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.

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.

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.

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

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."

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

During the inspection we spoke with people and their relatives about living at The Branches.

People who used the service expressed satisfaction with the care and service that they received.

One person said "Staff are lovely and very helpful". Another person said "I have friends here and we have a right good chat". Another person said "It is a pretty good place here. I like it here."

Relatives spoken with during the visit said, "All the staff are very good and friendly. This is a really good home where all of his/her needs are met."