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Inspection carried out on 4 November 2019

During a routine inspection

About the service

The Branches is a care home providing accommodation and personal care for up to 24 people including people living with a dementia. At the time of inspection, 19 people were living at the home.

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

People told us they liked living at the home. Feedback from relatives and one visiting professional was very positive regarding the level of care and support people received.

People told us they received safe care. Appropriate environmental and personal risk assessments were in place to keep people safe. Medicines were handled safely by staff who had received appropriate training in this area. Staff were recruited safely.

People’s needs were fully assessed by the registered manager prior to coming to live in the home. Staff told us they received training to support them in their role.

Staff told us they felt supported by the registered manager. They described them as approachable, honest firm and fair. Staff told us the registered manager listened to any concerns they had.

People were supported to maintain a varied, healthy and balanced diet. Feedback from people and relatives confirmed everyone enjoyed the home cooked meals which were on offer. People could choose what they wanted to eat from the menu or could ask for an alternative if they wished. People told us they had access to refreshments and snacks throughout the day. Where necessary, people were referred to healthcare professionals to support their health and well-being.

Without exception, people and relatives told us staff supported them in a very caring way. They also told us they felt comfortable talking to staff. Relatives told us the reason they had chosen the home for their loved ones was because the atmosphere was like one big family and staff got to know people inside out.

People were encouraged and supported to maintain their spiritual faith as well as longstanding friendships. People had access to activities within the home and could access the garden area as they chose. People’s end of life wishes had been captured in their care plans.

The registered manager welcomed feedback through various sources. They sent out yearly questionnaires to gather people’s and relative’s opinions. This feedback was used to further improve the level of care provided. The registered manager carried out a range of monthly quality checks across all aspects of care and service provided.

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 good (published 4 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 1 February 2017

During a routine inspection

This inspection took place on 1 February 2017 and was unannounced. A second day of inspection took place on 10 February 2017 and was announced.

We previously inspected the service on 10 December 2015 and found the service was in breach of regulations around premises and quality audit systems. During this inspection we found the service had made improvements.

The Branches provides residential care and support for up to 24 people, most of whom are living with dementia. At the time of our inspection there were 18 people using the service.

The home had a registered manager. 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.

Staff had a good understanding of safeguarding and were confident in their role of safeguarding people. The provider had a safeguarding policy and procedure in place.

People had risk assessments in place and associated care plans were clearly linked and updated in line with risk assessment reviews.

Medicines were managed effectively with safe storage and appropriate administration. All records were completed accurately and up to date with regular medicine audits being carried out.

Staff were recruited in a safe and consistent manner with all necessary checks carried out. Staffing requirements were assessed in line with people’s needs. Staffing levels were consistent and relief cover was provided by staff within the home, without needing to use agency staff.

Records were kept for all accidents and incidents including details of investigations, outcomes and action taken.

Staff told us they felt supported in their roles and they received regular supervisions, as well as annual appraisals and regular training. Records we viewed reflected this.

The registered manager and staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interest assessments were evident within care files and DoLS authorisations were in place where appropriate.

We observed during mealtimes that people enjoyed their meals, some independently and others with support from staff. There were choices available for people and support was provided by staff with patience and at an appropriate pace to each individual.

Care plans were personalised, detailed and contained people’s personal preferences, likes and dislikes. Care plans were up to date and reflective of each person’s individual needs.

A range of regular audits were carried out that related to the service the home provided, as well as the premises and environment.

Views were sought from people who received a service, relatives and external health professionals about the quality of the service and any improvements that could be made.

Inspection carried out on 10 December 2015

During a routine inspection

This inspection took place on 10 December 2015 and was unannounced. This meant that the provider did not know we would be visiting.

The Branches is a 24 bedded care home providing residential care. The service does not provide nursing care. The service is based in a converted building, with all of the communal areas on the ground floor and bedrooms situated on the ground floor and first floor. At the time of the inspection 23 people were using the service, most of whom were living with dementia.

There was a registered manager in place. 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.

The building was clean and appropriately maintained. However, items were inappropriately stored in communal and food storage areas in a potentially hazardous way. This also meant that some areas did not look homely for people living at the service. The registered manager said that they carried out checks and audits to several areas of the service, but did not keep records of these that could be used to monitor trends or for other people to examine.

These were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

Risks to people were assessed and care plans were in place to minimise them. This helped to keep people safe.

People were supported by staff that had been appropriately recruited through a robust selection process. Staff had to complete induction training before they could support people.

People were supported to access and administer their medicines safely, but we made a recommendation about recording information on ‘as and when required’ medicines for people who have difficulty communicating.

Staff received suitable training, supervision and appraisal to enable them to appropriately support people and felt that they could ask for more support if they needed it. We made a recommendation about medicines training.

Staff understood and applied the principles of the Mental Capacity Act, and were aware of people’s rights when they could not consent themselves.

The service worked with external professionals to support and maintain people’s health.

People were treated with dignity and respect. Staff knew the people they supported well, and people clearly enjoyed the time they spent with staff. Staff supported people in a kind and caring way.

The service would assist people with advocacy services if needed.

Care records were detailed, personalised and focused on individual care needs. People’s preferences and needs were reflected in the support they received. Plans were reviewed to ensure that preferences and needs were up to date.

People had access to activities and had opportunities to socialise with other people. People clearly enjoyed spending time with each other in the lounge and during meals.

The service had a clear complaints policy that was applied when issues arose. This was publically displayed so that people and relatives were aware of it.

Feedback was sought from people and staff in order to monitor and improve standards.

Staff felt supported and included in the service by the registered manager and provider, and said they would be confident to approach both with any issues they had.

The registered manager understood their responsibilities in making notifications to the Commission.

Inspection carried out on 4 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;-

� Is the service caring?

� Is the service responsive?

� Is the service safe?

� Is the service effective?

� Is the service well led?

This is a summary of what we found-

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people, treating people them with dignity and respect. A relative told us they were happy with the care their relative received at the home. Comments included; "My mums happy so I am happy." and "They seem to have staff that stay that is important."

Is the service responsive?

People were given the chance to make decisions for themselves. Records showed that people�s preferences, interests and needs had been taken into account and care and support had been provided in accordance with people�s wishes. People and their relatives knew how to make a complaint if they were unhappy.Relatives said they knew how to raise any concerns and felt that staff were always at hand.

Is the service safe?

We saw checks had been completed by the manager around areas in cleanliness, fire safety and hygiene. This meant that the provider ensured the building and practices were safe for the people who lived at the service. CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. While no applications had been submitted, policies and procedures were in place.

Is the service effective?

People�s health and care needs were assessed with them and they were involved in writing their plans of care. Relatives we spoke with told us they were also involved in the planning of care and were invited to assessment meetings. We saw that support plans and risk assessments were up to date and reflected people�s individual needs.

Is the service well led?

The provider gathered information about the safety and quality of their service from a variety of sources. The manager held regular team meetings with staff and asked people and their relatives their opinions on how the service was run. Regular checks of the premises took place to ensure it was safe and suitable for the people who lived there.

Inspection carried out on 6 September 2013

During an inspection to make sure that the improvements required had been made

We saw that systems were in place for recording people's consent to care and treatment within their care plans.

Inspection carried out on 3 May 2013

During a routine inspection

Some people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how care staff supported people and this was positive and respectful.

We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that care plans were in place.

We saw that systems were in place for monitoring the quality and service provided.

Comments from relatives included, "I do not have any complaints with The Branches. The staff are lovely", "My x is well looked after."

Inspection carried out on 12 October 2012

During an inspection to make sure that the improvements required had been made

We did not receive any comments from people using the service about this outcome area.