All inspections: Aquarius Care Home - Care Quality Commission

We carried out this assessment between 27 October 2025 and 19 November 2025. Aquarius Care Home is a residential service providing support to older people living with dementia and physical disabilities for up to 20 people. At the time of our assessment there were 20 people using the service. Two of these people had a learning disability.

We completed this assessment to follow up enforcement action we issued after our last assessment where significant shortfalls had been found in relation to safe care and treatment, person centred care and good governance.

At this assessment, we found the provider had made some improvements and was no longer in breach of regulation with regards to person centred care. [MS1][ND2]This was because new care plans contained personalised information and they were working towards everyone’s records being of the same standard. However, overall actions taken were not sufficient to improve all areas of the service and we found continued breaches of regulation in relation to safe care and treatment and good governance.

This assessment has been undertaken of a service that is used by autistic people or people with a learning disability but is not registered as a specialist service. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

People felt safe, but staff were not always guided how to minimise potential risks in their daily lives. There had been a deterioration in the home environment and safety concerns had not been addressed in a timely manner.

Although assessments of people newly admitted to the service were comprehensive and person centred, this was not reflected for people who had lived at the service longer term. The service had not updated the care plans of people currently living at the service, so they provided the necessary guidance for staff.

People and relatives told us there was a high turnover of staff which impacted the quality of care people received. People and relatives said staff were kind and caring but did not always have time to sit and talk with them. There had been improvements in how staff were supported through the use of formal supervisions. However, there were mixed responses from staff about how well they felt supported and listened to.

People continued to be supported to maintain their health and the service had received positive feedback from health care professionals about their working relationship. People had a choice of what to eat and drink to stay healthy.

Improvements had been made in monitoring accidents and incidents and systems to monitor the quality of care had been introduced. However, these processes had not enabled the service to make all the necessary improvements in a timely manner.

We carried out this assessment between 17 January to 24 February 2025. Aquarius Care Home is a residential service providing support to older people living with dementia and physical disabilities for up to 20 people. At the time of our assessment there were 18 people using the service. At the time of this inspection, the service was supporting 1 person with a learning disability. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. The provider was previously in breach of the legal regulation in relation to safe care and treatment and good governance. Improvements were not found at this inspection, and the provider remained in breach of these regulations. The provider failed to have effective systems in place to identify, monitor and manage risks for people . The provider failed to provide robust quality monitoring processes as the necessary information required to provide assurances about the quality and safety of the service was lacking . In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.

About the service

Aquarius Care Home is a residential care home providing accommodation for persons who require nursing or personal care to up to 20 people. The service was not providing nursing care, people’s nursing needs were met by community nurses. The service provides support to older people, some of who lived with dementia. At the time of our inspection there were 19 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

Staff did not provide effective support to identify people's aspirations and goals and assist people to plan how these would be met. There was not a consistent approach to supporting people to learn new skills or maintain their skills for as long as possible, where this was appropriate. Staff focused on people's strengths and promoted what they could do. People’s communication needs were not always met, easy read signage providing information and reminders was not always available.

The service provided people with care and support in a clean and well-equipped environment. The service was undergoing a programme of redecoration and repair. However, some safety aspects had not been identified and mitigated prior to the inspection. The risk to people from access to hot water and hot pipes and risks arising from people's diagnosed health needs had not been addressed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. This is an area for improvement.

The service had systems and processes in place to safely administer and record medicines use. Medicines were administered in line with the prescription.

Right Care

People's care was not always person centred and did not always meet their assessed needs, they had not had baths or showers as often as they would like. However, people told us they were treated with dignity and respect and their privacy was respected.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough staff to meet people's needs and keep them safe. However, staff had not always had the necessary training to meet people's assessed needs. Training to work with people with learning disabilities had been provided to 8 out of 13 staff.

Right Culture

The provider's quality monitoring processes had not always identified concerns and improvements in the service. People, their relatives and staff had been encouraged and supported to provide feedback about the service. People and their relatives felt listened to.

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

Rating at last inspection and update

The provider registered with CQC under a new legal entity, 7 October 2021. The service continued to run with the same nominated individual and directors, management team and staff team under the new legal entity. The last rating for the service under the previous legal entity was requires improvement, published on 7 August 2021.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This is the first inspection under the provider’s new legal entity.

You can read the report from our last comprehensive inspection under the providers previous legal entity, by selecting the ‘all reports’ link for Aquarius Care Home on our website at www.cqc.org.uk and choosing ‘old profile’.

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.

Enforcement and Recommendations

We have identified breaches in relation to risk management, mental capacity assessments, training, person-centred care, accessible communication and 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Aquarius Care Home

All Inspections

During an assessment under our new approach

During an assessment under our new approach

5 December 2022

During a routine inspection