Bramhall Manor Care Centre

Updated 22 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was undertaken by 4 inspectors, a medicines’ inspector, and an Expert by Experience over the course of 2 days. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bramhall Manor Care Centre is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bramhall Manor Care Centre is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included any information of concern and notifications the service is required to submit regarding any significant events happening at the service. We sought feedback from the local authority, professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan the inspection.

During the inspection

We reviewed staffing levels and walked around the building to ensure it was clean and a safe place for people to live. We observed how staff supported people and provided care. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 11 people who use the service, 4 relatives and 16 members of staff, including the registered manager, nurses and senior care workers, care workers, auxiliary staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with 1 visiting healthcare professional.

During the inspection we reviewed medicine administration records for 6 people and looked at medicines related documentation.

We reviewed a range of records including full care plans for 10 people and additional care records in relation to the management of other specific needs. We looked at 8 staff files in relation to recruitment, training and support. A variety of records relating to the management of the service, including policies and procedures were examined.

Updated 22 February 2024

About the service

Bramhall Manor Care Centre is a purpose-built care home registered to provide nursing and personal care for 71 people across three floors. The service is commissioned to provide 35 short-term, intermediate care placements for people discharged from hospital but not yet ready to return home. The other placements are for people who require nursing or residential care on a longer term basis. At the time of our inspection there were 68 people using the service.

People’s experience of using this service and what we found

We found the systems in place to manage people’s medicines were not always effective and safe which placed people at risk of harm. Risks were not always robustly assessed, managed and mitigated. It was not always evident that systems were used to ensure lessons learnt were embedded within staff practice. Most people told us they felt safe at the service and spoke positively about staff. The home was clean and tidy, and people were able to receive regular visits from friends and family. Staff were safely recruited and there were sufficient staff to meet people’s needs on the days of inspection, although feedback about staffing levels and staff responsiveness to call bells and requests for help varied.

Systems for service oversight were in place and used but were not robust enough to ensure they led to the required action to address any shortfalls. The provider and registered manager were very responsive and took immediate action to address specific concerns and improve systems, in order to reduce future risk as a result findings during this inspection. The service worked well with partner agencies and had various processes in place to support people to express their views. When concerns were raised these were investigated and responded to.

People were supported to have choice and control of their lives, but records did not always demonstrate that staff supported them in the least restrictive way possible and in their best interests; suitable policies and systems were in place in the service but were not always followed to support good practice.

Staff spoke positively about the induction and training. We noted shortfalls in some areas of training which was immediately rectified. Records did not always demonstrate ongoing and accurate assessments of people’s needs and it was not always evident that care records were updated when people’s need changed. People appeared to enjoy their meals, however, records did not always evidence how people with specific dietary needs were having these needs met. People were supported to access other agencies and the service had good working relationships with external services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 November 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk in relation to falls and moving and handling. This inspection examined those risks. The inspection was also prompted in part due to concerns received about staffing and management of medicines. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bramhall Manor Care Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to how people were supported to take their medicines; how individual risk was assessed, managed and mitigated; and how the provider maintained oversight to ensure people received safe, good quality care.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.