This comprehensive inspection took place on 7 June 2018 and was unannounced. At our last inspection of the service in April 2017 we found three breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 of safe, effective and responsive to at least good.

At this inspection we found that the provider had completed those actions and we found the service was meeting the fundamental standards of quality and safety.

Amathea 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. 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 personal care is provided for up to 40 older people with disabilities or with chronic illness, the ground floor unit is designated for the care of people living with dementia.

There was a registered manager in post who had been appointed after the last inspection in April 2017. 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.

Improvements to the processes used when employing people had been made that ensured the recruitment of fit and proper persons more robust. All of the required checks of suitability had been completed in a robust manner.

Medicines were being administered and kept safely. We have made a recommendation that the provider ensures that the records for administration of as and when required medications (PRN) include written protocols for their use. To ensure that medications prescribed were being optimised to their best use for the people they were prescribed to.

There were sufficient numbers of suitable staff to meet people’s needs. Staff training was ongoing and people had received sufficient training to safely support and care for people. Some staff had been supported into extending their roles as champions in areas of their own interests. This increased staff knowledge and in turn ensured people experienced good outcomes. Staff were also supported through regular staff meetings, supervision and appraisals.

We saw that the service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people.

People’s rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

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.

People living in the home were supported to access activities that were made available to them and pastimes of their choice.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the home.

We observed staff displayed caring and meaningful interactions with people and people were treated with respect. We observed people's dignity and privacy were actively promoted by the st

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 activ

We considered all the evidence we had gathered under the outcomes we inspected. We

used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

Staff we spoke to understood how to protect vulnerable adults from abuse. However we judged there were insufficient staff to meet people's needs in a timely manner. We also found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Is the service effective?

Although we found that there were insufficient staff at Amathea people were cared for by staff who were supported to deliver care and treatment to an appropriate standard. We have asked the provider to ensure that supervision is regularly available to all staff as this may support them in devising more effective care plans.

Is the service caring?

People were cared for by warm and friendly staff who had developed good relationships with the people they supported.

Is the service responsive?

We found that people's care needs had been assessed and their choices were responded to. However care plans did not correctly reflect those needs and lacked detail about how people's needs were to be met.

Is the service well-led?

We found that there was a quality assurance system in place at the home. The manager demonstrated that they were aware of most of the problems in the home and the staff spoke highly of the way the manager provided support. However the provider's quality assurance systems had failed to identify all of the issues highlighted in this report.

For the purpose of this inspection we focused on the elderly mentally infirm unit (EMI) which was called the Forget Me Not unit. People we spoke with told us that they were satisfied with the service provided by Amathea. One person said "I like it here." Another person told us "I don't have any problems, I get on well with the staff."

Some people who used the service were unable to tell us about their experience as they were to unwell. However we observed how staff looked after them and interacted with them. We found that staff treated residents with care and respect in a professional manner.

The environment required attention but we were informed that the provider intended to refurbish the home.

People who used the service were protected from abuse because the provider had taken steps to ensure that staff knew how to identify abuse and who to report it to.

There had been improvements to the way medication was administered which helped to ensure people were not harmed.

Staffing levels had increased since our last inspection and appropriate training was being provided for all new starters and existing staff.

The provider had an effective system to regularly assess and monitor the quality of service that the residents received.

People were receiving effective, safe and appropriate care which was meeting their needs. People in the home confirmed that they felt well cared for and had no problems with their care regime and support. Staff told us; “The food is good, there is always a good choice and an alternative offered if people do not like what is on offer.” We were also told that the home had employed a new chef who was; “Very good and does a lot of their own baking.” We looked at three individual care records and found that all had a person centred plan of care setting out the action that was to be taken by support staff which ensured that the health, personal and social care needs of the people living at the home were being met.

When we visited the upstairs floor we found two people wandering around in a distressed state still in their nightclothes. There was no staff visible to support them at this time. We were told that staff felt that staffing both day and night was ‘stretched’. One member of staff told us; “We worry when we are tied up in a resident’s room that other residents may be wandering unsupervised. This could put these people at risk of injury.” We spoke with three people about medicines handling at the home. Everyone we spoke with was happy with the arrangements in place when nurses administered their medicines. However, as identified by the manager in their medicines audits, we found that the home’s medicine policies were not consistently adhered to.

The people we spoke with confirmed they had been involved in the ongoing assessment of their care which had identified their religious and cultural, care, nutritional and relationship needs and they had agreed with the level of support to be provided. They told us their views about how they wished their support to be delivered had been listened to and respected.

We spoke with three relative who all said they were satisfied with the care their relative received. All confirmed they had been involved in the planning of care for their relative and were kept informed if there were any changes to that care.

A relative stated: “I have an excellent relationship with the manager. I can openly discuss with her any of my concerns and tell her what I think.”

One person told us: "You get well treated here, I have no complaints.”

Whilst another said: "The staff are very good, they will do anything for you."

A relative told us: “She always has her hair done and looks nice. I am quite happy and do not have any problems with the care provided.”

One person said that: "The staff are brilliant. They are always so kind."

Whilst another commented that: "The staff are very attentive, they always come very quickly when I need assistance."

One relative told us: "Staff cope very well with my relatives deteriorating condition. I have every admiration for them as they never loose their cool and are so patient."

We carried out an unannounced inspection of this service on the 30th and 31st of December 2014. We previously inspected Amathea on the 23rd July 2014 and we found that they were not meeting all the regulations assessed.

Amathea is located a short distance from the town centre of Workington. It provides care across two floors for up to 40 older people with disabilities or chronic illness. The first floor of the building is dedicated to caring for people who live with dementia. At the time of our inspection the registered manager was on leave. 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. However Methodist Homes for the Aged had arranged management cover for the service.

At the previous inspection the home was in breach of regulation 22 of the Health and Social Care Act 2008. Because there was insufficient staff to meet people individual needs. We found at this inspection that the service was no longer in breach of this regulation but improvement was required to ensure that it is safe. Vacancies for nursing staff had been recruited to but further work was required to ensure that there continued to be sufficient care staff to meet people’s needs.

At the previous visit the service breached regulation 13 as they had failed to manage medicines appropriately. The management of medicines had been improved though the service was unable to demonstrate that this improvement could be sustained. We will continue to monitor this.

The service had also breached regulation 9 at the previous visit. However during this inspection we found that care and support plans had sufficiently improved.

Staff were well trained and were confident in their roles. People were provided with adequate nutritional support. The service engaged with other providers to ensure people’s care needs were met. They ensured that they were compliant with legislation relating to the Deprivation of Liberties Safeguardings (DoLS)

People who used the service were supported by people who were caring and professional. Staff had taken time to get to know the people who used the service. People were treated in a dignified manner and empowered to make their own choices wherever possible,

Assessments of people’s needs were comprehensive and care plans were based upon the information gathered. There were clear written interventions that outlined how people should be supported. The manager engaged with people who used the service and their relatives to ensure that compliments, concerns and complaints were listened to and learned from.

The service was well led by the manager with the support of senior managers from Methodist Homes for the Aged. The service had improved under their leadership. The manager was forthcoming with information relating to the service. There was a quality assurance system in place that helped ensure the delivery of good quality care.