Bramble House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider and registered manager shared the same vision for the service. The provider had also employed an operations manager to support them with necessary changes to their systems and processes, to support their organisational vision. The operations manager also provided support and guidance to the registered manager and staff also found them to be supportive.

Positive feedback from relatives suggested staff were caring and committed and staff feedback told us they shared a vision which was of an inclusive service where each person was valued and people’s human rights were protected.

Leaders had begun incorporating values-based discussions into supervision sessions and team meetings and had introduced a speak up champion to make it easier for staff to speak up. However, these initiatives were not yet fully implemented and some issues between the management team and staff remained unresolved.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

All leaders were appropriately qualified and experienced. They kept their knowledge and professional qualifications up to date through continual professional development and by attending sector related meetings and forums. All understood CQC requirements including requirements relating to duty of candour. The provider was aware of CQC’s assessment process and had reviewed their systems and processes to support compliance.

We received mixed feedback about the approach of some leaders with some being more visible, supportive and encouraging than others. One member of staff said, “Here I feel at home and supported. (Senior managers) can't do enough for me” while another said, “(Manager) is not out and about a lot, stays in (their) office a lot, not very approachable, if you go to (their) office (they) say (they’re) busy.” A recently appointed senior member of staff was regarded by staff as being very approachable.

The provider had recognised through their auditing processes, that work amongst senior staff needed to be more equitable, an example being care plan management, so this was being addressed. There was support in place for newly appointed staff and for staff taking on new responsibilities, such as the Freedom to Speak Up champion.

People did not always feel they could speak up and that their voice would be heard.

While some staff felt confident to raise concerns and described management as being “approachable,” others did not feel confident to do so, or when they did speak up, they did not feel listened to and issues impacting on them were not getting resolved.

The provider had introduced a Freedom to Speak Up champion to help formalise the process of speaking up and to promote a more open culture where issues could be discussed openly and suggestions listened to. This role was new, not fully embedded and not fully understood at the time of this assessment. Plans were in place to provide the champion with formal training to help them embed the role further.

Both staff and managers told us about arrangements in place to reflect and learn from incidents which had happened and the provider took action to investigate concerns and took learning from these.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider promoted equality and diversity in the workforce through their values-based recruitment processes. Workforce diversity was celebrated with staff from several different ethnicities having been recruited. Managers had addressed the use of languages other than English being used when on duty, to ensure an inclusive environment for people who used the service.

There was evidence of reasonable adjustments having been made to support staff with specific needs, such as dyslexia and health conditions although some staff felt more could be done. Examples included amended duties, occupational health referrals and support with learning.

Overall, there was evidence of compliance with the Equality Act and efforts to foster an inclusive workplace.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Governance systems were established, including audits of care plans, medicines, falls, weights and the monitoring of call bell response times. Audits were used to assess whether improvement actions were achieving better care practices and outcomes. Following participation in a local falls‑prevention project, continued falls auditing had shown a significant reduction in falls.

Work was underway to strengthen the auditing process by aligning audits with updated policies and procedures. Audits had highlighted the need for improved record keeping, prompting the provider to provide additional support in this area but also to introduce an improved electronic care records system.

Additional monitoring processes supported oversight of health and safety, including fire and environmental risks. We identified the need for improved monitoring of incidents involving challenging behaviour and the provider took immediate action to address this.

The provider had identified the need to improve ways of obtaining feedback from people’s relatives and professionals so this could contribute to service improvements. The process of obtaining feedback from professionals had begun and initiatives were being explored to obtain more feedback from relatives.

Some staff reported audit outcomes not being consistently shared with them and the operations manager had focused on improving communication with these staff.

Business continuity plans, including plans to manage whole home emergencies were in place. The provider had processes in place to hold managers and staff to account for their actions, behaviours, and performance.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The provider understood the need to work effectively and collaboratively with external health and social care partners to support a seamless care journey for people and to improve outcomes for people. Some healthcare partners told us the service needed to develop better ways of working with them while we also saw evidence of other professionals having found joint working to be effective and successful.

The activities coordinator-maintained links with local community groups, including dementia choirs and church organisations, and facilitated outings when possible. These partnerships contributed positively to people’s experiences.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The service demonstrated a commitment to improvement through investment in systems to improve policies and procedures, auditing and care planning.

There was little evidence to show that feedback from people and their representatives currently contributed to the provider’s service improvement work. Although the provider had arrangements in place where feedback could be given, these were not proving overly effective in obtaining feedback. New initiatives were being explored to encourage and obtain feedback, such as the use of a quick response (QR) code for visitors.

There was evidence of reflective practice including debriefs for staff following incidents to support learning, including areas where practice needed to improve. An example was shared with us of the action taken to address the feedback provided by a healthcare professional on urinary catheter bag care. The provider had organised further training sessions for staff, with some staff booked to attend a relevant training session held by local healthcare professionals.

New initiatives to drive improvement also resulted from lessons learnt and had included the introduction of champion roles. Members of staff took on these roles and were responsible for supporting and reinforcing best practice, for example, in catheter care and infection, prevention and control.

The provider had taken part in a countywide project providing data on falls and skin tears. This information was to be used to promote and support future initiatives in these areas to help reduce the number of these experienced by people in care homes.

The provider invested in train the trainer courses so some staff were trainers in certain subjects and could support staffs learning in these areas.