The inspection took place on the 10 and 11 July 2017 and was unannounced.

The service 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. On the day of our inspection the registered manager was on annual leave. The service was being led by the deputy manager.

The Birches Nursing Home is registered to provide accommodation and support for 24 older people who may require nursing care and who may have a physical disability. The home is located approximately one mile from Totton town centre and is accessible by public transport. The home has 22 single rooms and one double room. Accommodation is on three floors with a passenger lift to all levels. The home has a lounge / dining area and gardens. On the day of our inspection 24 people were living at the home.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. Staff knew how to identify abuse and protect people from it.

People told us they were safe and well cared for at the home. People knew how they could raise a concern about their safety or the quality of the service they received.

Assessments were in place to identify risks that may be involved when meeting people’s needs.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. The provider operated safe and effective recruitment procedures.

Medicines were ordered, stored, administered and disposed of safely.

The deputy manager and staff were knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The deputy manager understood their responsibility to ensure people’s rights were protected.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

Training records showed that staff had completed training in a range of areas that reflected their job role.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

People were provided with meals and drinks that they enjoyed. People who required support to eat or drink received this in a patient and kind way.

People were involved in their care planning, and staff supported people with health care appointments and visits from health care professionals.

Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People and relatives were asked for their views on the service and their comments were acted on. There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

There was a quality assurance system in place. The deputy manager and registered provider were open to feedback about the service and took prompt action to address areas when concerns were identified.

The Birches Nursing Home is registered to provide accommodation and support for 24 older people who may require nursing care and who may have a physical disability. The home is located approximately one mile from Totton town centre and is accessible by public transport. The home has 22 single rooms and one double room. Accommodation is on three floors with a passenger lift to all levels. The home has a lounge / dining area and gardens.

We undertook an unannounced inspection of The Birches Nursing Home on 7 April 2015. On the day of our visit 23 people were living at the home.

There was a registered manager at the home. 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 and associated Regulations about how the service is run.

We did not see people engaged in meaningful and stimulating activities. The registered manager told us activities took place as often as possible but this was not always planned and was organised on a daily basis and around people’s changing needs.

Staff understood the needs of the people and care was provided with kindness and compassion. People, relatives and health care professionals told us they were very happy with the care and described the service as excellent. A visiting GP told us, “Staff provide excellent care. I have no concerns at all regarding anyone living here. The home contacts us if they are unsure or need advice”.

Staff were appropriately trained and skilled to ensure the care delivered to people was safe and effective. They all received a thorough induction when they started work at the home and fully understood their roles and responsibilities.

The registered manager assessed and monitored the quality of care consistently involving people, relatives and professionals. Care plans were reviewed regularly and people’s support was personalised and tailored to their individual needs. Each person and every relative told us they were asked for feedback and encouraged to voice their opinions about the quality of care provided.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the

home was currently subject to a DoLS we found the registered manager understood when an application should be made and how to submit one. The registered manager was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were

made in the person’s best interests.

Staff talked to people in a friendly and respectful manner. People told us staff had developed good relationships with them and were attentive to their individual needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring and professional manner. People who used the service told us they felt staff were always kind and respectful to them.

Staff were encouraged to raise any concerns about possible abuse. One member of staff said, “We talk about what we would do if we witnessed abuse. If I thought someone was being abused. I would talk to the manager and I know she would report it”.

People and relatives knew how to make a complaint if they needed to. The complaints procedure was displayed in the home. It included information about how to contact the ombudsman, if they were not satisfied with how the service responded to any complaint. There was also information about how to contact the Care Quality Commission (CQC).

The home listened and learned from people and visitor experiences through annual resident/ relatives’ survey. The surveys gained the views of people living at the home, their relatives and visiting health and social care professionals and were used to monitor and where necessary improve the service.

We have made a recommendation about how the provider can reduce the risk of social isolation. You will find this in the responsive section of this report.

On the day of our visit the registered manager was on leave and therefore not in the service. Her duties were covered by the nurse in charge who was suitably qualified to fullfill the position and responsibilities.

The nurse in charge told us that all care workers had undertaken training in mental capacity which related very closely to consent issues, and any mental capacity concerns would be included in the persons care plan. This ensured that people's needs were fully considered in respect to decisions in their best interest about their safety and welfare. A care worker we spoke with said: "People's needs and moods can change daily and it is important to ask people how they feel, and how they want to be supported each day".

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans showed that risk assessments had been completed and reviewed on a monthly basis or as people's needs changed. One person told us: "All the care workers are very kind. I really do enjoy living here and the food is good as well". Another person who used the service said: "It’s really nice living here. It’s like a home from home. Everyone is very caring and so friendly".

During our visit we observed people at lunch time being treated in a dignified and respectful way. One person who used the service told us: "The food is really good here and if I don't like what's on the menu I can always ask for something else" People told us they enjoyed their meal. The mealtime was calm and people were treated politely and supportively.

During our inspection we spoke with three care workers who told us they had received training in safeguarding people. We also looked at the training records which confirmed that all staff had received training in the safeguarding of vulnerable adults in 2013. They were aware of the action to take if they had any concerns.

We looked at three staff files, all contained evidence of identity and that all staff had completed DBS (Disclosure and Barring Service) checks. The care workers had completed an application form which requested details of their employment history and reasons for leaving their last employment.

People living at the service told us they were treated with respect and dignity, and staff always knocked and waited, before entering people's rooms. People said they were able to personalise their rooms with furniture and family photographs. One person described their room as "home from home." Care plans had information on what help was needed, the aim of the care plan and the actions needed by staff. We saw plans about the support needs of individuals throughout the day and night.

We saw that all medicines were stored in a locked trolley and controlled drugs were stored in a locked cabinet. There were enough qualified, skilled and experienced staff to meet people's needs. The senior nurse and the staff we spoke with said that there were adequate staff to meet people's needs.

People who use the service, their representatives and staff were asked for their views annually about their care and treatment. The last survey in May 2012 showed that people were positive about the care that they were receiving.