The Tulips Care Home II

The Tulips Care Home II is a small residential care home providing personal care for up to four adults with mental health needs. At the time of the last inspection four people were receiving care at the service. At the time of our review three people were living in the service.

Background to this report

At our previous comprehensive inspection at The Tulips Care Home II on 20 and 21 August 2019 we identified concerns relating to well-led. We found that quality assurance systems were not robust enough to demonstrate the service was effectively managed.

This was a breach of regulation 17 (Good Governance) for which we issued a requirement notice. The key question well-led was rated requires improvement and the overall location rating was requires improvement.

The full report of that inspection can be found by selecting the ‘all reports’ link for The Tulips Care Home II on our website at www.cqc.org.uk.

Why we carried out this review

We carried out this review on 21 April 2022 to follow-up on the requirement notice and assess whether the provider has addressed the improvements required at our previous inspection.

We did this using a ‘desk-based’ review process because evidence to demonstrate that the requirement notice had been met could be obtained and assessed remotely without needing an inspection visit to the location. This was not an inspection: the scope of this review did not include a visit to the service or an assessment of the outcomes for people using the service.

What we found

Details of the findings from this remote assessment can be found under the well-led section of this report.

Through this desk-based review, The Tulips Care Home II was able to provide sufficient evidence that they have taken action to address the breach identified at the last inspection. They therefore are no longer in breach of regulation 17.

Rating at last inspection and update

Following the last inspection, this location was rated requires improvement. Although only the well-led key question was rated requires improvement, if there is a breach of a regulation a location cannot be rated higher than requires improvement overall. As the provider is no longer in breach of regulation 17 the overall rating has changed to good.

We found the following examples of good practice.

There were protocols in place to ensure visitors could enter the home safely, with a requirement to take or show a lateral flow device (LFD) COVID-19 test before entering the home. Relatives were updated and given information about any changes in visiting procedures and guidelines in the home.

The provider carried out weekly stock checks to ensure staff had a sufficient supply of personal protective equipment (PPE). Staff had ongoing infection prevention and control training and we observed staff following best practice during the inspection.

The service was taking part in regular COVID-19 testing for people and staff in line with current government guidance.

Staff told us they felt supported in their role and had been kept regularly updated with any changes throughout the pandemic. Staff were given opportunities to discuss their wellbeing in supervision and team meetings. One staff member said, “The support has been good and they look out for us. They have taken this very seriously.”

Staff were proud of their achievement that there had not been an outbreak of COVID-19 in the home since the start of the pandemic. A staff member added, “With the training, learning and always getting updated, I would feel confident in managing an outbreak if there was one.”

Tulips Care Home II is a small residential care home providing personal care for up to four adults with mental health needs. At the time of our inspection four people were living in the service who had mental health conditions, with one person living with dementia.

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

People and their relatives were positive about the kind and compassionate attitude of the staff team. People and staff complimented the friendly and homely environment.

We observed positive interactions between people and staff throughout the inspection, with staff being knowledgeable about people’s needs.

Where people had limited communication, we saw they were comfortable and relaxed in the presence of staff. Due to the size of the service and the consistency of the staff team, people had developed positive relationships with staff.

People were involved in how they received their care and staff worked closely with them to help their understanding of how they wanted to be supported.

People were supported to a range of healthcare appointments and staff contacted the necessary health and social care professionals if people’s health changed.

People were supported to take part in a range of events and activities, both within the home and within the local community. Friendships were supported with people in the provider’s two other homes on the same street to help reduce social isolation.

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.

Although there were monitoring processes in place, there were inconsistencies with how people’s financial transactions were kept and recorded, which was not in line with the provider’s policies and procedures. There were also shortfalls with some health and safety checks.

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 2 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to good governance. 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 for the provider to understand what they will do to improve the standards of quality. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

The service had a manager in place. The service is not required to have a registered manager.

People received care and support from a service that demonstrated good practice in relation to safe medicines management. Records confirmed the administration, storage and recording of medicines was carried out safely. People were protected against the risk of harm and abuse by staff that received on-going safeguarding training and knew the correct action to take if they suspected abuse. Risk assessments identified the risk and gave staff guidance on how to manage the known risks safely.

Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. At the time of the inspection the manager was completing the MCA assessments.

People’s choices and decisions were supported and respected. People were encouraged to make choices and decisions about the care and support they received. Consent to care and treatment was sought prior to care being delivered.

People were supported to access sufficient amounts to eat and drink. The service encouraged people to maintain a healthy diet in line with their health care needs and preferences. People had access to a wide range of health care professionals to ensure their health was monitored and maintained.

People confirmed they were supported by staff that were compassionate, empowering and caring. Where possible people were encouraged to maintain relationships with people that mattered to them.

The manager developed care plans that were person centred and tailored to people’s individual needs and preferences. People confirmed they were supported to develop their care plans and these were regularly reviewed to ensure they reflect people’s changing needs and preferences.

People were supported to participate in a wide range of activities both in the community and within the service. The service placed emphasis on people integrating with the local community.

Both staff and the manager were aware of how to respond positively to complaints and concerns raised. Records confirmed the service had not received any complaints within the last 12 months. The service made the complaints procedure available to people.

The service questioned the service delivery through annual quality assurance questionnaires. The manager informed us that should people raise any concerns through the questionnaires action would be taken immediately to manage the concern.

The service carried out regular audits of the service to drive improvement. Audits looked at the safety of the service and where issues were identified, action was taken in a timely manner.

People and staff spoke highly of the manager and told us, they could approach the manager and their views would be listened to and acted on if appropriate.

We saw that one of the people using the service was in a reception area on her own and when we spoke with her she told us that she preferred to be on her own but that she could go and sit with the others or talk to a staff member when ever she wanted to.

All three people told us that they liked the sanctity of their own bedrooms and that they felt safe and well cared for.

The premises in The Tulips Care Home II were well maintained. The provider had suitable arrangements in place to ensure the premises complied with legal requirements, such as health and safety, and fire regulations.

People with relevant qualifications, knowledge, skills and experience were employed to care for people at The Tulips Care Home II. Robust recruitment and background checks were completed before new staff joined the service

The provider sought people's views, carried out audits and completed assessments of risks to assess and monitor the quality of service provision.