This comprehensive inspection took place on 9 and 10 January 2018 and was announced. At the last comprehensive inspection in October 2015 the service was rated as ‘Good’.Tulips Care Home III 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. Tulips Care Home III accommodates six people in one building across two floors, with each person having their own bedroom and two communal bathrooms. There was also a communal living room, kitchen and access to a garden. At the time of the inspection the care home was supporting six people with mental health conditions and those living with dementia.
There was a manager in post at the time of the inspection as there was no requirement to have a registered manager in place. This is because the manager is registered as an individual provider and there is no statutory requirement to have a registered person at this location.
People who required support with their medicines received them safely from staff who had completed training and been observed in the safe handling and administration of medicines. Staff completed appropriate records when they administered medicines and these were checked daily by staff to minimise medicines errors.
People and their relatives told us they felt safe using the service and staff had a good understanding of how to protect people from abuse. All staff had received training in safeguarding adults and were confident that any concerns would be investigated and dealt with immediately.
People’s risks were managed safely and care plans contained appropriate and detailed risk assessments and emergency plans. The provider worked closely with health and social care professionals and ensured people had a review if their needs changed.
New starters received an induction training programme to support them in meeting people’s needs effectively and shadowed more experienced staff before they started to support people independently. Staff received regular supervision and told us they felt supported and were fully involved with the supervision they received.
Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent. The provider was aware when people had restrictions placed upon them and notified the local authority responsible for assessment and authorising applications.
People had regular access to healthcare services and staff were aware when people’s health and medical appointments were due. Staff worked closely with other health and social care professionals, such as the care home intervention team and we saw evidence of this in communication records and people’s care plans. Health and social care professionals confirmed they were always updated if people’s health conditions changed or needed any further guidance and support.
People were supported to have a healthy and balanced diet, which took into account their preferences as well as their cultural, medical and nutritional needs.
We observed positive interactions between people and staff throughout the inspection. We saw that staff treated people with respect and kindness, respected their privacy and promoted their dignity and independence. People were also supported to access independent advocates where necessary.
People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. Staff understood the importance of getting to know the people they worked with and showed concern for people’s health and welfare in a caring manner.
People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. Care records were person centred and developed to meet people’s individual needs. People were supported to follow their interests and encouraged to take part in a range of activities to increase their health and well-being and reduce social isolation.
The provider had an accessible complaints procedure in place which was regularly discussed with people. Relatives knew how to make a complaint and were able to share their views and opinions about the service. There were also surveys in place and monthly residents meetings to allow people the opportunity to feedback about the care and support they received.
The service promoted an open and honest culture and staff spoke highly of the working environment and the support they received from the manager. Staff felt valued and spoke positively about how they were encouraged and supported to sign up for vocational qualifications in health and social care to aid their learning and develop their careers.
There was a range of daily, weekly, monthly and annual quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. However, the provider was not meeting one of the conditions of their registration at the time of the inspection. We asked them to submit the necessary application documents immediately.