Tulip Gardens

About the service

Tulip Gardens is a residential care home providing personal care to eight people at the time of the inspection. The service can support up to eight people some of whom are living with physical disabilities, learning disabilities, sensory impairment and autism.

People’s experience of using this service and what we found

Based on our review of Safe and Well led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

People had not always had the risks associated with their care assessed, monitored and mitigated.

The provider had not always ensured incidents were reviewed to reduce the chance of reoccurrence and take learning from them.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Staff communicated with people in ways that met their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care:

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture:

Systems and processes to monitor the quality and safety of the service had not always been effective.

Staff placed people’s wishes, needs and rights at the heart of everything they did. Staff felt well supported in their role, felt able to raise any concerns and enjoyed their roles in supporting people who lived at the service.

People and those important to them were involved in planning their care. The service enabled people and those important to them to worked with staff to develop the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 August 2018).

Why we inspected

We undertook this focussed inspection as part of a random selection of services rated Good and Outstanding.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to how incidents and accidents were managed and in how the systems at the service enabled oversight and monitoring.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tulip Gardens 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.

Tulip Gardens is a home without nursing and can accommodate up to 8 people. At the time of our inspection, 8 people were living at the home.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

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. Tulip Gardens did not have a registered manager in post at the time of our inspection, but the acting manager was in the process of applying to become registered with us.

People were protected from potential abuse by staff as they were trained and understood how to safeguard them. People had risks to their safety assessed and there were plans in place to reduce the risks, which staff understood and followed. There were sufficient staff that had been recruited safely to support people when they needed it. People received support to have their medicines as prescribed.

People had their needs assessed and were supported to meet them by trained and knowledgeable staff. People had their nutrition and hydration needs met and enjoyed mealtime experiences with choices and options. The building was being upgraded and improved in line with people’s wishes. 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. We found that Tulip gardens had submitted applications appropriately.

People had good relationships with staff and were supported in a kind and caring manner. People made choices about their care and support and were involved in decision making. People were supported in a way which maintained their dignity, and staff were respectful. People had their preferences met and staff understood people's needs. There were opportunities for people to follow their interests and take part in a range of activities. People's communication needs were considered and some improvements with literature had been made in this area. People had support to follow their religious beliefs and cultural practices.

People understood how to complain and complaints were responded to in line with the

provider's policy. A manager was in post and people, relatives and staff found they were easy to talk to and available to them. People and their relatives had an opportunity to have a say in how the home was run. The manager had formal and effective checks in place to assess the quality of the service people received. The manager had a vision for the service and plans in place to make continual improvements.

Tulip Gardens is a care home without nursing for up to eight people who have learning disabilities. At the time of the inspection eight people were living at the home. Most of the people who lived at the home did communicate verbally. The home has a registered manager and an operations manager who were present during the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People, their relatives and staff told us they felt people were safe in the home. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice. People were protected from possible errors in relation to their medicines because the arrangements for the storage, administration and recording of medicines were good and there were systems for checking that medication had been administered to people in the correct way.

People’s relatives told us that they were happy with the care provided. People had opportunities to participate in some activities in the home and community. Most people who lived at the home had limited verbal communication and we saw that staff asked people how they wanted to be supported in a way that they understood. When necessary people were supported by those important to them to express their views. People were treated with dignity and respect.

Staff understood the needs of the people who used the service. We saw that staff communicated well with each other. Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills.

The registered manager did not have a good understanding of the principals of the Mental Capacity Act (2005), and associated guidance in respect of making best interest decisions on behalf of people. They had not applied for authorisations to deprive people of their liberty.

People were supported to have their healthcare needs met and had regular access to healthcare professionals. Some people did not have sufficient food to meet their nutritional needs. Personal evacuation plans had not been completed for each person as was the providers' processes, and in the event of a fire or other evacuation staff would not have instructions about how to support people. We were advised after the inspection that 5 members of staff had participated in a fire drill and evacuation with people using the service. However staff we spoke with gave us inconsistent answers about how to support people to leave the building in the event of an emergency, and could not tell us when they had taken part in fire drills.” We found that people may not have been safely supported in such circumstances.

The provider did not have effective systems in place to monitor that the service was compliant with the regulations and striving to continually improve.

You can see what action we told the provider to take at the back of the full version of this report.

We contacted four relatives of people who lived in the home. They provided many examples of good practice and praised the manager and staff for the way in which they involved relatives, where appropriate, and kept them informed about developments in the home. One person told us, 'We are very lucky in the sense that we do not worry about X as we know the care he is receiving at Tulip Gardens is exceptional.' Another wrote, 'I could not be happier with the way Y is cared for.'

People were supported to be part of the community. They went out on a regular basis to places of interest, shops and parks, in addition to taking holidays. People attended college courses in a range of subjects including floristry, computers and gardening.

Staff made sure that people received appropriate nutrition and hydration. People told us that they enjoyed their food.

There were good arrangements for the storage and administration of medication. These included the maintenance of good records.

There were enough staff, with appropriate experience and qualifications, to meet people's needs.

There were good systems for making sure that the high standards in this home were maintained and improved upon where possible, including using feedback from people in the home, their relatives and professional visitors.

Staff helped people to be healthy and to take part in a wide range of activities in the home and the wider community.

People who use 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.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff were supervised regularly and provided with suitable training.

We met six people who lived in the home. They all looked relaxed in the company of staff and indicated that they were happy.

We met four members of the staff team and the manager. They showed that they were well able to communicate with the people who lived in the home and knew their needs well.

We spoke with four relatives/advocates for people in the home. They all praised the manager and staff and gave examples of the progress which people had made since being at the home. They told us how people had been helped to improve their speech and communication and the efforts which staff made to ensure that people could make choices.

There were good systems to assess and monitor the quality of service that people received. These included asking people if they were happy.