The inspection took place on 8, 9 March 2017 the first day being unannounced.

This was the first inspection of Birch Court since it had been re-registered with The Care Quality Commission in January 2017. The re-registration had taken place as a business entity to reflect changes to the providers named responsible people. This did not create any changes to the overall registration of the home.

Birch Court Nursing and Residential Home is split into five separate single -storey houses: Brook House; Moss House; Fern House; Bank House and Waterside House, each with the capacity to accommodate 30 people who need nursing, dementia, palliative, respite or residential care. The home is situated in the Warrington suburb of Howley, within a quiet residential setting. At the time of our visit Bank House was not in use and there were 20 people living in Moss House, 20 people living in Waterside House, 25 people living in Fern House and 26 people living in Brook House.

There was a registered manager in place. 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.

People were well cared for at Birch Court. People told us they were happy with the care and support provided and that staff were kind and caring. Staff maintained people's privacy and dignity ensuring that any care or discussions about people’s care were carried out in private. We saw that interactions both verbal and none verbal between staff and people who used the service were caring and respectful with staff showing patience, kindness and compassion. External health and social care professionals told us that the standards of care appeared to be very high.

Arrangements were in place to protect people from the risk of abuse. We spoke to staff about their understanding of safeguarding and they knew what to do if they suspected that someone was at risk of abuse or they saw signs of abuse. People who lived in the home and their relatives told us that they felt that staff provided safe and supportive care.

Relatives told us they were made to feel welcome and staff and managers were considerate to them and ensured they felt looked after and valued. They were kept informed of any changes and had open dialogue with staff about concerns or changing needs.

Staff were recruited through a rigorous procedure and attend mandatory training as part of their induction and continuous personal development. The registered manager ensured that staff had a full understanding of people's care and support needs and had the skills and knowledge to meet them.

Staffing provision was responsive to the numbers of people living in each house and their changing needs. We saw that staff on duty in one house were quite rushed around the lunchtime as a meeting had been arranged for one staff member to attend and they were therefore unable to assist with the care and support provision. However we noted that an extra staff member quickly joined the staff team to ensure that there were sufficient staff around to provide needs led care.

People’s nutritional needs were met and they had access to a range of professionals in the community for advice, treatment and support.

People received their medicines as prescribed by their GP. The home had a medication policy in place and a range of associated procedures which included arrangements for the administration of homely medicines. Medicines were managed safely to ensure people received them in accordance with their health needs and the prescriber’s instructions.

The service had a complaints policy details of which were provided to all of the people who used the service and their relatives. One person told us they had raised a concern and it was quickly dealt with. Other people told