CQC report explained · a nursing home
What the CQC found at Bramhall Manor Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, February 2024
Rated Requires Improvement; inspectors found unsafe medicines and weak risk and governance systems, with warning notices issued.
This was an unannounced, focused inspection on 3 and 4 October 2023. Inspectors reviewed medicines, care and risk records, staffing, training, the building and the home's management systems. They spoke with people, relatives, staff and a visiting healthcare professional.
The home was clean and well maintained. Most people said they felt safe and spoke positively about staff. Staff were safely recruited, family visits were supported, and the home worked with health and local authority services.
There were serious shortfalls in medicines management, risk assessments and record keeping. Care plans were not always updated when needs changed. The systems used by managers did not consistently make sure problems were fixed or lessons were put into practice.
The overall rating is Requires Improvement. Safe, Effective and Well-led were each rated Requires Improvement. The home remains in breach of Regulations 12 and 17 and has been rated Requires Improvement for two consecutive inspections.
People generally felt safe
Most people told inspectors they felt safe and spoke positively about staff.
“Most people told us they felt safe at the service and spoke positively about staff.” from the report
Clean and maintained home
Inspectors found the home very clean and well maintained. Equipment checks were also being carried out.
“The service was very clean and well maintained.” from the report
Family visiting
People could receive visits from friends and family, and visitors said they felt welcome.
“We observed many people enjoying visits, and visitors told us they felt welcomed when they visited the home.” from the report
Positive partnership working
The home had good working relationships with NHS and local authority services and made referrals when people needed extra support.
“The service had good relationships with partner agencies in the NHS and Local authority” from the report
Managers responded to feedback
The provider and manager took immediate action on several issues identified during the inspection, including reviewing care plans and risk assessments.
“The provider and registered manager were very responsive to our feedback and took immediate action to review all care plans and risk assessments to ensure they were correct.” from the report
Medicines were not consistently safe
seriousStaff did not always follow the medicines policy. Some medicines were not available when needed, patch sites were not always recorded, and information for medicines given through feeding tubes was sometimes missing.
“Medicines were not always managed and administered safely This was a continued breach of Regulation 12” from the report
Risks were not always managed
seriousRisk records sometimes disagreed with each other, and care records did not always show that staff followed plans for blood glucose, fluids or pressure relief. One wheelchair without footplates was being used until inspectors reported it.
“People's individual risk was not always clearly identified and appropriate action taken to mitigate this risk.” from the report
Weak management oversight
seriousAudits and checks identified repeated problems, but did not consistently show that action was completed. Records did not always prove that daily checks or lessons from incidents had been followed through.
“The providers systems and processes were not being operated effectively to ensure compliance in the assessing, monitoring, and mitigating risk” from the report
Care records were not always up to date
needs fixingCare plans were not always updated when people's needs changed or when outside professionals gave advice. This could make it harder for staff to provide the planned care.
“This meant that planned care was not always reflective of current needs.” from the report
Staffing and call-bell delays
needs fixingPeople and staff reported that staffing was sometimes short, especially at busy times. Records showed that some people waited longer than the home's five-minute call-bell standard.
“there were times when people had to wait longer time frames than the service's 5 minute gold standard.” from the report
Mental capacity records
needs fixingRecords did not always show decision-specific capacity assessments or best-interest decisions. Reviews were not always completed when additional restrictions or equipment were introduced.
“Records did not demonstrate how the service was working within the MCA process and decision specific assessments and best interest decisions were not evident.” from the report
- 01What has changed to make sure every person's medicines are available, given safely and recorded correctly?
- 02How do you now check that risk assessments and care plans match each other and are updated when needs change?
- 03How are you checking that staff follow plans for fluids, blood glucose monitoring, pressure relief and moving and handling?
- 04What are the usual staffing levels on weekdays, nights and weekends, and how do you monitor call-bell waiting times?
- 05How do you record mental capacity assessments, best-interest decisions and reviews when restrictive equipment is introduced?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward when calculating the overall rating. This explanation was written from the published report of 22 February 2024 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, April 2022
Bramhall Manor Care Centre: Inspected but not rated; infection prevention was good, but visitor restrictions did not fully consider people's emotional wellbeing.
This was an unannounced, targeted inspection on 26 January 2022. Inspectors looked at infection prevention and control, visitor arrangements, and whether COVID-19 staffing pressures affected the service.
The home was clean and well maintained. Inspectors found good arrangements for visitor screening, personal protective equipment, testing, vaccinations, cleaning, waste disposal and infection control.
The home had stopped visits for families and essential care givers between 10 December 2021 and 24 January 2022, except for families of people receiving end-of-life care. Inspectors found that the possible emotional, psychological and mental health effects of this restriction had not been assessed.
The home was inspected but not rated. This was not a full inspection of all five areas of care.
Visitor screening
Essential visitors were screened using health questions, temperature checks, lateral flow test evidence and vaccination checks for visiting professionals.
“A robust screening process was in place for all essential visitors to the home.” from the report
Clean premises
The home was visibly clean and in good order, with regular cleaning of frequently touched areas and suitable arrangements for clinical waste.
“The premises was visibly clean and in good order.” from the report
PPE and testing
Staff had access to personal protective equipment and training. People using the service and staff received regular COVID-19 testing, and all had received vaccinations.
“Staff had access to supplies of PPE and had received training to ensure they used this correctly.” from the report
Impact of visitor restrictions
needs fixingThe home communicated the reason for stopping most visits, but did not assess the possible emotional, psychological and mental health effects on people. Inspectors signposted resources to help improve this approach.
“we found the provider missed the opportunity to assess the potential emotional, psychological and mental health impacts for people” from the report
- 01What are the current visiting arrangements for families and essential care givers?
- 02How do you assess and reduce the emotional and psychological impact if visits have to be restricted?
- 03How do you screen visitors and check testing, vaccination and infection symptoms?
- 04How do you manage staffing pressures when staff are affected by COVID-19?
- 05What ratings or inspection findings cover caring, effectiveness, responsiveness and leadership?
This was a targeted inspection of infection prevention and control, visiting arrangements and COVID-19 staffing pressures; the service was inspected but not rated and the other areas were not assessed. This explanation was written from the published report of 12 April 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.
Every inspection of Bramhall Manor Care Home
2 rated inspections over 2 years: the service has held its Requires improvement rating throughout.
- February 2024Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2022Inspected but not ratedSafe: Inspected but not rated
- November 2021Requires improvementSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- October 2020Inspected but not ratedSafe: Inspected but not rated
- March 2020
Registered with the Care Quality Commission on 24 March 2020.
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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Most charge £980 to £1,260 a week. 88 can care for a couple. 10 years' experience on average.
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