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Inspection on 16/12/08 for Atlantis

Also see our care home review for Atlantis for more information

This inspection was carried out on 16th December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The people who live at Atlantis are provided with a good level of support by staff who are well trained and have a good understanding of dementia. One person responding to a survey commented "Very pleased with the way my mother is looked after", another commented "I can`t praise them or thank them enough at Atlantis". We found that visiting health care professionals considered the home to offer a good service for people with dementia, and that they sought and used the advice that was available. We observed that the people are treated with respect and staff try to provide activities that people will enjoy or find interesting. The home is clean and comfortable, and there are no unpleasant smells. People enjoy the food and they are involved in choosing what is provided. The staff are well supported by the management of the home. Mrs Brailey, the Registered Provider, is aware of what is happening in the home. The open culture means that if there are issues or concerns then these can be picked up and dealt with promptly.

What has improved since the last inspection?

One area where improvements had been identified is in that the home uses outside agencies to provide some of the training, including in relation to dementia.

What the care home could do better:

The recruitment system needs to be improved, two written references need to be taken prior to a person starting work at the home. Also a "POVA" check also needs to be made prior to employment, this is a check of a list of people who are not suited to work with vulnerable people. These checks help to keep people safe.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Atlantis Polperro Road Polperro Cornwall PL13 2JE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Tworkowski     Date: 1 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Atlantis Polperro Road Polperro Cornwall PL13 2JE 01503272243 01503273061 atlantis.care@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Catherine Brailey,Mr Steven Paul Brailey Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Atlantis provides care for twenty older people, ten of whom can be admitted to the home with a dementia or mental disorder. Communal accommodation for the service users with a dementia and or a mental disorder is in a separate locked facility. Atlantis is a large detached house, part of which is a more recent extension. It stands in its own large grounds consisting of lawned areas, orchard with views over the surrounding countryside and distant sea views. Parking is available in the grounds of the home. Garden furniture offering seating and table facilities is available on the level patio area outside the front entrance and the garden is accessible to service users by the way of Care Homes for Older People Page 4 of 25 Over 65 10 10 10 0 0 0 Brief description of the care home slopes and steps. Accommodation is provided on two floors which are connected by stairs and a stair lift. There are sixteen single rooms with six of these being en-suite and two double rooms having en suite facilities. Day care, respite care and meals on wheels are provided within the home, collecting and returning service users to their home for day care. There are three communal lounge areas, one of which can also be used to dine within and one of which is a sun lounge. There is a separate dining room but service users are able to exercise choice and can choose to eat in their own private room. Fees for the home are between 357 pounds and 460 pounds, the fee does not include items such as toiletries and chiropody. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection included an unannounced site visit to Atlantis that took place on 16th December 08 between 9.15 am and 5.40 pm, by one inspector. Throughout this report the term we is used, this reflects that the report is written on behalf of the Commission. Mrs Brailey, one of the Registered Providers, was present thought out most of the visit. As part of this visit we spent time with people during breakfast and over lunch time. We sat and observed what had happened in one of the lounges and noted the interactions between people and how staff responded. We looked at records of care, talked with two of the staff, and was shown around the home by one of the staff. We looked at the medication system, at staff recruitment and training, and how people are Care Homes for Older People Page 6 of 25 kept safe. We spoke with two visiting health care professionals, and a visiting relative. We sent surveys to ten of the people who live at Atlantis, and received three back. We also received a completed annual quality assurance form, from the Registered Providers. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs will be known about before they decide to move to Atlantis. Evidence: We looked at the information about a person who had come to stay in the home a few weeks earlier. We found that an assessment had been completed and that this information was used to complete an inital plan of care. The Manager told us that many of the people who came to stay at the home were known as they used the attached domiciliary services. The Manager, Mrs Brailey, said that sometimes people came for a short stay and then decided they wanted to stay on a permanent basis. She said that it was important that the person went home before they made that important decision to move to a home. One of the people who responded to the survey when asked if they received information about the home before a move said yes, and that she was given a personal touch. Care Homes for Older People Page 10 of 25 Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Atlantis are given a good standard of personal and health care, staff know about their needs. Staff seek and take the advice of health care professionals. Evidence: We sent ten surveys to people who use the service, three were returned. Two of the people said that they always receive the care they need, the other person said that usually did. We looked at plans of care that are on file. We found that the information was well organised. There was information on file about peoples past and things that are important to them. This is important in caring for people with dementia, and where they may not be able to explain these things to staff themselves. We were told that all care staff are expected to read and sign to say that they had read care plans, we spoke with two of the care staff, and they told us that they felt that there was a good standard of care, one person said that it was the nicest home she had worked in, this was because it was more personal. We also spoke with two health care professionals, one person said that when he asked about the well being of a resident they knew what Care Homes for Older People Page 12 of 25 Evidence: was going on, and they gave informed input. He also said that the staff in the home did what was asked in relation to any treatment. The other health care professional commented that there approach works well, that they were flexible and anticipate needs. She also said that staff in the home were very informative, they were happy to seek and take advice from professionals. If they had concerns they phoned, and were flexible in their response. We looked at files and saw that there were good records of visits by health care professionals. We looked at issues relation to diabetes and saw that needs relating to this condition were identified in the care plan. We discussed with the Manager the development of a specific diabetic care plan, that describes the individuals condition, how it is to be managed and controlled and who is responsible for its management. The Manager said that they used very few continence pads in the home, because they placed an emphasis on getting people to the toilet on a regular basis. She said that this was good for peoples dignity and for their health. Visitors told us that there was never any unpleasant smells in the home. We noted as part of this inspection that all of the people who live at Atlantis had a good standard of personal hygiene and care and thought had gone into their clothing. We looked at the medication system, and found that it was well managed. There were records of when medication was administered, including when someone said that they did not need medication, for example for pain relief. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Atlantis are provided with the opportunity to take part in a range of activities, and enjoy a good standard of meals. Evidence: As part of this visit we spent an hour and a half sitting, observing and noting the way people interacted in the lounge used by people with higher care needs. We observed that all of the interactions with staff were positive, staff behaved with consideration and were respectful with the people who live at Atlantis. People were involved in tasks and activities. It was also noted that individuals, in spite of considerable difficulties related to dementia, still felt able to communicate with each other. This reflects that people feel confident and secure at Atlantis and with their relationships with those around them. We asked visitors to the home if there was enough to do and was told that there was usually something going on, and staff try to get people involved. Singing and dancing were observed to be an important part of life at Atlantis. The Manager showed us a new selection of DVDs of musicals that had been purchased. The Manager said that some of the external Christmas decorations had been set out so that people sitting in Care Homes for Older People Page 14 of 25 Evidence: the lounge could see them. Some of the people who live at Atlantis have dementia, and it was noted how staff encouraged one person to help them with tasks such as cleaning. The individual was spoken to with respect. The Manager explained that they tried hard to work with other professionals to avoid over-medication. Where appropriate additional staff were provided so that a resident could go out for walks in the countryside. We sat with a group of people whilst they ate their breakfast and another group, who needed more support, during lunch. People told us that they enjoyed the food, and we observed that their was a choice. We spoke with the cook and he explained that they used good quality ingredients. He explained that the menu was developed in consultation with the people at Atlantis. We discussed with the Manager the provision of soft diets. One person responding to a survey commented that My mother has an excellent appetite and has praised the food (and the chef), portions are ample. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Atlantis or who have contact with the service are able to raise any concerns that they might have. Evidence: We found that staff had received training in relation to protecting people from abuse, and the Manager told us she was trying to access courses run by Cornwall Social Services. We asked the staff about the culture and was told that they were confident they could raise any issue that they were not happy about. People who responded to the surveys said that they knew how to complain, one person said that my mother would not be backward in coming forward. We were told that no complaints had been received in the last year. As will be seen in the next section checks on staff to ensure that are suited to working with vulnerable people are being made, however they are not always being made before people start work at the home. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Atlantis provides a good standard of comfortable and clean accommodation. Evidence: We looked around the home, it was clean and in good order, the lounges were decorated for Christmas. Bedrooms had been decorated to suit the individuals who occupied them. We were told that moving and handling equipment was supplied by the Health Service, via the District Nursing Service. There are two main lounge areas in the home, one for more able people, the other for people who needed a higher level of supervision. Doors to different areas of the home are coded, so that people can not wander out. This is noted and agreed in Care Plans. We found that only one of the bathrooms had a working door lock, bathrooms and toilets must have a door lock that can be over ridden in an emergency. We also saw that many of the bedrooms did not have locks, rooms should have locks that can enable people to lock their rooms if they choose. Such locks also must be capable of being over-ridden in an emergency. The home was clean and there were no unpleasant smells. One person completing a survey said I made an unannounced visit to check the home over prior to my mothers admission. I was extremely impressed with the standards of furnishing and Care Homes for Older People Page 17 of 25 Evidence: cleanliness- the whole package. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Atlantis Care Home benefit from staff who are well trained and competent in their work, particularly with people with dementia. The recruitment practises are not robust, and people could be placed at risk by unsuitable staff being employed. Evidence: We talked to two of the staff about their views of the home. Both staff were extremely positive about their work, and felt that the standard of care was very high. They felt that there are enough staff, and that they were well supported and trained. We observed staff through out this inspection and saw that staff were very skilled and sensitive in their work with people with dementia. We looked at records of staff training and saw that staff had received a range of training including training in relating to diabetes, dementia, the Mental Capacity Act, Diet and Nutrition, and mental health. The manager said that all staff had done a course in relation to dementia, and that they benefited from training from the local community psychiatric nurse. As part of this inspection we looked at the records of two people who had recently started in the home. We found that whilst references had been taken and checks had Care Homes for Older People Page 19 of 25 Evidence: been made of the suitability of the individual to work with vulnerable people, these checks had been received after the individuals had stated work. Two satisfactory written references must be received before an individual can start work in a care home. In addition a check must have been made of a list of people who are proscribed from working with vulnerable people. An individual may start work prior to a Criminal Records Bureau check being received, however they may only work in a supervised capacity. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Atlantis benefit from a well managed home. Evidence: We were informed in information sent to the home that both of the Registered Providers, Mr and Mrs Brailey, have obtained the Registered Managers Award, and have substantial experience in running a care home. Mrs Brailey told us that she is involved in the day to day running of the home, and was a very much a hands on manager. This was confirmed by our observations about how she worked and from what the staff told us. Mrs Brailey explained to us the way that she delegated responsibilities in the home, and how staff were encouraged to take responsibility for their work. All care staff were expected to record their own work. Also the cooks and domestic staff were considered very much as part of the team, and received training so that they too could understand the needs of people with dementia. We were told that the last staff Care Homes for Older People Page 21 of 25 Evidence: meeting was in November 08 and that these were held every couple of months. We looked at some of the records to ensure people are kept safe and saw that generally environmental risk assessments had been completed. We found that a fire risk assessment had been done, however no Legionella Risk Assessment had been done. We discussed with Mrs Brailey that guidance is available on the Health and Safety Executive Website as to how to carryout and implement such a risk assessment. We were shown a quality assurance system that is used in the home. Most importantly the people we spoke ith, who were visiting the home, had confidence in approaching staff to raise any issues. The presence of Mrs Brailey meant that she was no hand to deal with problems if needed. We were told in the questionnaire completed by Mrs Brailey that no money is kept on behalf of the people who live at Atlantis. This is dealt with by family and friends if an individual cannot manage their own finances. We were told that where necessary the home will pay for items and invoice relatives. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Proper employment checks 02/03/2009 must be completed prior to staff being employed. This must include a POVA check and two written references. No one who is not suitable to work with vulnerable people should work at Atlantis. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 21 Bathrooms and bedrooms should be provided with suitable locks that can offer privacy, security and be over ridden in the event of an emergency. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!