Archived: Aquarius Care Home

Aquarius Care Home is a single storey residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 20 people. The service was not providing any nursing care when we inspected. This was being provided by community nurses for those that needed it.

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

People gave us positive feedback about the service and the staff. People told us, “The staff are easy going and polite, I don’t have favourites they are all very nice”; “I’m quite happy, they treat me well, good care, they are excellent people” and “I have lovely life. The staff are nice and they treat me well.”

Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. People had not experienced harm as a result of this. Records of medicines that required special storage and recording did not always balance with the amount held in stock. Medicines were securely stored and kept at the correct temperature to ensure their efficiency. Staff had been suitably trained and had their competency checked to make sure they practiced safe medicines administration.

When people’s needs had changed their care plans had not always been updated and amended to detail their current assessed needs. Care plans and supporting documentation were not always individualised and person centred. Which meant that people may receive care and support which did not meet their needs.

The service was not always well led. The registered manager knew people well and people were comfortable communicating with them. The registered manager and provider had carried out the appropriate checks to ensure that the quality of the service was maintained. However, the audits and checks were not robust. They had not captured the issues we had identified relating to; risk management, staff recruitment practice and management of medicines requiring special storage. After the inspection the registered manager submitted an action plan detailing how they planned to meet these areas of action.

We were somewhat assured that the provider was using PPE effectively and safely. We signposted the provider to resources to develop their approach. Staff wore personal protective equipment (PPE) and followed guidance to make sure this was disposed of safely. Staff had access to PPE whenever they needed it. People had been isolated for the required amount of time on admission the service was clean, and all areas of the service were regularly cleaned.

Information in the service was available in a variety of formats to meet people’s communication needs. However, the menu board in the dining room was not in use to support people to know what was on offer and to remind people of the choices they had made. Clocks on display around the service which showed people what time, day and date it was were not working (or were showing different times and dates). This did not enable people to orientate themselves.

There were suitable numbers of staff on shift to meet people's needs. People’s call bells were answered quickly. Staff understood their responsibilities to protect people from abuse. People told us they felt safe.

People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care. A range of activities were available for people who lived at the service and people were able to choose if they wished to join in with activities.

People told us they would complain to the staff or registered manager if they were unhappy about their care. The complaints policy was on display and gave people all the information they needed should they need to make a complaint.

People supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was Good (published 6 March 2018).

Why we inspected

We received concerns in relation to infection control, management of pressure ulcers and staffing levels. As a result, we undertook a focused inspection to review the key questions of Safe, Responsive and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aquarius Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

We observed staff wearing appropriate Protective Personal Equipment (PPE). PPE ‘stations’ were located around the service to make sure staff had access to PPE when needed.

People were provided with information about COVID in different formats, such as easy to read versions, to help people understand the virus and to give information about vaccinations.

Cleaning and infection prevention and control measures had been increased during the pandemic. Areas, such as light switches, handrails and door handles were cleaned regularly. Items delivered to the service, such as parcels, were quarantined to help reduce any risk of COVID. Regular audits were completed to monitor the cleanliness of the service.

Aquarius Residential Care Home 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 Residential Care Home provides accommodation with personal care for up to 20 older people. At the time of the inspection, 20 people lived at the home, however one person was in hospital. One person received their care and support in bed. People’s nursing needs were met by visiting community nurses.

There was a registered manager in place. 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. The registered manager had been off work for some time and had handed in their resignation. The provider had employed a new manager who was in the process of applying to CQC to become the registered manager. The new manager was present at the inspection.

The provider of the service had recently changed their legal entity. The change meant that this was the first inspection for the new provider. However the service had been inspected before. We inspected the home on 22 and 24 November 2016, and rated the service requires improvement overall.

At our previous inspection on 22 and 24 November 2016, we found a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action and meet the regulation. We also made recommendations to the provider. We recommended that prescribed thickeners were appropriately stored to ensure people were safe at all times. We recommended that the provider followed good practice guidance in relation to topical medicines records. We recommended that the provider ensured that people’s care needs were reviewed when their needs changed. We also recommended that the provider reassessed the systems and processes for monitoring water temperatures in the service.

The provider sent us an action plan on 09 January 2017, the action plan detailed that they had already made some changes and they were supporting staff to attend training and supervision sessions.

At this inspection we found improvements had been made. People and their relatives told us they received safe, effective, caring, responsive and well led care.

The provider followed safe recruitment practice. Essential documentation was in place for all staff employed. Gaps in employment history had been explored to check staff suitability for their role. There were suitable numbers of staff deployed on shift to meet people’s assessed needs. It was not clear how the staffing levels were determined in the home. We made a recommendation about this.

Staff had attended training relevant to people's needs and they had received effective supervision from the management team.

Risk assessments were in place to mitigate the risk of harm to people and staff. Medicines had been well-managed.

People were provided with meaningful activities to promote their wellbeing. People accessed their local community their relatives and friends. Plans were in place to improve activities to enable people to access the community with staff support.

People had choices of food at each meal time. People had adequate fluids to keep themselves hydrated.

Staff had a good understanding of the Mental Capacity Act 2005 and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the management team.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

People were supported and helped to maintain their health and to access health services when they needed them.

Maintenance of the premises had been routinely undertaken and records about it were complete. Fire safety tests had been carried out and fire equipment safety-checked.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time.

People’s care was person centred. Care plans detailed people’s important information such as their life history and personal history and what people can do for themselves. People were supported to be as independent as possible. People’s care records did not always detail that they had baths and showers as frequently as they had wanted. We made a recommendation about this.

People and their relatives had opportunities to provide feedback about the service they received. Compliments had been received from relatives through the completion of their surveys and through comments left in the provider's comments book.

People and their relatives knew who to talk to if they were unhappy about the service. No complaints had been received. The complaints information was not available to people in different formats or accessible versions to help them understand the information. We made a recommendation about this.

Relatives and staff told us that the service was well run. Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

There were quality assurance systems in place. The management team and provider carried out regular checks on the service. Action plans were put in place and completed quickly. Staff told us they felt supported by the management team.

The management team demonstrated that they had a good understanding of their role and responsibilities in relation to notifying CQC about important events such as injuries, safeguarding concerns and deaths.