Bramhall Manor Care Centre

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.

We found the following examples of good practice.

A robust screening process was in place for all essential visitors to the home. This included completion of a health screening questionnaire, temperature check, evidence of a recent lateral flow test and a vaccination check for visiting professionals.

The premises was visibly clean and in good order. We saw cleaning schedules included regular cleaning of touch points around the home, such as door handles and light switches. Appropriate disposal arrangements were in place for clinical waste.

Staff had access to supplies of PPE and had received training to ensure they used this correctly. All staff and people living at the service had regular testing for COVID-19, and all had received their vaccinations.

Further information is in the detailed findings below.

About the service

Bramhall Manor Care Centre is a new, purpose-built care home registered to provide nursing and personal care for 71 people across three floors. The service is not a traditional care home as it exclusively provides short-term, intermediate care placements for people discharged from hospital but not yet ready to return home. At the time of our inspection there were 62 people using the service.

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

Medicines were not always managed safely which placed people at risk of harm.

Systems and processes to ensure oversight of the service were not always effective. Audits completed had not always identified the concerns we found on inspection. The management team were helpful and quick to investigate when we fed back our findings during the inspection.

Staff were recruited safety and had a comprehensive schedule of induction and training to understand and meet people's needs.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We received good feedback from people and their relatives about the high standard of food. Hospitality staff were knowledgeable and passionate about providing a pleasant and nutritious dining experience.

Staff were kind and caring and we observed some respectful interactions between people and staff. Feedback around staff was positive from people who felt well cared for.

All people who came to live at the home were required to isolate in their room for 14 days as per Government guidance. Although the provider told us there were systems in place to promote wellbeing, people and their relatives, along with staff members, told us people living at the home lacked social stimulation and some people told us they felt lonely. People and their families told us communication with the home was not always good and knowing how their loved one was feeling was important to them during a 14-day isolation period. We have made a recommendation about improving wellbeing support during the isolation period.

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

Rating at last inspection

This service was registered with us on 24/03/2020 and this is the first comprehensive inspection.

Why we inspected

The inspection was prompted in part due to concerns received about poor communication with families, medicines management and administration, nutrition, pressure care and wellbeing. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe management of medicines, records relating to people’s care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bramhall Manor Care Centre is a residential care home providing nursing and personal care for up to 71 people in one adapted building. We inspected one unit which is to be used as a designated care setting. The unit can accommodate 16 people.

We found the following examples of good practice

¿ Preadmission assessments were completed to ensure people's needs could be met. Managers of the home worked closely with the local hospital. The systems in place allowed people to be admitted to the home safely from hospital.

¿ The unit was separated from other units in the home to prevent cross infection. There was no movement of staff or residents between units. Dedicated staff provided a support bubble within the unit to support people’s needs, including their meals and social support. Each bedroom had fully ensuite facilities.

¿ National guidance was followed on the use of personal protective equipment (PPE) and regular covid 19 testing was taking place. There were supplies of PPE readily available to staff and visitors. There was clear signage on the correct use of PPE and handwashing techniques throughout the unit and staff had received appropriate infection control and prevention training.

¿ A detailed risk assessment was in place for ensuring safe visits, this included health screening and use of PPE. Local restrictions on visiting were in place at the time of the inspection and alternative measures such as video calls were being used.

¿ The environment was very well lit, clean and clutter free. Very clear and detailed cleaning processes and procedures were in place.

¿ There were detailed procedures and risk assessments to manage and minimise the risks Covid 19 presented to people who used the service, staff and visitors. Managers and staff worked closely with a range of external health care professionals. There was a general practitioner (G.P.), assistant nurse practitioner, occupational therapist and physiotherapist based on site.

¿ Staff had volunteered to work on the unit and had been consulted with about their specific risks or concerns. Each staff member had a health risk assessment. Staff were offered access to a variety of support and well-being initiatives.

We were assured that this service met good infection prevention and control guidelines as a designated care setting

Further information is in the detailed findings below.