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 initi

This inspection took place on 7,8 and 19 October 2015 and was unannounced.

The Tulips III is a residential home for up to six people with a mental health condition. At the time of the inspection there were six people living at the service. There was a manager in post, the service is not required to have a registered manager.

We have made a recommendation about the management of fire safety.

People received their medicines in line with company policy. Staff underwent training to ensure they were knowledgeable and competent to administer medicines to people. Staff had sound knowledge and understanding of the medicines people took and the reasons why. We carried out an audit of one person’s medicines and found that these were recorded, stored and administered in line with good practice.

People at the service told us they felt safe because the staff were always on hand to help them. Staff had sufficient knowledge of how to identify signs of abuse and who to raise their concerns to should they suspect abuse.

The provider was aware of their responsibilities relating to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). These aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not deprive them of their liberty and ensures that people are supported to make decisions relating to the care they receive. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and lawful manner.

Staff underwent a comprehensive induction process when first employed. Inductions were tailored to staff’s individual needs and were extended should staff require additional support and training. Staff received on-going supervisions from the manager to help them reflect on their work and identify training requirements.

Care plans were person centred and where possible people were involved in the development of these. Care plans covered all aspects of care delivered and were regularly updated and reviewed to reflect people’s changing needs.

Risks to people were identified and plans were in place to manage them. Staff had a clear understanding on how to minimise these risks and were aware of the importance in following the set guidelines.

People’s consent was sought for care that was provided in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Information was shared with people in a way that they could understand so that they were well informed and supported to give their views.

The service actively sought feedback on the delivery of care. Yearly quality assurance questionnaires were sent to people, their relatives and staff to seek their views on how the service is run. The provider acted appropriately to suggestions made.

People’s complaints and concerns were listened to by the manager and felt their concerns were listened to and acted upon.