This was an unannounced inspection that took place on 26 April 2017. 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