This comprehensive inspection took place on 27 and 28 February 2017 and the first visit day was unannounced. We last inspected Amathea in December 2014 and we rated the service as good overall. Amathea is located a short distance from the town centre of Workington. It is a modern two story building set in its own grounds with parking to the front and a private secure garden to the rear. Accommodation and care is provided for up to 40 older people with disabilities or with chronic illness, the ground floor unit is designated to people living with dementia.
There was a registered manager in post at the time of 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.
During this inspection we found breaches of Regulation 19 Fit and proper persons employed, Regulation 11 Need for consent and Regulation 9 Person centred care of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Not all of the appropriate suitability checks required by law to ensure that the persons being employed were of good character had been completed before people commenced employment. This was a breach of Regulation 19 Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Medicines were being administered and were being kept safely but records relating to the application of topical medicines and creams had not been consistently completed.
We have made a recommendation that the records for the application of topical medicines and creams are reviewed to ensure that the correct application instruction is identified consistently.
On the days of the inspection there were deemed to be sufficient numbers of staff but we observed they were not always available at the time when people most needed them. The provider was in the process of recruiting more staff and developing the current staff team skills.
The processes used for identifying how best interest decisions were made for people who lacked the capacity to make complex decisions for themselves had not always been recorded. We also saw that consent to care and treatment had not always been obtained from the relevant persons with the legal authority to do so. This was a breach of Regulation 11 Need for consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People told us they had a good choice of foods made for them and that they enjoyed it. We saw that people were not always sufficiently supported during the mealtime to ensure they had their needs met. People who were at risk of not having their nutritional needs met had been referred to the appropriate health professionals.
Staff had received a variety of training on commencing employment and on going training in specific topics to assist them in their roles. However we did not see that their knowledge and skills were consistently applied. Areas of development for staff had been identified by the registered and area support manager. One of these areas for development was the consistent demonstration by staff of dignity and respect.
We have made a recommendation that further staff development is provided to support staff in promoting dignity and respect of the people they are caring for.
Care records lacked some current information about peoples individual care needs. Care was not always being provided in a person centred way. We did not see that people had always been involved in their care planning or had consented to their care and treatment. This was a breach of
Regulation 9 Person centred care of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People living in the home were supported to access activities that were made available to them and pastimes of their choice.
The registered manager and provider had recognised areas of improvement required in the service and had already taken action to address these areas.
‘You can see what action we told the provider to take at the back of the full version of the report.’