Bramhall Manor Care Home

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 requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

This service scored 62 (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.

Further work was needed to ensure progress toward a shared vison for the service through effective systems for oversight.

The registered manager spoke highly of the staff team and demonstrated pride in their efforts and achievements in providing good‑quality care to people. Most staff described a positive culture and strong teamwork, with one staff member commenting, “There is a strong sense of teamwork and community, which makes even the more demanding days manageable.” A range of systems were in place to ensure people, families, and staff felt listened to and able to share their views.

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

The registered manager told us they operated an open‑door policy and ensured they were accessible to all staff, including night staff, through regular out‑of‑hours visits. Staff generally spoke positively about the management team and felt well supported. One staff member commented, “I have personally always found [the registered manager] to be approachable, supportive, and easy to talk to. They have often been a valuable sounding board when I’ve needed guidance or simply someone to listen. I feel trusted in my role and confident in carrying out my responsibilities, knowing I have the support of management behind me.”

The registered manager recognised the importance of being visible within the home and had introduced a home choir for people living at the service. They explained how this initiative had helped them strengthen relationships with people and fostered positive engagement with the staff team.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People and families generally felt able to raise concerns and share feedback. A range of forums were in place to support this, including bi‑annual surveys, resident and relative meetings, and opportunities to provide feedback via the electronic signing‑in and out system. Feedback received through these channels was generally very positive, and the service had received a low number of complaints.

Staff also generally spoke positively about the support they received. One staff member told us, “While no organisation is without its challenges, I have observed that concerns and conflicts are managed appropriately. I recall a misunderstanding some time ago where all parties involved were given the opportunity to be heard, and the matter was addressed fairly through the proper processes.” However, some staff raised concerns that they were not always free to raise concerns, especially to visiting professionals, and that not all staff were treated equally, with some staff members being treated more favourably.

Some staff told us they were not always clear about outcomes when feedback had been provided, for example in relation to the rotation of staff across the home. To address this, the registered manager told us they held full staff meetings where information and feedback about the service were shared. In addition, care staff were given opportunities to attend the daily flash meeting once a week to share information and contribute to discussions about the management of people’s needs.

The provider valued diversity within their workforce and worked to promote an inclusive and fair culture by improving equality and equity for people who worked for them.

Overall, staff spoke positively about working at the home and the support they received. One staff member told us, “Bramhall Manor also provides fair opportunities for career growth. I started as a carer, and when the opportunity arose for a team leader position, the process was transparent and open to all applicants. Throughout my transition into the role, I received continuous support from both my manager and the wider management team. I was reassured that support would always be available, and this has remained the case.”

The provider ran an initiative called ‘Wellbeing Wednesday’, which focused on supporting staff mental wellbeing. In addition, the provider had several other initiatives and reward schemes in place for employees. Most staff spoke positively about the registered manager, with one member of staff describing how they had been supported through a flexible and compassionate approach following changes in personal circumstances. However, some staff raised concerns with one staff member commenting, "They [management team] only start caring when it’s beneficial to them."

The provider did not always have clear responsibilities, roles, systems of accountability, or effective governance arrangements. They did not consistently act on the best information available regarding risk, performance, and outcomes, nor did they always share this appropriately when required.

A range of audits and checks were completed by the management team, including the registered manager; however, not all were used effectively to drive improvement or were sufficiently robust. For example, while there was good oversight of fluid intake for people with a current infection through daily flash meetings, this did not extend to all people identified as having fluid intake targets within the electronic care planning system. In addition, although people at increased risk of infection, including those with a catheter, had guidance within their care records to promote adequate fluid intake, there were no clear systems to demonstrate how this was being overseen.

Records relating to thickened fluids were reviewed; however, this did not include adequate oversight of the total amount of fluid people were consuming. Some records we reviewed indicated low fluid intake, raising concerns people may not have been adequately supported to drink sufficient fluids, or records were not being accurately completed to demonstrate people were receiving appropriately thickened drinks.

We found repeated areas of concern in relation to the management of medicines, which had not yet been fully resolved.

Whilst we noted some improvements in the overall quality and accuracy of record‑keeping, the registered manager acknowledged this remained an ongoing area for development. They told us they were continuing to work with staff to ensure care records accurately reflected the support provided to people.

We noted improvements in recruitment practices and in the support provided to staff through the introduction of a more formal supervision process.

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

Families generally felt involved in people’s care, although this was not always clearly evidenced within care records. One person told us, “Staff always ask questions to find out what a person is like. I am not involved in the care planning, but I am asked what I think. Staff are always polite and welcoming.” A range of processes were in place to involve people, families, and staff, including meetings and surveys. Action taken in response to feedback was clearly displayed on a ‘you said, we did’ noticeboard within communal areas.

Feedback from professionals was overall positive, although one professional commented, “I believe that there’s room for improvement in terms of dissemination of information …. On occasion I have found that I have seen the same request week to week.”

The activities team was developing links with the local community and promoted intergenerational work by working with a nursery group and supporting people to access the local community. One staff member commented, “We have quarterly meetings and families are encouraged to come along. We have get‑togethers next week for St George’s Day and a party planned for residents and families.”

The registered manager reported good working relationships with external professionals and one external professional commented, “We have developed a strong working relationship which I think has improved patient care in both acute and chronic settings.”

The provider did not always focus on continuous learning, innovation, and improvement across the organisation and wider local system. The provider did not always ensure the development of safe and effective practice through learning and improvement.

The provider and registered manager had a range of tools in place to support learning and improvement. However, we continued to identify areas of shortfall which had either not been recognised or not effectively addressed through the provider’s own governance and oversight systems. This included repeated concerns relating to the management of medicines, which had not yet been fully resolved.