CQC report explained · a nursing home
What the CQC found at Burgess Manor
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors were assured about infection prevention and control, including visitors, testing, personal protective equipment, cleaning and managing outbreaks. They also noted chipped and damaged paintwork in communal corridors.
- Effective?
- Good
- This area was not rated in this targeted inspection.
- Caring?
- Good
- This area was not rated in this targeted inspection.
- Responsive?
- Good
- This area was not rated in this targeted inspection.
- Well-led?
- Good
- This area was not rated in this targeted inspection.
What inspectors found, February 2022
Inspected but not rated; inspectors found good infection control and visiting arrangements, with some damaged paintwork noted.
This was a targeted inspection on 10 February 2022. It looked mainly at infection prevention and control during the COVID-19 pandemic, and asked about staffing pressures. The visit was announced one day in advance.
Inspectors were assured that the home was managing visitors, testing, personal protective equipment, cleaning, social distancing and admissions safely. People could receive visitors in a designated area and could also use virtual visits.
The home had trained staff, supplies of personal protective equipment and links with health professionals. Inspectors noted some chipped and damaged paintwork in communal corridors, although the home had identified this and had refurbishment plans.
The service was inspected but not rated. This was not a full assessment of all five areas of care, so the report does not give an overall quality rating.
Safe visiting
The home supported face-to-face and virtual visits. It used a separate visiting area, health questionnaires and evidence of a negative lateral flow test.
“The home facilitated face to face visits, in line with government guidance.” from the report
Infection control
Inspectors were assured that the home had appropriate infection control procedures, including testing, personal protective equipment and outbreak arrangements.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Trained staff
Staff had training in infection prevention and control and in using personal protective equipment. The home also had adequate supplies.
“Staff were trained and competent in infection prevention and control best practices and how to put on and take off PPE.” from the report
Testing
People living in the home and staff were tested regularly for COVID-19.
“People and staff were tested regularly for COVID-19.” from the report
Damaged paintwork
minorInspectors saw chipped and damaged paintwork in communal corridors. The home had already identified this and had plans to continue refurbishment.
“We noted some chipped and damaged paintwork in the communal corridors which could prevent effective cleaning” from the report
- 01What progress has been made with the planned refurbishment of the chipped and damaged communal corridor paintwork?
- 02Have COVID-19-related staffing pressures affected staffing levels or care for residents, and how are these pressures being managed now?
- 03How are visits arranged now, and can residents choose between face-to-face and virtual visits?
- 04How often are residents and staff currently tested for COVID-19, and what happens if there is an outbreak?
- 05How are residents supported to access the community safely?
This was a targeted inspection of infection prevention and control and COVID-19-related staffing pressures; it did not provide ratings for the other care areas or an overall rating. This explanation was written from the published report of 19 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.
What inspectors found, May 2021
Burgess Manor was inspected but not rated; targeted checks found safe infection control, staffing and risk management, with some improvements still needed.
This was a targeted inspection on 30 April 2021, followed by calls for more evidence. Inspectors looked at infection control linked to COVID-19, staffing, clinical risk and how challenging behaviour was managed.
Inspectors spoke with 10 people, managers and care staff. They reviewed four people's care records and records about infection control, risk and staff training. People said they felt safe, and inspectors found suitable staffing, risk assessments and positive behaviour support plans.
The home had arrangements for PPE, testing, social distancing and preventing infections. Staff training in safe holding and de-escalation had not been updated for some time, although updated training was being prepared. One incident had not been reported to the CQC at first, but this was dealt with after the inspection.
The overall rating and the Safe and Well-led ratings are shown as 'Inspected but not rated'. The previous overall rating was Good, published on 23 January 2020. This inspection did not assess the whole service, so it did not change the previous rating.
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing COVID-19 infection, including PPE, testing and social distancing.
“We were assured that the provider was using PPE effectively and safely.” from the report
Staffing
There were enough suitably qualified and trained staff. People said staffing was fairly consistent and that they felt safe.
“Enough numbers of suitably qualified and trained staff were deployed to meet people's needs.” from the report
Risk planning
Care records contained risk assessments and clear plans for positive behaviour support and challenging behaviour.
“Care files had clear examples of positive behaviour support plans, challenging behaviour plans, and supporting documentation such as behaviour monitoring charts in place.” from the report
Stable management
Inspectors found a settled and consistent management approach, with systems that monitored the quality and safety of the service.
“Systems and processes in place to monitor the quality and safety of the service were effective in monitoring and developing the service.” from the report
Training needed updating
needs fixingTraining in safe holding and de-escalation had not been updated for some time. The manager and company trainer had attended external training and planned to roll this out to staff.
“Staff had been trained in safe holding and de-escalation, but this had not been updated for some time.” from the report
Incident notification missed
needs fixingOne incident had not been notified to the CQC as required. The manager acted after the inspection.
“We reviewed one incident in the home which had not been notified to CQC; the registered manager actioned this post inspection.” from the report
Garden improvement planned
minorInspectors raised the condition of the external garden environment on the mental health unit. The home had identified this for improvement and had a plan to upgrade it.
“We made observations regarding the external garden environment on the mental health unit; this had been identified for improvement and there was a plan to upgrade this area.” from the report
- 01Has all staff training in safe holding and de-escalation now been updated, and how is staff competence checked?
- 02What support is given to staff and residents after any restraint incident?
- 03What was the incident that was not notified to the CQC, and what has changed to prevent this happening again?
- 04What improvements have been made to the external garden on the mental health unit, and when will the planned work be completed?
- 05How are regular care reviews involving the wider multidisciplinary team used to change people's support?
This was a targeted inspection of specific concerns about infection control, COVID-19, staffing, clinical risk and management of challenging behaviour, so the other areas and full key-question ratings were not reassessed. This explanation was written from the published report of 13 May 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.
Every inspection of Burgess Manor
8 rated inspections over 5 years: the service has improved, from Inadequate to Good.
- February 2022Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- May 2021Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- January 2020Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2019Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- January 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2016Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- September 2015Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2015InadequateSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- August 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 19 January 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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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.”
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