Archived: Aquarius Lodge

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).

The manager had sent us updates about the action being taken to improve the service.

People we observed were involved in what was happening at the service. Staff engaged and interacted with them.

People indicated and told us that were happy living at the service. People told us they were satisfied with their care. When their care needs changed they were getting the care and support that they needed to promote their health and well-being. Care planning reflected the individual and personalised care being provided.

We found that care plans and risk assessment had been re-written and updated. Local community specialists were contacted for extra support for people where needed.

The house where the people lived was clean and improvements had been made to the d'cor, furnishings and facilities at the service. Maintenance work was on-going and there were still areas within the service that needed attention. People said that they were happy with their rooms and with the environment in general.

We found that records were like care plans, risk assessments were current and accurate.

At the time of our inspection there was a manager in post but they had not yet registered with the Care Quality Commission.

People we observed were involved in what was happening in the home. Staff engaged and interacted with them.

People indicated and told us that were happy living at the service. People told us they were satisfied with their care. However, when their care needs changed we could not be sure that people were getting the care and support that they needed to promote their health and well-being. Care planning did not always reflect the individual and personalised care being provided.

We found that the manager had started to audit care plans and risk assessment and had made referrals for extra support for people where needed.

The house where the people lived was clean but it was not adequately maintained. Areas needed redecorating and some furnishings and equipment needed replacing.

We found that the training needs of the staff had been identified and staff were receiving the necessary training and skills to make sure they undertook their roles as safely and effectively as possible at Aquarius Lodge.

People told us they did not have any complaints but would not hesitate to speak to the manager or staff if they had any concerns and they would be listened to.

Not all the people at Aquarius Lodge were able to talk to us directly to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

People we observed were involved in what was happening in the home. Staff engaged with them every time they walked past and they were encouraged to participate in the activities. People indicated that they were happy at the home.

People told us they were satisfied with their care. However, care plans did not always reflect the individual and personalised care being provided and did not show how risk would be managed. Records were therefore not fully accurate or up to date.

All staff had received safety checks before they started working at the service to make sure they were safe to work with vulnerable people.

We saw that staff listened to people and took their views seriously and answered their questions in a way that they could understand. We saw that the staff were friendly and people seemed relaxed in the home. We did find that for a period of time during the day there was not always enough staff on duty to meet all the needs of the people. The owner took immediate action to rectify this. We found that not all staff had the necessary training and skills to make sure they undertook their roles as safely and effectively as possible Aquarius Lodge.

Relatives told us, 'My husband gets everything they need. Its small and cosy here and my husband likes small and cosy' and 'Staff speak kindly and nicely. They are very gentle.'

We found that at times people may not be consistently receiving the care and support they needed to make sure all their needs were being met in the way that was best for them as individuals.

People told us and we observed that there was enough staff available throughout the day to give them the support and care that they needed. They said that if they needed anything the staff responded quickly.

Relatives said that there was always staff around when they came to visit. They told us that there was staff available to speak to them if they wanted to discuss any issues about their relative.

We did find that the service did not always notify the Care Quality Commissions of incidents and events affecting people who live at the service.

Relatives said that there was always staff around when they came to visit. They told us that there was staff available to speak to them if they wanted to discuss any issues about their relative.

Staff said the increase in staffing numbers throughout the day had made a difference. They said they had more time to spend with people and the busy times of the day were not so rushed.

We saw that when staff spoke with people they took their time to make sure they had the chance to understand what they were saying.

There were 12 people living at Aquarius Lodge when we did the inspection.

Not all the people at Aquarius Lodge were able to talk to us directly to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Some people told us that they were treated with respect by the staff that supported them and that their privacy was maintained.

Other people were able to tell us that they had the care and support they needed to remain well and healthy. All of the people we spoke with gave us positive feedback about the service.

People said they felt listened to and supported to make decisions about their care.

People told us 'I like their attitude. They always have time to listen to what I have to say. They help me when I need it but let me do as much as possible for myself'. Another said, 'The staff know how I like things to be done'. Another person said, 'I am alright here, I get on well with the staff. They always make sure I am alright'.

One person said,'If I was worried about anything I would go straight to the manager, she would know what to do'.

People told us that there were some activities at the home and they could choose whether or not they wanted to join in. One person said, 'I don't mix much with other people and that is respected'.