People’s experience of using this service:

The provider had implemented new quality monitoring systems and checks which was identifying some shortfalls. However, the registered manager did not record their checks, and this was not identified by the provider as a shortfall. We found that this was an area for improvement.

here was a warm and welcoming atmosphere at Aquarius Lodge. Every person we spoke to told us that they enjoyed living at Aquarius Lodge; people felt safe and that staff were caring and respectful.

People decided how they wanted to be supported and felt comfortable raising any concerns or ideas for activities or for improving the quality of the service in various reviews, resident's meetings and annual questionnaires. People told us that staff respected their decisions and dignity. We observed staff knocking on people's doors before entering and explaining to people what they were doing and why.

People were kept safe from harm and abuse. Staff had appropriate training and risks to people were assessed and mitigated. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and what it meant for people.

People were encouraged to live healthy, independent lives as far as possible. Staff encouraged people to do as much as possible for themselves, to maintain mobility and independence. Healthy eating was promoted, and people praised the variety, flexibility and quality of food offered at the service. When people were un-well or their behaviour changed, this was identified and acted quickly upon by staff. People told us that staff were quick to respond if they rang their call bell and they received medical assistance as and when they needed it.

People received their medicines on time and had access to 'as needed' medicines such as; cold and cough medicines.

There were enough staff to support people, and staff had appropriate training to provide people with the right care and support. Staff worked closely together and felt supported and valued by the registered manager.

The premises had undergone a significant refurbishment programme since the last inspection. As a result, the premises now smelt odour free and looked clean and well-maintained. People had a choice of how they wanted their rooms to be decorated, and staff had brought new bed linen and towels to match the new colour scheme.

People's care plans were up-to-date and contained people's life histories and preferences. However, the records were often confusing to read. We discussed this with the registered manager and they accepted that this was an area for improvement to be followed up on the next inspection.

More information in Detailed Findings below.

About the service:

Aquarius Lodge 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 Lodge is a privately-owned service providing care for up to 17 people. At the time of inspection there were 15 people living there.

Rating at last inspection:

Requires Improvement (report published 17 January 2018)

Why we inspected:

This was a planned inspection based on the previous rating. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s); safe care and treatment, good governance and premises and equipment to at least good. Since this inspection, the provider and registered manager had actioned their plan, as a result the service is no longer in breach and we have rated the service good.

Follow up:

We will continue to monitor the service through the informatio

We inspected Aquarius Lodge on 04 and 05 December 2017 and the inspection was unannounced.

Aquarius Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

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. At the time of the inspection there were 14 people living there.

At the last comprehensive inspection in April 2017 the overall rating for the service was Inadequate. Four breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The provider failed to mitigate risks to people and ensure that medicines were managed safely. They had not made sure that the premises were clean and suitable for the people who lived there. The provider had failed to carry out the relevant recruitment safety checks on staff. Records were not complete and accurate. The systems and processes used to improve the service were not effective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led to at least good.

At this inspection we found some improvements had been made and two breaches of Regulation had been met. There were still improvements to be made and embedded to ensure improvements were sustained. However, we found three continued breaches of Regulations.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

A registered manager worked at the service each day. 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.

Care was not consistently safe and staff did not always reduce risks to people by using the correct equipment to help keep them safe. Staff did not always record accurately and at the time it should be written.

Some improvements had been made to the environment. Air purification equipment had been purchased by the provider to eliminate offensive odours and help control infection. However, there were still areas of the service which smelled of urine. There was dementia friendly signage around the service. People had access to communal areas and the gardens.

The providers and registered manager completed checks and audits to make sure the service was providing safe and effective care.

Risks to people, including the risks of abuse and discrimination, were assessed, monitored and reviewed. Any accidents and incidents were analysed by the registered manager to make sure people were referred to the right health professionals if needed. Lessons were learnt when things went wrong and advice from health care professionals was acted on. People’s medicines were stored, managed and disposed of safely. Staff understood their responsibilities in relation to hygiene and infection control, completed training about this and wore personal protective equipment, such as gloves and aprons.

People were supported by staff who had been

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