Aquarius Lodge

We found the following examples of good practice.

¿ Staff had changed their shifts to minimise the number of people in and out of the service. Staff had completed training on COVID 19 and infection control including in depth distance learning.

¿ Staff received training in how to use personal protective equipment (PPE) correctly. On the day of inspection staff were using PPE in line with guidance. The registered manager told us they had a good supply of PPE available at all times.

¿ When people had loved ones or friends they could plan window visits. Staff supported them to make video or phone calls. A summer house had been erected in the garden to provide a safe space for people to have visitors, once permitted under government guidance.

The provider had implemented new quality monitoring systems and checks which was identifying some shortfalls. However, the registered manager did not record their checks, and this was not identified by the provider as a shortfall. We found that this was an area for improvement.

here was a warm and welcoming atmosphere at Aquarius Lodge. Every person we spoke to told us that they enjoyed living at Aquarius Lodge; people felt safe and that staff were caring and respectful.

People decided how they wanted to be supported and felt comfortable raising any concerns or ideas for activities or for improving the quality of the service in various reviews, resident's meetings and annual questionnaires. People told us that staff respected their decisions and dignity. We observed staff knocking on people's doors before entering and explaining to people what they were doing and why.

People were kept safe from harm and abuse. Staff had appropriate training and risks to people were assessed and mitigated. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and what it meant for people.

People were encouraged to live healthy, independent lives as far as possible. Staff encouraged people to do as much as possible for themselves, to maintain mobility and independence. Healthy eating was promoted, and people praised the variety, flexibility and quality of food offered at the service. When people were un-well or their behaviour changed, this was identified and acted quickly upon by staff. People told us that staff were quick to respond if they rang their call bell and they received medical assistance as and when they needed it.

People received their medicines on time and had access to 'as needed' medicines such as; cold and cough medicines.

There were enough staff to support people, and staff had appropriate training to provide people with the right care and support. Staff worked closely together and felt supported and valued by the registered manager.

The premises had undergone a significant refurbishment programme since the last inspection. As a result, the premises now smelt odour free and looked clean and well-maintained. People had a choice of how they wanted their rooms to be decorated, and staff had brought new bed linen and towels to match the new colour scheme.

People's care plans were up-to-date and contained people's life histories and preferences. However, the records were often confusing to read. We discussed this with the registered manager and they accepted that this was an area for improvement to be followed up on the next inspection.

More information in Detailed Findings below.

About the service:

Aquarius Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Aquarius Lodge is a privately-owned service providing care for up to 17 people. At the time of inspection there were 15 people living there.

Rating at last inspection:

Requires Improvement (report published 17 January 2018)

Why we inspected:

This was a planned inspection based on the previous rating. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s); safe care and treatment, good governance and premises and equipment to at least good. Since this inspection, the provider and registered manager had actioned their plan, as a result the service is no longer in breach and we have rated the service good.

Follow up:

We will continue to monitor the service through the information we receive. We will follow up on identified areas for improvement at the next scheduled inspection.

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

Aquarius Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Aquarius Lodge provides accommodation and personal care for up to 17 older people, some of whom are living with dementia. The property is a three storey detached building and bedrooms are on all three floors. There are communal lounges and a dining room. At the time of the inspection there were 14 people living there.

At the last comprehensive inspection in April 2017 the overall rating for the service was Inadequate. Four breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The provider failed to mitigate risks to people and ensure that medicines were managed safely. They had not made sure that the premises were clean and suitable for the people who lived there. The provider had failed to carry out the relevant recruitment safety checks on staff. Records were not complete and accurate. The systems and processes used to improve the service were not effective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least good.

At this inspection we found some improvements had been made and two breaches of Regulation had been met. There were still improvements to be made and embedded to ensure improvements were sustained. However, we found three continued breaches of Regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

A registered manager worked at the service each day. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Care was not consistently safe and staff did not always reduce risks to people by using the correct equipment to help keep them safe. Staff did not always record accurately and at the time it should be written.

Some improvements had been made to the environment. Air purification equipment had been purchased by the provider to eliminate offensive odours and help control infection. However, there were still areas of the service which smelled of urine. There was dementia friendly signage around the service. People had access to communal areas and the gardens.

The providers and registered manager completed checks and audits to make sure the service was providing safe and effective care.

Risks to people, including the risks of abuse and discrimination, were assessed, monitored and reviewed. Any accidents and incidents were analysed by the registered manager to make sure people were referred to the right health professionals if needed. Lessons were learnt when things went wrong and advice from health care professionals was acted on. People’s medicines were stored, managed and disposed of safely. Staff understood their responsibilities in relation to hygiene and infection control, completed training about this and wore personal protective equipment, such as gloves and aprons.

People were supported by staff who had been recruited safely and there were enough staff on duty to keep people safe. Staff completed an induction and regular training to keep their skills and knowledge up to date. They met with senior staff on a one to one basis to discuss their performance and personal development.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s physical, mental, emotional and cultural needs were assessed and reviewed. They were encouraged to eat healthily and to drink plenty. Staff supported people to stay as healthy as possible and worked with health and social care professionals; following any advice they were given.

People were treated with kindness and compassion. Their privacy, dignity and independence were promoted and maintained. Staff treated people as equals with their own individuality and showed a concern for people’s physical and emotional well-being. Records containing people’s personal information were stored securely to protect their confidentiality.

People were supported to be as involved as possible with the planning and reviewing of their care. When this was not possible people’s representatives were consulted to make sure care and support was provided in a way that suited the person best. People’s needs and choices were assessed, monitored and reviewed regularly. People were encouraged to maintain relationships with those who were important to them. Their friends and family were able to visit when they chose and there were no restrictions on this.

People’s care plan’s detailed guidance for staff about people’s preferences and gave information about their life history. Staff spoke with people and their representatives about their choices and preferences for their end of life care so their wishes could be respected.

Staff knew people well. People were supported to remain active and took part in activities both in the service and in the local community. People told us they would talk to staff if they were unhappy about anything. They and their relatives knew how to complain if they needed to. Staff understood how to deal with any concerns and were aware of the provider’s whistle-blowing policy.

There was an inclusive culture which was promoted by the registered manager and staff. Staff told us they enjoyed working at Aquarius Lodge and were supported well by the registered manager. Their views, and those of people, relatives and health professionals were sought to make sure they were involved in making improvements at the service.

The registered manager and staff worked with the local authority and health and social care professionals to ensure people’s care and support needs were met.

All services that provide health and social care to people are required to inform CQC of events that happen, such as a serious accident, so CQC can check that appropriate action was taken to prevent people from harm. The registered manager notified CQC and the local authority in a timely manner.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had conspicuously displayed their rating in the service. At the time of the inspection they did not have a website.

You can see what action we told the provider to take at the back of the full version of the report.

Aquarius Lodge provides accommodation and personal care for up to 17 older people, some of whom are living with dementia. The property is a three storey detached building and bedrooms are on all three floors. There are communal lounges and a dining room. There were 13 people using the service when we visited.

In August 2016 the providers, who were previously registered as an organisation, became a partnership and the legal entity changed. The providers and the registered manager remained the same and had been in charge of the service for several years.

The service had a registered manager in post who assisted with the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was not safe as the provider had failed to make sure that risks to people, staff and others had been managed to protect people from harm and ensure their safety. Risks to support people with their mobility and behaviour had been assessed but staff did not always have clear guidelines to follow to ensure the risks were managed safely.

Risks assessments to prevent people from choking did not record what staff should do if the person started to choke and may need medical assistance. People that had been assessed as at risk of falling did not always have guidance for staff in place to reduce the risks of the person falling.

Equipment to reduce the risk of people developing pressure areas had not been checked to confirm the correct settings for each person. Accidents had been recorded and logged and medical attention had been sought, however people’s care had not been reviewed when their needs changed to reduce the risk of accidents happening again.

People were living in premises that had not been well maintained. Although some areas of the environment had been improved, such as a new wet room, new flooring in some bedrooms, and redecoration, there were still areas where risks had not been identified and managed.

Infection control audits had not identified the risks of infection and there was an unpleasant odour in some parts of the service. The floor of the laundry room had broken tiles and the fire door was not safe as it would not be effective in a fire. Although checks on the fire system had been made on a regular basis the fault on the laundry fire door had not been detected or recorded.

People could not access the garden without staff as this was not safe. The grass was over grown, with washing lines across the garden, which would pose a risk to their safety. Equipment was not stored safely. There was old equipment and other items, such as old curtain rails/blinds and Christmas decorations stored in the lounge on the ground floor, which led to the garden. There was an old hoist by the entrance to the garden, with wheelchairs and walking frames at the side. There were no risk assessments in place to manage these risks and ensure people were protected from harm.

The bath in the ground floor bathroom had split panelling and there was a ceiling light fitting in need of repair with exposed wires. The bathroom on the first floor had tiles. The windows were in need of repair with flaking paint and open woodwork. The registered manager told us that the windows in the lounge and one other were being replaced the next day but there were still others that were in need of repair or replacing. There were no plans or timescales for this work to be carried out.

The call bell system was not working in in all of the bedrooms, and there were areas on the ground floor which required re-decoration.

The maintenance person worked 20 hour per week and was decorating the hallway at the time of the inspection. There was no detailed maintenance plan in place with timescales as to when the outstanding work would be completed.

Cleaning materials were not stored safely so people, who may be confused, could access them. Archived files were kept in a cupboard in unlocked filing cabinets which were not being stored securely.

The towels that the provider had made available for people to use were old, threadbare, coming apart at the edges, faded and worn. Some of the bedding was not suitable as the single sheets did not fit over the mattresses and were just laid on the top. Duvet covers looked worn and faded. The registered manager told us that the provider had purchased some new flannels but there was no new bedding or new towels.

There were not always enough staff to meet people’s needs, especially at weekends, when there was no cook on duty and care staff were then responsible for cooking the meals. New staff had not been recruited safely as not all references were in place to confirm new staff were of good character and were suitable to work and support people.

Staff were receiving regular supervision but had not completed an appraisal to discuss their development, and review their performance over the previous year. We have made a recommendation to ensure that all staff receives an appraisal.

Staff were receiving training however their competencies were not being checked to ensure they understood and applied the training in line with good practice. The registered manager had not received formal supervision from the provider, or an appraisal to identify their training and development to continuously develop their skills and competencies.

People’s mental capacity had been assessed; however, when complex decisions had been made by others, there was a lack of clarity to confirm that these decisions had been made in people’s best interests. We have made a recommendation about involving people in decisions about their care.

People and relatives told us that staff monitored their health and they received the support they needed. However, when people attended outpatient clinics the outcome of the visits was not always recorded to update staff if the person’s needs had changed. People’s medicines were not always given to people safely. There was no guidance for ‘as and when’ required medicines, such as pain relief.

People’s privacy and dignity was not always respected as staff just walked in to their bedroom without knocking before entering.

Some parts of the care plans were personalised whilst others lacked detail about people’s preferences, and what they could do for themselves to remain as independent as possible. Further information was required to ensure that staff had detailed guidance about people living with diabetes and catheter care.

The activities co-ordinator worked three mornings a week which resulted in limited time for people to be supported to follow their interests and take part in social activities of their choice. We have made a recommendation about involving people in decisions about their care.

Checks completed on the quality of the service were not effective. The shortfalls found at this inspection had not been identified. The provider had not forged links with the local community to involve the service in local events.

People and staff had completed a quality assurance survey; however action had not been taken to regularly obtain the views of relatives and health care professionals.

Staff recognised different types of abuse and knew who to report any concerns to. Staff were aware of the whistle blowing policy and the ability to take concerns to agencies outside of the service if they felt they were not being dealt with properly.

The provider had an emergency plan in place to reduce the risk to people in the event of a major incident. Each person had a personal emergency evacuation plan in place. Checks on equipment, such as the regular servicing of hoists, and the servicing of boilers and equipment were in place.

People told us they enjoyed the food. Care plans contained information and assessments about how to support people with their nutritional, skin care and continence needs. People had been assessed before coming to live at the service.

Complaints were responded to appropriately. Additional signage around the building had been added as advocated by dementia care good practice guidelines

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered provider had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines

No rating of the service was on display as this was the first inspection under the new partnership registered in August 2016.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection