CQC report explained · a nursing home
What the CQC found at Birch Abbey
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, August 2022
Rated Good overall, but inspectors found leadership and record-keeping needed improvement.
Inspectors visited the home without advance notice on 29 June 2022. They spoke with people, relatives and staff, observed care, checked the building, medicines and records, and reviewed care plans and quality checks.
The home was rated Good for safe, effective, caring and responsive care. Inspectors found people were protected from harm, treated kindly and respectfully, supported with their health needs, and involved in decisions about their care.
The home was rated Requires Improvement for being well-led. There had been several management changes, staff morale was low, staffing did not always feel timely, and some care records were not accurate or complete. The report says this was the first inspection under the new legal entity. The previous rating, under the former legal entity, was Good.
Kind and respectful care
Staff were observed being friendly, helpful and warm. People were treated with dignity and supported to keep as much independence as possible.
“Our own observations showed staff to be friendly and helpful, staff demonstrated a genuine warmth towards people.” from the report
Health support
The home worked with health professionals and acted promptly when people's health needs changed.
“When I was unwell, they [staff] called an ambulance and had me taken to hospital, they acted quickly.” from the report
Choice and involvement
People were involved in decisions about their care, food and daily routines. Relatives were included in care planning where appropriate.
“People were directly involved in decisions about every aspect of their care and support wherever possible, so their human and legal rights were upheld.” from the report
Staffing did not always feel timely
needs fixingAlthough the provider's staffing tool said there were enough staff, people and staff said needs were not always met promptly. Inspectors recommended reviewing how staff were deployed and allocated.
“We recommend the provider considers the deployment and allocation of staff to ensure people's needs are met in a more timely way.” from the report
Care records were not always accurate
needs fixingSome records did not properly show the care provided. This included records of people's required position changes.
“People's care records did not always properly evidence the care and support that had been given.” from the report
Management changes affected morale
needs fixingSeveral changes in home manager had led to different ways of working. Staff said this was unsettling and that morale was low.
“The service had undergone changes in the home manager over a relatively short space of time.” from the report
Limited activities
needs fixingSome people and relatives said there were not enough activities to keep people occupied and stimulated. The home was recruiting a full-time activities coordinator.
“However, some people and their relatives told us that there were not enough activities to keep people occupied and stimulated.” from the report
Medicine trolley location
minorOne medicine trolley was kept on a staff-used staircase. The provider said a clinic room would be made available within a few days.
“Although the trolley was kept secure to the wall, this wasn't a suitable location to store medicines.” from the report
- 01How have you changed staff deployment so people's needs are met promptly, especially when staff are covering one-to-one care breaks?
- 02What checks now make sure care records, including repositioning records, are completed accurately at the time care is given?
- 03What has changed to improve management visibility and staff morale since the inspection?
- 04Has a full-time activities coordinator been appointed, and what activities are now available?
- 05Was the medicine trolley moved to a suitable clinic room, and how are medicine storage temperatures checked?
This was an unannounced first inspection under the new legal entity and covered all five key questions, including infection prevention and control. This explanation was written from the published report of 5 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2022
Birch Abbey: inspected but not rated; inspectors were assured about infection control and visiting arrangements.
Inspectors visited on 4 February 2022. This was an announced, targeted inspection focused on infection prevention and control during the COVID-19 outbreak. They also asked about staffing pressures.
The inspectors were assured that the home was managing infection risks. They found procedures for visitor screening, testing, PPE, cleaning, social distancing and safe admissions. The environment appeared clean and hygienic.
The home was supporting visits from relatives in line with government guidance. Inspectors saw visits taking place and said these had a positive effect on people's wellbeing. The service was inspected but not rated, so this report does not provide an overall quality rating.
Infection control
The home had infection-control procedures, cleaning schedules and audits. Inspectors found the environment clean and hygienic.
“The environment appeared clean and hygienic. Cleaning schedules and audits were in place to help maintain cleanliness and minimise the spread of infection.” from the report
Safe visiting
The home supported face-to-face visits and used a booking process, health questionnaire and negative lateral flow test evidence for visitors.
“During our inspection, we observed visits being conducted between people and their relatives.” from the report
Staff infection-control practice
Staff had training in infection prevention and control and in using PPE. The manager also carried out checks on practice.
“Staff were trained and competent in infection prevention and control best practices and how to put on and take off PPE.” from the report
Links with health professionals
The home maintained links with external health professionals, using virtual and in-person consultations when needed.
“The manager maintained links with external health professionals to enable people to receive the care and intervention they needed.” from the report
Inspectors raised no specific concerns in this report.
- 01What staffing pressures are you experiencing now, and how do you make sure they do not affect people's care?
- 02How do you currently screen and test visitors before they enter the home?
- 03How often are staff trained and checked on using PPE and infection-control procedures?
- 04How are face-to-face visits arranged now, and what alternatives are available when an in-person visit cannot take place?
- 05When did the home last receive a full inspection covering Effective, Caring, Responsive and Well-led?
This was an announced, targeted inspection of infection prevention and control and COVID-19-related staffing pressures; it did not provide ratings for the other key questions or an overall quality rating. This explanation was written from the published report of 24 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Birch Abbey
3 rated inspections over 3 years: the service has held its Good rating throughout.
- August 2022Goodcurrent ratingSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2022Inspected but not ratedSafe: Inspected but not rated
- February 2021Goodstayed GoodSafe: GoodWell-led: Good
- September 2019GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2021
Registered with the Care Quality Commission on 19 July 2021.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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38 live-in carers within about an hour of Sefton
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,270 a week. 34 can care for a couple. 11 years' experience on average.
“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
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