Tulipa House

Updated 16 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of two inspectors

Service and service type

Tulipa House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Tulipa House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with six people who used the service and two relatives/ friends or people who used the service. Some people were not able to express their views. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We sought feedback from the local authority and professionals who work with the service.

We spoke with ten members of staff including the nominated individual, registered manager, a manager from another of the providers services, maintenance staff. senior care staff and care staff. We reviewed a range of records. This included all or parts of five people's care records and multiple medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including audits, training records and procedures were reviewed.

Updated 16 March 2023

About the service

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.