Tulipa House

Tulipa House is a residential care home providing accommodation and personal to up to 31 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 28 people using the service. The service is provided in one adapted building. There is a lift to enable people to reach the upper floors.

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

There were positive interactions between staff and people living at the service. People were comfortable in staff’s company and with their support. Feedback from relatives/ friends was positive. One relative said, “It is clean and tidy, and the staff are sweet and caring.”

However, we identified concerns at the service. Quality systems were not effective at identifying some risks and some areas where improvements were needed. The action plan put in place following the last inspection had not led to an improvement in the services quality standards. The service remained reactive to findings through inspections but were not as proactive as they needed to be. Prior to the inspection some notifications had not been submitted to CQC when they needed to be. The service worked in partnership with other services to improve care and support. However, there were times where advice from partners could have been sought quicker.

Incidents were not always well managed which increased the risks to people. When incidents occurred, there was a lack of effective trend analysis to determine if there were contributing factors such as staff deployment or environmental risks which could be mitigated. Risks to people were not always well managed. For example, medical advice was not always sought when it should have been.

Staff knew how to identify safeguarding concerns. However, concerns had not always been identified by the management where they needed to be reviewed as possible abuse. Medicines were not well managed.

There was enough staff to support people. People were kept safe from the risk of transference of infection.

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 offered people choices and understood where people had the right to make decisions for themselves.

Staff were happy in their role and felt supported by the registered manager. Staff treated people with kindness. The registered manager understood their responsibilities in relation to duty of candour. There were systems in place to enable people and their relatives/ friends to provide feedback about the service. Feedback had been positive.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 May 2022). The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of a death of a person. The circumstances of this death is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the death of a person. However, the information shared with CQC about the death indicated potential concerns about the management of risks to people’s safety. This inspection examined those risks.

You can see what action we have asked the provider to take at the end of this full report.

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 not changed from 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 full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tulipa House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tulipa House is a residential care home providing personal care to older people who may be living with dementia. At the time of the inspection there were 24 people living there. The service can support up to 31 people in one adapted building.

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

People were happy and calm living at Tulipa House; staff told us there was a positive culture. Relatives told us their loved ones were safe and well looked after. However, we found improvements needed to be made to the oversight and governance systems. Shortfalls were not always identified and acted on by the registered manager and provider. For example, rips in flooring in two bedrooms created trip hazards for people. Risk assessments and care plans were not always up to date and learning from incidents was not reflected in care plans to inform staff.

There were enough staff to keep people safe and meet their needs. When staffing levels dropped due to sickness the registered manager worked with staff or organised agency staff. Staff felt confident with identifying abuse and knew how and where to report any concerns.

Staff followed Government guidance in relation to personal protective equipment, and the service was clean. Relatives were able to visit the service when they wanted to.

People and staff were involved in the service, and their opinions were used to improve the service. Staff and the registered manager worked with healthcare professionals to ensure people received support for all aspects of their lives.

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.

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 5 August 2021).

Why we inspected

We received concerns in relation to infection control and the care of people living with dementia. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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. You can see what action we have asked the provider to take at the end of this full report. During and following our inspection the provider and registered manager took action to address the shortfalls we identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tulipa House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to audits, oversight and improving the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. 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.

Mont Calm Margate is a residential care home providing personal care to older people who may be living with dementia. At the time of the inspection there were 16 people living there. The service can support up to 31 people in one adapted building.

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

People were living in a much-improved environment. Areas of the service that had deteriorated at the time of our last inspection, had been improved and there was now a plan for further improvements. There was now a system in place to report maintenance issues and to check the required action had been taken.

Improvements had been made to the management of medicines; people received their medicines as prescribed. A new system of checks and audits had been introduced and these had been effective in identifying shortfalls. Action had been taken to rectify any issues found. The provider had increased their oversight of the service.

There was enough staff who had been recruited safely to meet people’s needs. Staff understood their responsibilities to keep people safe and reported any concerns they had to the registered manager.

Risks to people’s health and welfare had been assessed. There was guidance for staff to mitigate the risks. Accidents and incidents were recorded and analysed to identify trends and patterns. Action had been taken and they had not happened again.

Staff worked with health professionals to make sure people received the support and care they need. People were encouraged to be involved in the service as much as possible.

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.

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

Rating at last inspection and update.

The last rating for this service was Requires Improvement (published 23 April 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We carried out an unannounced comprehensive inspection of this service on 4 February 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, premises and environment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mont Calm Margate on our website at www.cqc.org.uk.

Follow up

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.

Mont Calm Margate is a residential care home which, at the time of this inspection, was providing personal care to 15 people. People using the service were older people, some people were living with dementia and other health care needs. Mont Calm Margate can support up to 31 people in one adapted building.

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

The condition of the building had deteriorated, and maintenance had not kept pace with the rate of wear. Hot water in some bedrooms was only lukewarm, two toilets dripped water from the soil pipe outlet, another toilet did not flush, and two handwash basins were not firmly attached to the wall. Some flooring had small tears in it and, in places, old stains from previous water leaks were evident on the decoration. The provider and registered manager were aware of this and working through an action plan to improve the quality of the service.

The cleanliness of the home was not to a sufficient standard. Systems intended to support effective infection prevention and control were not fully embedded into daily practice.

Medicines were not always managed safely. Records of controlled medicines were not accurate, and processes had not always been followed to correctly account for them. Controlled medicines are tightly controlled by the government because they may be abused or cause addiction.

Some compressed oxygen cylinders were not safely stored and signage, required to let emergency services know of its presence, were not in place.

The registered manager and provider completed checks of the environment and audits of the quality of service provided. However, these were not sufficiently robust to address the concerns found at this inspection, so were not fully effective in their use.

Staff had received safeguarding training. Potential safeguarding matters were brought to the attention of the registered manager and had been referred to the local authority safeguarding team.

Risks to people had been identified and processes ensured mitigation was in place to reduce them. This included ensuring appropriate equipment was used and healthcare professionals were involved in people’s care. The provider continued to have systems in place to monitor accidents and incidents, learning lessons from these to reduce the risks of issues occurring again.

There were enough numbers of staff to support people. Recruitment of staff was underway, and the home used agency staff to fill vacancy gaps while recruitment was on going. Staff felt supported by the registered manager and a schedule of supervision meetings was in place.

People told us they felt happy living at the home. Comments included, “The staff have been really great, they work hard” and “I feel looked after well”.

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

Rating at last inspection and update

The last rating for this service was Good (published 24 February 2018).

Why we inspected

We received concerns in relation to the cleanliness of the home, its upkeep and a lack of hot water. There were additional concerns about practice intended to reduce the risk of COVID-19. These included a COVID-19 positive member of staff isolating within the home, incorrect use of personal protective equipment (PPE), staff shared between this home and another home owned by the same provider as well as unauthorised people visiting the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has deteriorated to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mont Calm Margate on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulation 12 the safe management of medicines, Regulation 15 the maintenance and cleanliness of the premises and Regulation 17 governance at this inspection. We have also signposted the provider to resources to develop their approach to infection prevention and control processes.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mont Calm Margate is a residential care home providing personal care to 24 older people and people living with dementia at the time of the inspection. Mont Calm Margate accommodates up to 31 people in one adapted building.

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

The service was clean and free from unpleasant odours. Some refurbishment works had been completed and further works were planned.

The registered manager and staff followed government guidance in relation to Covid-19 to reduce the risk of people becoming unwell.

There were enough staff deployed to meet people’s needs. Staff had the skills to keep people safe.

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 24 February 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concerns we had about cleanliness of the building and low staff numbers. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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.

Mont Calm Margate is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Mont Calm Margate accommodates 31 people living with dementia in one adapted building. There were 31 people using the service at the time of our inspection.

The registered manager had worked at the service for over 10 years. People and staff told us the registered manager was approachable. 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.

At the last inspection on 4 January 2017, we asked the provider to take action to make improvements to the way they managed medicines and checked the quality of the service. 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, safe and well-led to at least good. The provider had completed all the actions and the key questions, safe and well-led are now rated good.

The provider and registered manager had oversight of the service. They had improved the checks and audits they completed. All areas of the service had been checked regularly to make sure they met the required standards and any shortfalls were addressed. The views of people, their relatives, staff and community professionals were asked for and acted on to continually improve the service. The provider planned to introduce electronic care records and had visited other services which used these to gather information about the advantages and any disadvantages.

Effective action taken since our last inspection to improve the way people’s medicines were managed and they were now managed safely. Staff followed guidance about people’s medicines and people received their medicines in the way their healthcare professional had prescribed.

The provider and registered manager had a clear vision of the quality of the service they expected. Staff shared the provider’s vision of a good quality service and provided the service to the standard the provider required. Staff felt supported by the registered manager, were motivated and felt appreciated. The registered manager was always available to provide the support and guidance staff needed. Staff worked together as a team to provide the care and support people needed.

Staff were kind and caring to people and treated them with dignity and respect. Staff told us they would be happy for their relatives to receive a service at Mont Calm Margate. Staff described to us how they supported people in private and people told us they had privacy. People were encouraged and supported to be as independent as they wanted to be. Staff had asked people about their end of life wishes and further work was planned to make sure staff had all the information they required before they needed it. People’s relatives had complimented the staff on their kindness and care at the end of their relative’s lives.

People had enough to do each day and enjoyed the activities on offer. The provider wanted to improve the activities and occupations people took part in and the activities coordinator was enthusiastic about making changes. They were researching activities and occupations for people living with dementia and planned to introduce them in the weeks following our inspection. People had been asked about their spiritual needs and were supported to attended services if they wished.

Assessments of people’s needs and any risks had been completed. People had planned their care with staff and received the support they needed to meet their individual needs and preferences. People were not discriminated against. Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager and provider. People knew how to make complaints or raise concerns and told us that they were listened to and action was taken resolve any worries they had.

Accidents and incidents had been analysed and action had been taken to stop them happening again. The registered manager worked in partnership with local authority safeguarding and commissioning teams, and a clinical nurse specialist for older people and acted on their advice to develop the service and improve people’s care.

Changes in people’s health were identified and people were supported to see health care professionals, including GPs and dentists when they needed. People told us they enjoyed the food at the service and were offered a balanced diet, which met their needs and preferences. Staff continued to support people to be as independent as they wanted at mealtimes.

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. Staff assumed people had capacity to make decisions and respected the decisions they made. When people needed help to make a particular decision staff helped them. The registered manager had assessed people’s capacity to make decisions and decisions were made in people’s best interests when necessary. The registered manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS), and had applied for authorisations when there was a risk that people may be deprived of their liberty to keep them safe.

There were enough staff to provide the care and support people needed when they wanted it. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

The service was clean and staff followed infection control processes to protect people from the risk of infection. The building was well maintained and plans were in operation to maintain and improve the environment and grounds. The environment had been designed to support people living with dementia to move freely around the building.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. We had been notified of all significant events at the service. Records in respect of each person were accurate and complete and stored securely.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall of the service.

Mont Calm Margate provides accommodation and personal care for up to 31 people who may be living with dementia. The service is a large converted property. Accommodation is arranged over two floors and a lift is available to assist people to get to the upper floor. There were 22 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. 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 received the medicines they needed. However, medicines were not always stored safely. Guidance had not been provided to staff about how to support people to take some medicines.

Detailed information was not available for staff to refer to about how to manage all the risks to people. This did not impact on people and staff knew how to keep them as safe as possible. The registered manager agreed this was an area for improvement. People had agreed with staff how risks such as cigarettes and lighters would be managed. Plans were in place to keep people safe in an emergency.

The registered manager completed regular checks on all areas of the service. They had not identified the shortfalls we found during the inspection. They worked alongside staff and checked that the quality of the service was to the required standard. Any shortfalls found were addressed quickly to prevent them from happening again. People, their relatives and staff were asked about their experiences of the care and their feedback was acted on.

People’s care was planned with them, to help them be as independent as possible. Detailed information was available to staff about people’s likes and dislikes and care preferences.

Changes in people’s health were identified quickly and staff contacted people’s health care professionals for support. Staff had provided care in the way one person preferred, which was different from the care their health professional had recommended. Following our inspection the registered manager contacted the person’s doctor for further advice and guidance about how to provider care in the way the person wanted to keep them as health as possible. People were offered a balanced diet and were offered food they liked. People had enough to do during the day.

Staff were kind and caring to people and treated them with dignity and respect at all times. Staff knew the signs of abuse and were confident to raise any concerns they had with the providers. Complaints were investigated and responded to.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). People were not restricted. Applications had been made to the supervisory body for a DoLS authorisation when necessary.

The requirements of the Mental Capacity Act 2005 (MCA) had been met. Staff supported people to make decisions and respected the decisions they made. When people lacked capacity to make a specific decision, decisions were made in people’s best interests with people who knew them well.

The registered manager had oversight of the service. Staff felt supported and were motivated. They shared the registered manager’s vision of a good quality service.

There were enough staff, who knew people well, to provide the support people wanted. People’s needs had been considered when deciding how many staff were required to support them at different times of the day. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Checks had been completed to make sure staff were honest, trustworthy and reliable. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff had completed the training and development they needed to provide safe and effective care to people and held recognised qualifications in care. Staff met regularly with the registered manager to discuss their role and practice and were supported to provide good quality care.

We found breaches 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 this report. We would recommend the registered manager refer to a reputable source for advice about how to create an environment that supports people living with dementia to be as independent as possible.