3 October 2023
During an inspection looking at part of 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.