Bramble House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.When we last assessed this key question it was rated good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff adopted a person‑centred approach to care, focusing on each person’s individual needs, preferences and circumstances.

Care plans detailed people’s likes, dislikes, preferences and choices, reflecting input from people themselves or their relatives on their behalf. These plans evolved as staff developed a deeper understanding of each person. A relative said, “Staff spend a lot of time getting to know [people] and if they’re unsure about something they’ll ask me.”

Care plans were reviewed at least monthly and when needs changed. Managers audited people’s care plans to ensure quality and accuracy. We found some care plans were more personalised and better reflected people’s needs than others and work was in progress to further personalise and improve the maintenance of these records.

The registered manager told us a whole care plan review was completed six‑monthly and relatives were invited to these. While most relatives confirmed involvement with care planning at the point of admission, their ongoing engagement experience varied. Relatives we spoke with were unaware of any formal care plan reviews despite their family member living in the care home for over a year, although 1 relative told us they had a copy of their family member’s care plans. Most relatives however, also confirmed they were kept informed about changes to their family member’s health or care.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff understood the diverse health and social care needs of the people they supported, although some staff felt they could benefit from more training to fully understand some specific aspects of people’s needs.

One group of healthcare professionals expressed concern about the quality of care provided. Some relatives commented their family members had not always been provided with the care they had needed and others were clear the care provided was good. This suggested quality of care may not always be consistent. One relative confirmed, since their relative had declined in health, their care provision had improved and another relative said, “It seems to me they look after (relative) well. (Relative) has made improvements and they (staff) go out of their way and are quite attentive.” We did not evidence any specific concerns relating to the care of those residing in the care home at the time of this assessment.

Managers and senior staff ensured people received care and support in line with their protected characteristics. The registered manager explained staff worked in a way which supported both continuity of care as well as care preferences.

Agency staff usage was low and when these staff were used, the provider attempted to obtain staff who were familiar with the care home and the people who lived there. Where people required additional care support managers advocated for them to receive additional funding.

Staff recognised people’s relatives as being integral to people’s care and to maintaining their wellbeing, therefore staff worked collaboratively with them. One relative told us staff supported their family member with hospital visits if family members were unable to do this and, they updated them with information on their return.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information was generally provided in a way people could understand. The registered manager explained that the Accessible Information Standard (AIS) was followed where specific needs were identified and this was recorded in people’s care records. One person’s records showed the AIS had recently been reviewed along with the recorded support the person required to receive information and to communicate. Tools such as picture prompt cards were used to aid communication.

Staff were aware of the support people required to help them understand what was being said to them and for people to be able to communicate effectively. Staff understood that by exhibiting different behaviours as well as facial expressions was also a way people expressed and communicated their needs. A member of staff told us they adopted patience in communication and used clear and simple language.

Relatives confirmed they were provided with information about any changes in their family member’s health including information about any infection which they needed to be aware of when visiting. Information was shared with relatives in their preferred method; some preferred a phone call and others an email.

Staff had received training in handling information which included awareness of the principles of the General Data Protection Regulation (GDPR) as laid out in the provider’s GDPR Policy. The policy and training provided staff with the actions they and the provider needed to follow to meet GDPR requirements. Staff had also received cyber training and all records, both electronic and paper were kept secure.

The provider had arrangements in place for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider’s complaints policy and procedures outlined how complaints, concerns, suggestions and compliments were managed. The registered manager confirmed any concerns were discussed in the weekly management meeting and lessons learnt from these discussed in staff meetings. Staff confirmed concerns and complaints were discussed in meetings and lessons learned from these were shared.

We reviewed records relating to complaints and the actions which had been taken in response to these. The provider had recognised that minor concerns, recognised by the provider as ‘niggles’ were not being recorded. The provider’s service improvement plan showed actions planned to address this. All relatives knew how to raise concerns but there was mixed feedback on how well these had been managed.

Relatives were unaware of ever being asked to provide service feedback. There was a suggestions box available, but the provider had realised that this was not being used. Again, on the provider’s service improvement plan there were plans to raise its profile, also plans to introduce QR codes for feedback. Provider audits in May and June 2025 recognised the need to gain staff and professionals’ feedback. Positive feedback, already gained from professionals, was shared with us as part of this assessment including compliments received from relatives.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People could access the care and support Bramble House could offer because there were good arrangements in place between the service and commissioners of care to facilitate admissions. The service had admitted people who had previously experienced failed placements or where other services had decided they could not meet their needs. The service also accepted people for short-term care. A relative told us their family member had been admitted for respite care, but it had become quickly obvious they required 24-hour care, so this was organised.

Staff received training on equality and diversity and looked to remove barriers which may result in people being discriminated against. Care plans considered, for example, mobility needs and the equipment that maybe needed to move people safely, such as hoists.

Although not purpose-built, adaptions had been made to the premises to aid accessibility, for example, for people dependent on a wheelchair. Other adaptions such as alarmed external doors and window restrictors were in place to support people’s safety.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff demonstrated awareness of people’s protected characteristics and took action to help people feel included. People’s religious beliefs were supported and visits from local clergy, church and community groups could be organised. A member of staff said, “Sometimes, no one wants to go to a service, but I have taken people in the past if they want to go.”

Staff and managers recognised the barriers some people faced when accessing the wider community and they took steps to help people feel included and to protect them from discrimination.

Barriers to equal access were addressed. Staff had advocated for 2 people to receive seating assessments, resulting in specialised chairs being provided. These enabled them to sit safely and comfortably in communal rooms and to be part of the care home’s wider community rather than remaining confined to bed or their bedroom.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

There were arrangements in place to support people and their representatives to plan for end-of-life care. The registered manager explained they had been trained to support difficult conversations, and they broached this subject when people or their representatives were ready.

These conversations helped to inform end of life care planning, which aimed to capture people’s end of life wishes; how they wished to be cared for at the end of their life and to provide support for loved ones. Important information relating to resuscitation was established and recorded soon after admission so all staff and attending healthcare professionals were clear about this.

During visits by the GP or Advanced Nurse Practitioner, people’s level of frailty was reviewed so staff and relatives knew if people were on an end-of-life pathway. This helped staff and relatives plan for changes which may take place as the person moved towards end of life. One relative confirmed they had been told by the GP that their family member was approaching end of life. They told us staff had made changes to their family member’s care and their family member’s bedroom was changed to a quieter area of the care home, which they had appreciated.

At the time of this assessment 81% of staff had completed on-line end of life care training with others being reminded to complete this. Staff inexperienced in end-of-life care or who were experiencing this for the first time, were supported by managers or other experienced care staff. Staff were also supported informally if this brought back personal memories of lost loved ones.

To show respect to the person who had recently died and to make visitors aware there had been a recent loss, staff lit a non-combustible candle in the entrance hall.