Archived: Aquarius Lodge

Updated 21 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 11 May 2015 and was unannounced. The inspection was carried out by two inspectors, and an expert-by-experience. The expert-by-experience was a person who had personal experience of using or caring for someone who uses this type of care service.

Before the visit we looked at previous inspection reports and notifications we had received. This was a follow up inspection to assess if the service was compliant with the requirement notices made at the previous inspection on 24 and 26 March 2015. A notification is information about important events which the provider is required to tell us about by law. We looked at information received from social care professionals.

During our inspection we spoke with five members of staff and the registered manager. We spoke with thirteen people using the service. We were not able to speak to any relatives or friends as there were no visitors when we visited the service. We observed the lunchtime meal and also observed how people were supported throughout the day with their daily routines and activities. We looked at how staff spoke with people and observed staff carrying out their duties. We looked around the communal areas, some people’s rooms with their permission and facilities such as the kitchen and laundry.

We looked at a range of records including care plans, monitoring records for five people, and medicine administration records. We also looked at four staff records and records for monitoring the quality of the service provided, including audits, complaints records and meeting minutes.

The last inspection took place on 24 and 26 March 2015 where breaches of the regulations were found.

Updated 21 June 2016

This was an unannounced inspection that took place on 11 May 2016.

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.

The provider had failed to notify the Care Quality Commission (CQC) that the legal entity of the service had changed. The service had been trading as Aquarius Lodge Ltd but this company had been dissolved and they were now trading as a partnership. This meant that the service was not legally registered. The provider is in the process of submitting a new registration application to CQC.

The service had a registered manager in post who had been appointed under the legal entity of Aquarius Lodge Limited. 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.

We carried out an unannounced comprehensive inspection of this service on 24 and 26 March 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. There were three breaches identified at the previous inspection and at the time of this inspection the provider has complied with one and parts of the other two breaches, therefore the provider had not fully met their legal requirements.

The call bell system in the service was being checked regularly and had been repaired in June 2015. However, recent checks had identified that two call bells in the rooms on the lower floor were in need of repair.

The water temperatures had been checked and valves had been fitted to ensure temperatures were within the recommended guidance to reduce the risk of scalds to people. A fire risk assessment had been completed and appropriate staff training had been provided so that staff knew what to do in the event of an emergency.

Although there was a programme of cleaning in place to ensure that the home smelt fresh, some areas of the service still had strong odours. The cleaner continually used fresh air sprays but these only masked the odour for a short time. There were systems in place to ensure that clean and soiled linen were separated to reduce the risk of infection.

The infection control audit had not picked up the shortfalls that we identified at the time of the inspection. Some areas in the service had not been redecorated or repaired and further action was needed to ensure infection control measures were in place. The wet room had been cleaned and checked but there remained a puddle of water beneath the toilet which appeared not to drain away.

The five year electrical check on the premises was out of date. The registered manager told us that this was in the process of being arranged.

Window restrictors had been reviewed and fixed and checks were being carried out to make sure they were working correctly. Radiators in the hallways had been guarded to ensure that people were protected from hot surfaces.

The handle on the back door to the garden had been repaired. Door handles on some people’s rooms were also being fitted at the time of the inspection. Further risk assessment was required to ensure the entrance to the garden and the garden was safe to ensure that people would remain as safe as possible.

Some parts of the service had been redecorated and new carpets had been laid in seven bedrooms, some corridors had been painted and the dining room had been decorated and new furniture purchased.

There was an ongoing action plan in place to improve the environment but the timescales had not always been achieved. The provider visited the service regularly but had not identified the further shortfalls identified at this inspection.

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 not submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Although some further details had been added to individual risk assessments and care plans, there were still shortfalls in the risk assessments to guide staff how to manage risks with people’s behaviour, mobility and falls. Staff were able to tell us how they moved people safely but this was not recorded in the care plans. People who were at risk of choking did not have full details in their risk assessments to show staff what action they should take if the person started choking. We observed that when one person had their meal staff were attentive and stayed with them to ensure they ate their food safely.

Some people were living with diabetes and were being supported daily by the district nurse to monitor and administer their insulin. There were no guidelines in their care plans to ensure that staff would recognise when a person may need medical attention if their blood sugar was too high or low. Further information was also required in care plans to ensure that staff knew the signs and symptoms to look for to recognise if people’s catheters were not working correctly to reduce the risk of infection.

Care plans had been reviewed and there was good communication with staff and management so that they were aware of people’s changing needs. People’s healthcare needs were monitored and appropriate advice sought from health care professionals when required. People’s nutritional needs for eating and drinking were assessed and supported. People received their medicines when they needed them and medicines were stored safely

A full training programme was in place to ensure that staff had the skills and competencies to give safe care. Staff were supported by the registered manager with one to one meetings and a yearly appraisal There were sufficient staff on duty to ensure people had their needs met and staff were recruited safely.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some people living at the service had a DoLS authorisation in place. Staff were aware who this applied to and understood they needed to follow the recommendations of the assessment, but this was not always recorded in the care plans. Policies and procedures were in place relating to the Mental Capacity Act 2005 (MCA) and the DoLS. When people lacked the mental capacity to make decisions the registered manager was guided by the principles of the MCA to ensure any decisions were made in the person’s best interests.

People felt safe and staff understood about different types of abuse and who to report to both inside and outside of the service. People spoke positively about the care and support they received. People told us that staff were caring and kind. Staff knew people well and understood their choices and preferences. Staff were patient and listened to people, responding positively to their requests.

People were enjoying a variety of activities. People who were able accessed the community to go to clubs, and outings. People who remained in their rooms were visited to ensure they did not feel socially isolated. Additional signage around the building had been added as advocated by dementia care good practice guidelines.

People knew how to raise any concerns and felt that they would be listened to. There was a complaints procedure in place and concerns had been responded to appropriately.

People, their relatives, staff and health professionals were encouraged to provide feedback to the provider to continuously improve the service.

There was an open and transparent culture and staff understood their roles. Staff told us the registered manager was ‘brilliant’ and talked about how much they had improved the service. Staff had gone the ‘extra’ mile and had decorated some of the areas of the home in their own time. They were also fund raising to provide people with a memory room.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and (Registration) Regulations 2009 (Part 4).