Bramhall Manor Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Pre-admission assessments were completed before people were admitted to the service to ensure their needs could be met. The registered manager and management team had a clear understanding of the level of needs they could support people with, and would only accept people whose needs they could support. Upon admission there were processes to ensure that risk assessments and care plans were prioritised in line with people’s needs in a timely way.

Staff told us information about new admissions was communicated appropriately with them at the beginning of a shift.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

It was not always evident that people were receiving evidence based care and treatment as required. For example, we noted that where people had fallen, it was not always clear that consideration to building strength and balance to reduce falls risk had been considered. The service had access to wellbeing provision which included activities and a range of exercise programmes tailored for older adults, but it was not evident from records how this was being delivered. The registered manager was proud to tell us about the wellbeing framework award they had received earlier in the year.

Care plans contained detail about the diets people may need if they were at risk of losing weight or had fragile skin, but the records did not reflect how these were being provided. Where people required repositioning due to immobility, care plans generally contained detail about the level of support required, but care records did not always demonstrate that these plans were being followed.

The provider’s oversight had identified issues with records, but this had not yet been resolved when we inspected the service. Generally, where people had wounds or skin damage these appeared to be healing well.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had good working relationships with each other, and with external professionals. External services generally spoke positively about the service and felt the staff sought support and responded to advice appropriately. Staff appeared to know people and were able to identify and meet people’s needs.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The provider completed regular reviews of people’s health needs, including in relation to nutritional risk and skin integrity. These risks were monitored regular by the clinical team to ensure appropriate care plans were in place. We noted some shortfalls in how the records reflected care was being given. People were happy with how they were supported and staff recognised signs of decline and generally escalated these appropriately.

Referrals were made to relevant services, such as dietician, or speech and language therapy where assessment and advice was required. One relative commented, “The staff know what they are doing and keep a good eye on her. They are very good at spotting if anything is wrong like when she has got a UTI.”

The provider did not always effectively monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider had multiple systems in place to support oversight and ensure people’s needs were monitored but these were not always being used effectively. Daily meetings were in place to monitor people’s wellbeing. However, it was not evident from the records that this oversight was leading to people being supported to have enough to drink in line with their target or that appropriate targets were in place for people when this was needed. The registered manager told us a member of staff was allocated to monitor people’s fluid throughout the day upon each unit, but the impact of this was not evident within the records.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

We observed staff sought consent before providing support to people and people told us that staff would respect their wishes. Care plans contained information about people’s cognitive abilities and mental capacity and where people lacked capacity, assessments and best interest decisions were made. Where people were subject to restrictions appropriate deprivation of liberties safeguard (DoLS) requests were made. Staff had completed training in relation to the mental capacity act and DoLS.