The inspection took place on 15 and 20 March 2017 and was unannounced.

Atlantis Care Home provides care to older people. The home can accommodate up to twenty people. Atlantis Care Home is also registered to provide personal care, in the form of a domiciliary care service, to people in their own homes. On the day of the inspection 19 people lived in the home and 21 people were being supported in their own homes by the domiciliary care service.

A registered manager was employed to manage the service. 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.

The inspection was carried out in response to a concern raised with CQC that people living in Atlantis care home were not receiving support to read letters, make phone calls, go shopping, maintain their physical independence or partake in any activities.

At this inspection we found people received support, if they requested it, to read letters, make phone calls and go shopping. The registered manager told us they would ask staff to regularly offer these services to people, to help ensure people knew they were available. We also found people were able to maintain their physical independence as far as possible. Staff followed people’s wishes and recommendations from relevant professionals to help ensure people’s needs were met. Activities were available to people. Staff endeavoured to provide group activities as well as one to one time with people.

Our previous inspection found a breach of regulation. This related to care plans for people using the domiciliary care service not containing guidance and direction to staff about how to meet people’s individual needs. During this inspection, we found people’s care plans relating to the domiciliary service included detailed information about how people wanted and needed to have their needs met.

People received support from staff who knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. Comments included, “The girls know what I want and what I need, all the time”

There was a positive culture within the service. The registered manager and provider had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff talked about people with fondness and respect and valued the relationships they had built with people. People told us, “The staff cheer me on, they are wonderful”, “The staff are so nice, I wake up in the morning and can’t believe how lucky I am”.

People had their healthcare needs met. People had their medicines as prescribed and on time. A local GP attended the home once per week and had a clear overview of people’s needs and the medicines they required. People were also supported to see a range of health and social care professionals including social workers, chiropodists, district nurses and doctors. Healthcare professionals confirmed they were contacted in a timely manner and staff followed their recommendations.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

People were kept safe by suitable staffing levels. People and relatives told us there were enough staff on duty in the care home; and people receiving support from the domiciliary service told us they rarely experienced late calls. Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had

There were 17 people living in the home on the day we visited. Atlantis Care Home also provided care to 10 people in their own homes. There was a different staff group who provided care and support to people in their homes than the group that provided care and support in the care home.

During our inspection we spoke with the registered manager about the care and support they provided. We also spoke to the administrator about training. We spoke to two staff and briefly to a visiting community psychiatric nurse and care co-ordinator from adult care, health and wellbeing (social services).

We observed staff helped people in a discreet manner and spoke to people with respect. We saw call bells were answered very promptly.

We saw care plans were detailed and directed staff as to the care and support people needed. They had been regularly reviewed. We were told about the range of activities available in the home.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening

Medicines were handled appropriately, kept safely, safely administered and were disposed of appropriately.

We saw the provider had effective systems in place to assess the quality of the service provided.

The home was clean and tidy, with light and spacious communal areas.

We carried out an inspection of Atlantis Care Home on 20 July 2012 as part of our annual inspection programme and to follow up on previous compliance actions that had been made in August 2011 and February 2012. During the course of our inspection we talked with one relative, and a friend who was visiting. We also spoke to four people who lived at Atlantis Care Home, the registered manager, three members of staff, the dementia liaison nurse and a community psychiatric nurse. We did not inspect the domiciliary care service.

Some of the people that lived at Atlantis Care Home were unable to tell us about their experiences. So to help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching the type of support people received. We observed that overall people had positive experiences living at Atlantis Care Home.

Comments from people who lived at Atlantis Care Home included “staff are very accommodating”, “I’ve been very well looked after here”, “they do attend to your needs”, and “I have never had to complain”. One person told us that they don’t get a choice about whether they would prefer a male or a female carer. They told us “I’d rather a female with personal care”.

We were told by a relative that staff are “very helpful, always cheerful”. Other comments included “any problems and they ring me at home” and "it’s a nice home, not too large". A visitor who had been visiting the home for the first time told us that her first impressions had been good and that she had “heard good things” about the care home.

Staff comments included, “brilliant, love the atmosphere”, “you get to know a part of their lives”, “we try and get people to do as much as possible”, “I know I can speak to the manager if I ever have a problem” and “very supportive”.

Nursing professionals that visited the home told us “they are always welcoming”, “the manager is professional”, “they always let us look at notes”, "I can not fault them", "they use their initiative", "they call me, and are precise about the concerns they have" and “I have never heard staff speak to people in a disrespectful way”.

During our inspection we looked at seven outcomes of the ‘Essential Standards’. We found that the provider was compliant in six areas and non compliant in one area inspected.

In the one area of non compliance, we found that people’s needs were assessed however, care and treatment was not planned and delivered in line with their individual care plan.

People who use the service told us that they were treated with respect and that staff did what was asked of them. Relatives said that they were contacted if their relative was not well, and were always made to feel welcome when they visited.

People who use the service told us that the care could not be faulted, and other comments included "marvellous" and "first class". People visiting the home added similar comments saying that "we count our blessings", and "I can't praise them enough".

People told us that they felt very comfortable about raising any concerns and that they would not hesitate to talk to the Registered Provider if the had an issue.

This inspection covered the care home and the domiciliary care service.

People told us that they thought that the individual carers were good and that they have a laugh. They also said that they were treated with respect. We were told that there is a "quick turnover of staff", and people do not know who their carers are. Some people said that visits are sometimes missed. We were told of concerns that proper recruitment on staff. Also, some of these staff were working on their own, with very little experience.

When we visited the service and looked at the recruitment records for staff we found that not all of the recruitment checks had been completed. When we checked a reference, we found it to have been falsified. We found that rota and daily recording sheets had been amended, and showed that inexperienced staff were not working alone, however information from people who use the service confirmed that inexperienced staff had worked alone.

We found that the home is not being managed by the registered manager, and that the manager gave us incorrect information about this. We were concerned that no consideration had been given to referring a concern about the conduct of a member of staff to the Social Services who have a responsibility for coordinating safeguarding. We had concerns that this service is not being properly or safely managed.

The inspection took place on 1, 2, and 3 December 2015 and was unannounced to the care home and announced to the domiciliary care part of the service.

Atlantis Care Home provides care and accommodation for up to 20 people who are living with dementia or who may have physical disabilities. On the day of the inspection 20 people were living at the care home. The home is on two floors, with access to floors via stairs or a stair lift. Bedrooms have wash hand basins. There are shared bathrooms, shower facilities and toilets. Other areas include two lounges, a dining room, and garden. The service also provides domiciliary care services to adults within East Cornwall. On the day of our inspection 21 people were using the service, with 14 people receiving personal care. The domiciliary care service provides palliative care, as well as supporting people with physical disabilities, sensory impairments and mental health needs, including people living with dementia.

The service had a registered manager in post. 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.

People felt safe. People were protected from avoidable harm and abuse that may breach their human rights. The registered manager and staff understood how the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) protected people to ensure their freedom was supported and respected. This meant decisions were being made for people with proper consultation.

The provider and staff understood their safeguarding responsibilities and staff had undertaken training. People were protected by safe recruitment procedures as the registered manager ensured new employees were subject to the necessary checks which determined they were suitable to work with vulnerable people.

People had risk assessment in place to help staff minimise risks associated with people’s care. People had personal evacuation plans in place, which meant people could be effectively supported in an emergency. The environment was assessed and monitored to ensure it was safe at all times.

People’s medicines were managed which meant they received them safely, however documentation, was not always in place, for example, people did not always have records in place when they preferred to take their medicine without any support. The registered manager told us immediate action would be taken to ensure this was rectified. People’s wishes for the end of their life, had been recorded so staff knew how people wanted to be cared for.

People received care and support from staff who were kind and caring, treated them with respect and promoted their privacy and dignity. Relatives told us they were happy with the care their loved ones received. People were supported by sufficient numbers of staff who had the knowledge, skills and experience to carry out their role. The registered manager ensured staff undertook training, and staff told us they felt supported.

People’s consent to care and treatment was not always reflected in their care plans, but the registered manager told us she would take action to make sure this was recorded. Staff, however, asked people for their consent prior to supporting them. People’s care plans did not always provide guidance and direction to staff about how to meet people’s individual needs, which meant care may not always be provided consistently or in line with people’s wishes and preferences. People’s care plans did not always demonstrate how people, their friends and family were encouraged to be involved in making decisions about their care. However, action was being taken to address this.

People told us they were happy with the quality of food. Staff supported people with their individual nutritional needs and took appropriate action when concerns were identified. People could access health care services and the registered manager had systems in place to ensure staff shared information about people’s health care to help ensure prompt action was taken when required. A health professional told us they were positive about their working relationship with the service and described communication as “excellent”.

People and those who mattered to them were encouraged to provide feedback about the service they received. People told us if they had any concerns or complaints they felt confident to speak with the staff or registered manager.

People on a daily basis, were not always able to participate in social activities, because activities were not always planned. Although people told us this was not an issue, relatives told us they felt more activities should be made available for people.

People lived in an environment which promoted the principles of dementia care, such as pictorial signage so people knew how to find their way about the service. The provider was planning further work to make improvements to the decoration of the service.

The provider had some systems and processes in place to help ensure people received a high quality of care, but the provider was also currently making improvements to make these more effective. The Commission was notified appropriately, for example in the event of someone passing away unexpectedly.

The registered manager and provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.