About the service: Branch Court Care Home is a residential care home that was registered to provide personal care for up to 30 people aged 65 and over at the time of the inspection. Some people were living with dementia.

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

This was an unannounced inspection which took place on the 31 July and 1 August 2018.

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 safel

This was an unannounced inspection which took place on 11 and 13 July 2015. There had been a change of provider to the service in February 2016. This was the first inspection since the new provider had taken over the running of the service.

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