealed.

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