Branch Court Care Home

Branch Court Care Home is a residential care home providing accommodation and personal care for up to a maximum of 30 people in one purpose built building. The service specialises in providing care for older people and people with dementia. There were 17 people living in the home at the time of the inspection.

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

We found shortfalls during the inspection in respect to the management of risk and the governance and record keeping systems.

People told us they felt safe living in the home, and they were happy with the service provided. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. The provider had an appropriate procedure for the recruitment of new staff. There were shortfalls in some people’s care plans and risks to people’s health, safety and well-being had not always been assessed and recorded. The home had a good standard of cleanliness throughout. People’s medicines were handled safely but on occasion supporting written information was not personalised.

People were supported to eat a nutritionally balanced diet and to maintain their health. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Whilst there were appropriate policies and systems, mental capacity assessments had not been carried out. We made a recommendation about this. People's needs were assessed prior to them using the service. There was ongoing training for all staff. Staff were well supported by the manager.

Staff treated people with kindness and respect and spent time getting to know them and their specific needs and wishes. We observed positive interactions between staff and people who lived in the home. However, people were provided with limited opportunities to express their views about the service. People’s dignity was not always promoted due to the condition of the bathroom flooring and uneven surfaces in some corridors and bedrooms. We made a recommendation about this. We received assurances from the provider’s representative that all necessary improvements would be made to the building.

People’s care plans had not always been updated in line with changing needs. The deputy managers were in the process of updating the plans during the inspection. People were given the opportunity to participate in activities, however, there were limited planned activities and the manager had identified this as an area for development. People told us they were confident any concerns would be resolved quickly. The manager had maintained detailed records of a complaint investigation, however, there were no records of complaints received during 2022.

Whilst some audits and checks had been carried out, others had not been completed for some time. People had not been given the opportunity to complete a satisfaction survey or participate in residents’ meetings.

The manager was new in post and was working hard to make improvements to the service. All people, their relatives, staff and visiting professionals praised her open and honest leadership style. The manager was committed to making the necessary improvements to the service and had made notable progress in a short space of time. Following the inspection, the manager sent us a detailed action plan to address the issues found at the inspection.

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

Rating at the last inspection

The last rating for the service was good (published 8 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the home, the management of medicines, person centred care and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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.

Enforcement and Recommendations

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 the management of risks and the governance and record keeping systems. We also made recommendations about the implementation of the Mental Capacity Act and the environment. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. The ones that applied to area this home was located were commonly known as 'Tier Three Rules'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

We noted good practices in all of the areas we considered including the use of and disposal of personal protective equipment (PPE). Staff, management and visitors were using PPE correctly and there were robust procedures in place around the use of PPE.

The provider and registered manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Where appropriate, and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions with infection outbreaks, these visits had been restricted and were only allowed in exceptional circumstances. We noted the processes around this were consistent with the rules and were regularly reviewed and adapted to reflect latest guidance and legislation.

We noted the provider and registered manager were considering developing a visiting area in the home's main lounge. We were told this would incorporate shielding and isolation processes to ensure visitors and residents were protected. The registered manager said that this would only be used when guidance allowed and the current rules were relaxed.

Visiting rules and process were communicated effectively to people using the service and their relatives.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. The registered manager insisted people were tested before admission and consistent with guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

People's mental wellbeing had been promoted by use of social media and hand held devices so people could contact their relatives and friends. Staff had comprehensive knowledge of good practice guidance and had attended Covid-19 specialist training. There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Areas of the home could be segregated in the event of widespread infection so as to assist with appropriate isolation of people. The registered manager said separate staff members could be used to help in this situation.

Policies and infection control processes were regularly reviewed when guidance changed. We saw good examples of this that took into account guidance from a wide variety of sources. A provider representative was the 'Champion' around keeping abreast of developments and we saw examples of where they had considered new guidance and provided this in a summary to management and staff in the home.

The home was clean and hygienic. The service had a designated cleaner. All staff had received Covid-19 related supervision and had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

People’s experience of using this service:

The registered manager had made improvements since our last inspection of 31 July 2018 and 1 August 2018.

Improvements had been made in how medicines were being managed. People told us they felt safe. The service had safeguarding policies and procedures to guide staff in their roles. Staff told us and records confirmed they had completed training in safeguarding. Staff regularly assessed and reviewed risks to people’s health and well-being to keep people safe. The service followed robust recruitment systems and processes when recruiting new staff members. The service was clean and tidy and we observed good infection control practices.

Improvements had been made in relation to the implementation of the Mental Capacity Act 2005 within the service. 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 carried out appropriate capacity assessments and best interest meetings and decisions were recorded. Where necessary, Deprivation of Liberty Safeguards applications had been made to ensure no one was being unlawfully restricted.

People felt staff had the appropriate knowledge and skills to support them. We saw staff had access to mandatory and optional training courses, including National Vocational Qualifications. Staff were also supported through supervisions and appraisals.

People and their relatives told us staff were kind and caring. We observed interactions that were sensitive, kind and respectful. Staff had access to equality and diversity policies and procedures.

Activities were available on a daily basis for people to enjoy. This included community activities as well as activities within the service. During our inspection, we saw a flower arranging session, light exercises and a game of bingo being played.

People’s end of life wishes had been considered and recorded within care plans. Staff were able to describe how they would support someone at the end of their life and the necessary policies and procedures were in place to guide them.

We received positive feedback about the management of the service. People we spoke with knew who the registered manager was and told us they had a visible presence within the service. Staff felt well supported in their roles by the registered manager. The provider used regular meetings and surveys as a means of gaining feedback on the service.

Improvements had been made in relation to the quality assurance systems in place. We found regular audits were being undertaken to monitor and improve the service.

Rating at last inspection: Requires improvement (29 September 2018).

Why we inspected: We undertook this inspection based on the previous rating of the service.

Follow up: We will plan a follow up inspection as per our inspection programme. We will continue to monitor the service and if we receive any concerning information we may bring the inspection forward.

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

Branch Court Care Home 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.

Branch Court Care Home is a purpose build care home, situated just over a mile from Blackburn town centre. The care home provides accommodation to 30 older people who require support with personal care needs and specialises in providing care for people living with dementia. All rooms are en-suite.

At the time of our inspection Branch Court Care Home was providing support to 30 people. There was a registered manager in place at Branch Court Care Home. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was supported in the day to day running of the service by a deputy manager.

At our previous inspection on the 11 and 13 July 2016 we found two breaches of the Regulations. We found people were not protected against the risks associated with the unsafe handling of medicines.The recruitment processes in the service were not sufficiently robust enough to protect people who used the service from the risk of unsuitable staff. 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 management of medication and the staff recruitment process.

During this inspection, we found that improvements had been made to the recruitment processes. However, our findings demonstrated there were three breaches of the Heath and Social Care Act 2008(HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches in Regulations were in respect to the implementation of the Mental Capacity Act, a lack of effective monitoring systems and a repeated breach in relation to the management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection the service was rated as overall "good." At this inspection the rating had deteriorated to overall " Requires Improvement."

We found there were continued shortfalls in the management of medicines, including the frequency and recording of applying creams, as well as inconsistencies around thickening fluids. We also found concerns around the safe temperature of storage of medication and the interpretation of "as and when required" medication.

The provider was not undertaking mental capacity assessments. Therefore, they were not working within the requirements of the Mental Capacity Act (2005) to help ensure people’s rights were protected.

Assessments of individual and environmental risks had been undertaken to ensure people's safety and well being. However, we identified a shortfall around the lack of Legionnaires risk assessment and water checks.

During our inspection we found shortfalls that had not been identified by the provider's monitoring systems. This meant the systems were not fully effective. People were given the opportunity to feedback on their experience. Where complaints had been made, these were investigated thoroughly and resolved. There was a positive culture in the home and the registered manager was clearly passionate about the service.

Changes in people’s health were identified and appropriate health professionals were contacted. People had sufficient amounts to eat and drink and their nutritional and hydration needs were well met.

People’s needs had been assessed, risk assessments had been undertaken and people were supported by staff who had been safely recruited and had received appropriate training and supervision.

People were supported by staff who were kind, caring and promoted their independence. People were treated with dignity and respect and had access to advocacy services if needed.

There were sufficient numbers of staff to meet individual need. People and their families were involved in the planning and review of their care. There were systems in place to ensure that people had access to meaningful activities.

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Branch Court is a purpose built home which provides accommodation for up to 30 older people who require support with personal care needs. The home specialises in providing care for people living with a dementia. At the time of our inspection there were 30 people using the service.

There was a registered manager in place at Branch Court. 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 registered manager was supported in the day to day running of the service by a deputy manager.

During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because the recruitment processes in place were not sufficiently robust. Appropriate arrangements were also not in place to ensure the safe handling of medicines. You can see what action we have told the provider to take at the back of the full version of the report.

Two of the staff personnel files we reviewed did not contain a full employment history. The registered manager had also not undertaken the required additional checks regarding why applicants had left any previous employment involving work with vulnerable adults or children. This meant there was a risk people might not be properly protected from the risk of unsuitable staff.

The stock of medicines held for one person did not correspond accurately with the administration records. Records relating to the administration of prescribed creams were not always fully completed. Staff had not taken action to ensure prescribed creams were always available for people.

We received conflicting information about staffing levels in the service. However, none of the people living in Branch Court expressed any concerns about the time it took staff to respond to their needs.

People who used the service and their relatives did not express any concerns regarding the care provided at Branch Court. Staff had completed training in safeguarding adults and knew the correct action to take should they witness or suspect abuse.

All areas of the home were clean and we saw that procedures were in place to prevent and control the spread of infection. Risk assessments were in place for the safety of the premises and systems were in place to deal with any emergency that could affect the provision of care.

We saw that the equipment and services within the home were serviced and maintained in accordance with the manufacturer’s instructions. This helped to ensure the safety and wellbeing of everybody living, working and visiting the home. The environment was decorated in a way which was intended to promote the independence and well-being of people who used the service.

Staff had received induction, training and supervision to help ensure they were able to deliver effective care. All staff had completed or were working towards a nationally recognised qualification in care.

Arrangements were in place to ensure people’s rights and choices were protected when they were unable to consent to their care and treatment in at the service. Staff had received training in, and understood, the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA.

Systems were in place to help ensure people’s health and nutritional needs were met. People gave us mixed feedback regarding the quality of the food in Branch Court. We observed that people received the individual support they required to ensure their nutritional needs were met.

All the people we spoke with during the inspection spoke positively about the caring nature of staff. Our observations showed staff were caring and respectful in all their interactions with people who used the service.

People's care records contained detailed information to guide staff on the care and support required. Care records showed that risks to people's health and well-being had been identified and regularly reviewed. All the staff we spoke with had a good understanding of the care and support that people required. They demonstrated a commitment to providing high quality care.

A programme of activities was in place to help stimulate people and maintain their contacts within the local community.

Records we reviewed showed people had opportunities to comment on the care provided at Branch Court. All the people we spoke with told us they would feel confident to raise any concerns with the staff and registered manager.

We saw that the service had a range of policies and procedures to help guide staff on good practice. Staff told us they enjoyed working in the service and received good support from the registered manager. Staff meetings provided staff with an opportunity to comment on the service provided and to suggest any improvements they felt could be made.

Systems were in place to monitor the quality of the service provided. There were procedures in place for receiving, handling and responding appropriately to complaints. Our discussions with the registered manager showed they were committed to driving forward improvements in the service.