Archived: Aquarius Residential Care Home

Aquarius Residential Care Home is a care home which provides accommodation with personal care for up to 20 older people. The home is a bungalow, which has been extended. It is located on the outskirts of Chatham. There were 20 people living at the home on the day of our inspection.

The home had a registered manager. 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.

At our previous inspection on 21 and 23 December 2015 we found breaches of Regulations 12, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to meet the regulations.

The provider sent us an action plan on 29 April 2016, the action plan detailed that they had already met some regulations and aimed to be fully compliant by 15 May 2016.

At this inspection, people gave us positive feedback about the home and told us they received safe, effective, caring, responsive care.

Staff responsible for providing care had not all undertaken training to enable them to meet people’s needs. Eight out of 14 staff had not completed dementia training despite providing care and support for people who lived with dementia. No staff had undertaken epilepsy training despite caring for people who had a diagnosis of epilepsy. The training records also evidenced that no staff had undertaken catheter care training despite providing care for four people that had catheters in place to help them with their continence needs.

Records of staff supervisions showed that these meetings had taken place for new staff, however staff that had worked at the service for some time had not received a formal supervision since July 2015.

Risks to people had been identified and mitigated where possible. However, water temperatures in parts of the building were excessive which could cause injury to people. Action had not been taken quickly to resolve this over a four week period between October and November 2016. We made a recommendation about this.

Risks assessments relating to one person’s swallowing and choking had not been updated to reflect changes to their health. We made a recommendation about that.

Prescribed thickener which is used to thicken fluids to aid swallowing was left out and unattended. Prescribed thickeners should be kept locked away to prevent accidental ingestion of the powder. We made a recommendation about this.

Medicines had been generally well managed, stored securely and records showed that tablets had been administered as they had been prescribed. Medicines charts relating to creams and topical solutions showed inconsistent recording of application. We made a recommendation about this.

The registered manager 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. The registered manager had not informed CQC about Deprivation of Liberty Safeguards (DoLS) authorisations that had been approved. We made a recommendation about this.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.

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.

The premises were well maintained, clean and tidy. The home smelled fresh.

Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.

Staff had a good understanding of the Mental Capacity Act and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the registered manager, care plans did not show clearly that DoLS authorisations were in place. This was amended by the registered manager during the inspection.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.

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 and were complimentary about the care their family member’s received.

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

People’s care was person centred. People were supported to maintain their independence. Care plans detailed people’s important information such as their life history and personal history.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People’s views and experiences were sought through surveys. People were listened to. People and their relatives knew how to raise concerns and complaints.

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

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection we set out to answer one key question; is the service safe?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that appropriate processes were in place to ensure that staff who were recruited to work at Aquarius Residential Care Home were suitable to work with people who may be vulnerable. Positive references had been obtained before staff started working in the home and staff had provided proof of identity. All of the staff at the home had completed Disclosure and Barring Service (DBS) checks to ensure that they did not have convictions or cautions that may have indicated that they were not suitable for working with vulnerable people.

The inspector gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People were protected from the risk of harm because steps had been taken to safeguard them. Staff understood their responsibilities in relation to safeguarding. People told us that they felt safe.

The provider had not carried out suitable recruitment checks. We found gaps in staff members employment histories that had not been checked. We found that some staff had not had DBS checks.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staff recruitment checks.

Is the service effective?

We saw that the care that was delivered reflected people's assessed needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that people's needs were met because appropriate assessments had been carried out and care was planned and delivered effectively. Care plans were reviewed monthly and were therefore relevant and up to date.

Is the service caring?

People were cared for by staff who were kind and attentive. People told us 'I'm well cared for'; 'I'm pretty happy here' and 'Staff treat me very well'. Relatives told us that the staff are 'Friendly and helpful'.

Is the service responsive?

We found that people were given opportunities to express their views and they told us that they felt they would be listened to if they made requests. We saw that actions had been taken when people had expressed preferences and made requests. People told us that if they had a concern or complaint they would talk to the manager.

Is the service well led?

Staff we spoke with told us that the manager at the home was approachable and they felt they were supported to do their jobs. A relative told us 'This [home] feels homely, friendly and nice'. We saw that the manager was involved with the delivery of care as well as running the home which showed they had a good understanding of people's needs.

We found that the home had taken steps to make sure that there were safe practices in place for the administration of medicines. Checks and audits of records and staff practices were being carried out, but these were not always being recorded to evidence that they had taken place.

The home was being extended to provide additional accommodation and facilities for the people who lived in the home. Measures had been taken to ensure that the home remained a safe place to live and work whilst this building work was being carried out.

The home was clean on the day of our visit with the exception to the kitchen. Action was taken to ensure that the whole of the kitchen was clean during our visit. The floor in the laundry room was not clean nor water tight. The provider confirmed that action had commenced to make the floor water tight and clean during the writing of this report.

Equipment in the home was available to people who required it. This equipment was maintained on a regular basis to ensure that it remained in good working order.

People said that they had enough to occupy them, that the staff were helpful and friendly. They said that they had no complaints, but they knew who to speak to if they had and believed that any complaint would be taken seriously.

We observed unsafe medication practices. Staff gave people their medicines and then left the room so they could not be certain that people had taken the medicine that was intended for them. Staff did not always complete the medication administration correctly when medicines came into the home and when there were changes in people's medicines. This put people at risk of not receiving their medication as prescribed by their GP.