CQC report explained · a nursing home
What the CQC found at Birch Tree Manor
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- COVID-19 testing, protective equipment and cleanliness were not always managed in line with guidance. Risk assessments and monitoring, including for choking and weight, were also incomplete or inaccurate.
- Effective?
- Requires improvement
- This question was not inspected during this visit. Its previous rating was carried forward into the overall rating.
- Caring?
- Good
- This question was not inspected during this visit. Its previous rating was carried forward into the overall rating.
- Responsive?
- Good
- This question was not inspected during this visit. Its previous rating was carried forward into the overall rating.
- Well-led?
- Requires improvement
- Audits and governance systems did not identify or deal with some infection-control and risk-management problems. Supervision records were also duplicated and contained little or no recorded discussion or feedback.
What inspectors found, December 2021
Birch Tree Manor rated Requires Improvement; inspectors found infection-control and risk-management problems, although medicines, staffing and safeguarding were generally managed well.
This was an unannounced focused inspection on 1 and 5 November 2021. Inspectors looked at Safe and Well-led, including infection control, records, staffing, medicines, audits and how the home was managed. They spoke with people, relatives and staff, observed care and checked records.
Inspectors found that COVID-19 testing, use of protective equipment and cleanliness were not consistently good enough. Some risks, including choking and weight loss, were not properly assessed or monitored. These problems increased the risk of harm, although immediate improvements were made to cleanliness, testing and protective equipment during the inspection.
People said they were happy and felt safe. Medicines were managed safely, staffing levels were considered appropriate, and staff understood safeguarding procedures. The overall rating remained Requires Improvement. Safe fell from Good to Requires Improvement, while Well-led remained Requires Improvement.
Kind and reassuring care
People told inspectors they were happy and felt safe. Staff spent time talking with people and supported them when they were distressed.
“People told us they were happy with the care they received and said they felt safe living at the home.” from the report
Medicines
Medicines were ordered, stored, given and disposed of safely. Staff had training, competency checks and clear information about people's individual medicines.
“Medication management procedures were in place and medicines were routinely ordered, safely stored, administered and disposed of in accordance with current guidance.” from the report
Staffing and recruitment checks
Staffing levels during the inspection matched the provider's dependency assessment. Recruitment files contained the required information and DBS checks had been completed.
“During the inspection there was an appropriate number of staff on duty in line with the providers dependency assessment tool.” from the report
Safeguarding and incident reporting
Staff understood how to report abuse and safeguarding incidents were reported to the local authority and CQC. Accidents and incidents were recorded and reviewed for possible patterns.
“Safeguarding incidents were appropriately reported to the local authority and CQC.” from the report
Working with health professionals
The home worked with health professionals, including the GP and falls team, to support people's needs.
“Effective connections with healthcare professionals such as Local GP's and falls team supported people to receive holistic care.” from the report
Infection control
seriousCOVID-19 testing and protective equipment were not always used as required. Parts of the home and some glasses were unclean, although the provider made improvements during the inspection.
“Safe infection prevention and control measures were not consistently followed to help prevent the spread of infection.” from the report
Risk assessments and monitoring
seriousSome care records did not show that planned support had been provided. There were gaps in weight monitoring and choking assessments, and one dependency score was wrong.
“There were gaps in weight monitoring and choking risk assessments for some people, and a dependency assessment score for one person was incorrect.” from the report
Management checks
needs fixingThe home's audits did not identify all the problems inspectors found. Supervision records were duplicated and contained little or no discussion or feedback.
“Governance and quality assurance procedures and processes were not always effective.” from the report
Use of agency staff
minorRelatives reported seeing many staff they did not recognise. The provider said it was actively recruiting more permanent staff.
“Relatives told us that they felt there was a high number of staff they did not recognise.” from the report
- 01What has changed to make sure COVID-19 testing and protective equipment follow the required guidance every time?
- 02How are you checking that bathrooms, equipment, furniture and residents' personal items are kept clean?
- 03How do you now assess and monitor choking risks, weights and other risks, and how often are these records reviewed?
- 04What action have you taken to make audits identify problems before they affect residents?
- 05How many permanent and agency staff are currently working here, and how do you make sure unfamiliar staff know each resident's needs?
This was a focused inspection of Safe and Well-led only; Caring, Effective and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 15 December 2021 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, December 2020
Birch Tree Manor is rated Requires Improvement; inspectors found safe care but weaknesses in leadership and communication.
This was an unannounced, focused inspection on 20 November 2020. Inspectors looked only at Safe and Well-led. They spoke with people, relatives and staff, and checked care records, medicines records, recruitment files and management records.
The home was rated Good for Safe. Inspectors found suitable care plans and risk assessments, safe medicines management, enough staff, safe recruitment checks and suitable infection control measures. A missing identity document and one missing set of instructions for as-needed medicine were fixed after the inspection.
The home was rated Requires Improvement for Well-led, as it had been at the previous inspection. Inspectors found that communication with relatives was not always effective. The overall rating remained Requires Improvement because the other areas were not inspected during this visit and their previous ratings were carried forward.
Safe medicines
Medicines were managed safely and administration records were completed accurately. Staff who administered medicines had their competence checked.
“Records regarding the administration of medicines were accurately completed” from the report
Staffing and recruitment
Inspectors saw an appropriate number of staff on duty and found that safe recruitment checks had been carried out, apart from one missing identity document that was later fixed.
“During the inspection we saw that there appeared to be an appropriate number of staff on duty.” from the report
People appeared comfortable
People appeared happy and healthy, and responded positively when staff approached them. The atmosphere was described as friendly and peaceful.
“People looked happy, healthy and responded positively when staff approached them or spoke with them.” from the report
Infection control
Inspectors were assured that the home was using protective equipment safely and had arrangements for testing, social distancing and managing outbreaks.
“We were assured that the provider was using PPE effectively and safely.” from the report
Communication with relatives
needs fixingRelatives told inspectors that communication with staff was not always effective. The deputy manager said this would be addressed.
“Feedback we received from people and their relatives was mostly positive however, we were told that at times the communication between the staff and relatives was not always effective.” from the report
Leadership still needs improvement
needs fixingThe Well-led rating remained Requires Improvement, as it had at the previous inspection. This means inspectors were not satisfied that leadership and oversight were consistently strong enough.
“At this inspection this key question has remained the same.” from the report
Record checks needed correction
minorOne staff file did not contain proof of identity, and one person did not have the required guidance for as-needed medicine. Both issues were confirmed as fixed after the inspection.
“However, we identified one person's personnel file did not contain proof of their identification.” from the report
- 01How has communication with relatives improved since the inspection?
- 02How do you check that every staff file contains proof of identity before staff start work?
- 03How do you make sure each person has clear instructions for medicines prescribed as needed?
- 04What progress has been made since the home remained rated Requires Improvement for Well-led?
- 05What were the latest ratings and findings for Effective, Caring and Responsive, which were not inspected during this visit?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 24 December 2020 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 Tree Manor
7 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- December 2021Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2020Requires improvementstayed Requires improvementSafe: GoodWell-led: Requires improvement
- February 2020Requires improvementup from InadequateSafe: Requires improvementWell-led: Requires improvement
- September 2019Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- August 2018Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2015Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2013
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- November 2011
Registered with the Care Quality Commission on 1 November 2011.
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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40 live-in carers within about an hour of Wirral
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 £1,230 a week. 37 can care for a couple. 8 years' experience on average.
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
“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.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.