Bramhall Manor Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to the ways people’s medicines were managed safely and the governance at the service.

This service scored 56 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

Staff informed us of delays in completing risk assessments due to shift rotation over weekends and we were not assured that risk assessments and care plans were implemented in a timely way following a person’s admission. The provider told us their policy was that care plans and risk assessments should be completed within 5 days of admission. However, we raised concerns with the provider about how staff were given the guidance they needed to care for people in a timely way at our previous inspections and were not assured the required action had been taken to mitigate this continued risk. This delay in formulating care plans meant there was a risk that staff were not aware of how to meet people’s immediate needs within the first five day of admission.

The provider had systems to check how effectively staff responded to call bells but it was not evident these were completed robustly with some ongoing issues which regularly left some people waiting for assistance for over 15 minutes. The system was not always effective in ensuring people received timely support.

There were a variety of systems for oversight, and whilst these appeared to have identified some issues, it was not evident that sufficient action had been taken to ensure these issues did not reoccur, such as maintaining accurate records of care provision and addressing concerns found at the last inspection.

Staff and people using the service were encouraged to raise concerns and shared positive feedback on the culture at the service

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Records showed that people's care needs were being met, with appropriate referrals being made to health professionals, for example dieticians, when needed. One person told us, "A doctor has been to see me and an occupational therapist has been to my flat to see if it’s okay for me to return. Age concern welfare has also been to see if a package has been sorted out for when I go home."

The provider had good working relationships with NHS services and local GPs and the registered manager had a clear process to identify the needs of people before admission into the service.

A service user guide was available to people and their families and contained relevant information to support people when transitioning into the service.

The provider did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Some records did not always contain timely reviews of people's relevant areas of risk following incidents, such as falls. The provider had recently introduced a specific care plan to manage risks related to falls with this previously being covered in a variety of different care plans which were used inconsistently by staff.

The provider received medicines documentation with discrepancies following one person’s discharge from hospital to the service. However, the discrepancy had not been identified or appropriately shared with healthcare partners, and we were not assured that risks of avoidable harm were being managed.

However, details of people's restrictions were up to date and in place with the necessary authorisations documented appropriately. Our observations also found that people appeared to be treated well and were cared for and people and families told us they felt the service and care provided was safe.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

It was not always evident that people’s risks were mitigated as much as possible. We found that the relevant care plans were not consistently reviewed for people following an incident. For example, one person who had a history of falls did not have their fall risk care plan reviewed until 4 days following a witnessed fall and this review failed to note the most recent fall within the review section, although other areas of the care plan, reviewed at the same time did note the fall.

Another person had several unwitnessed falls and these were not referred to with the update of the falls risk assessment, and had not led to reviews of the person’s mobility or environment. We found no indication that people had experienced harm as a result of these shortfalls, and generally found appropriate equipment was in place to mitigate falls. However, the inconsistency in approach to managing and reviewing people’s needs following an incident meant that staff may not always have accurate or up to date information and placed people at risk.

Records did not show that risk’s relating to people’s skin integrity was always appropriately managed. We found one person had developed a tear to their skin and the frequency of repositioning had been increased, but this information had not been transferred into other areas of the care plan and records did not show the frequency that the person was being repositioned had increased in line with this change. We also found some shortfalls in records in relation to the application in topical creams. These shortfalls meant we were not assured that people’s skin condition was always being suitably managed. We found good oversight of people who had wounds and these appeared to be healing and appropriate pressure relieving equipment such as suitable mattress and cushions were in place.

The provider's training records showed that many staff had not completed training in line with their own policy, including mandatory and refresher training. Therefore, we were not assured that staff were always able to meet people's needs in a way that was safe.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We found that the garden area was not always kept suitably secure with access to a waste area and carpark accessible to people. We observed at time fire doors were propped open when the home was receiving deliveries meaning they would not be effective in the event of a fire.

Processes for securing items which could present a risk to people such as cleaning products and thickening powder were not always used appropriately. Lock box codes were not reset after use and keys were left in cupboard doors. Therefore, we were not assured that the provider had embedded processes to ensure that equipment, facilities, and technology were suitable, secure, and appropriate to support safe care.

An on-site maintenance manager carried out appropriate checks to detect and control risks in the care environment and the provider was in the process of implementing some improvement works identified following recent risk assessments and analysis.

The provider did not always make sure there were enough qualified, skilled and experienced staff available. They did not always make sure staff received effective support, supervision and development. Staff were not always effectively deployed to ensure they met people’s individual needs in a timely way.

Recruitment processes were not always followed in line with the provider's own policy. Records showed that employment references had not always been sought in line with their policy relating to previous employment in health and social care. We could not be sure that recruitment practices were robust or that an accurate audit trail of the recruitment process was being maintained.

Records we reviewed showed induction forms, appraisals and supervisions were not consistently completed. The provider's own quality assurance reports had also identified inconsistencies in the number of supervisions given to staff which was not in line with their policy. Therefore, we were not assured that staff had received appropriate levels of supervision in their role. However, staff had told us that they felt supported in their role.

People were not consistently supported in a timely way. Whilst people spoke positively about how they were supported by staff records did not always demonstrate that timely support was consistently being provided by the staff team or that staff were readily available when assistance was needed. Concerns in relation to record keeping are discussed further in the well led section of this report.

A recent survey indicated some visitors and families had concerns about how quickly call bells were responded to and these concerns had been identified at our previous inspection. We received mixed feedback about staffing levels from people and families and observed that staff were not always available within the unit.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was clean and tidy and domestic staff addressed malodours quickly. We noted that some domestic staff also had positive interactions with people who were being cared for in their rooms. Feedback from people was generally positive with one person telling us, "It’s like a 5 star hotel. It’s got a lovely dining room and lounge."

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff did not always involve people in planning. During the assessment we found 2 medicine errors that the service had not identified. The service took appropriate action and there was no evidence of any harm. We found when people had thickening powder added to their drinks to reduce the risk of choking, the records did not always show the drinks had been thickened to the correct consistency. This meant people were at risk of choking. We found when people were to have the amount of fluid they drank monitored, due to a health condition, this was not always recorded. Therefore, there was a risk they might have had too much to drink, which placed them at risk of harm.

When people were prescribed a medicine to be given with a specified time interval between doses, the records showed the time interval between doses was correctly observed. We also found when medicines were prescribed to be given at specified times; the records showed the medicine was given at the correct times. However, when the directions stated to give the medicine before or after food, the records showed the staff did not always follow the directions. This meant the medicine might not work properly and people might experience side effects. When people were prescribed a medicine to be given ‘when required’ there was not always person centred information to support staff to know when to give the medicine. There was a risk people might not have been given the medicine when they needed it. When people were prescribed a medicine with a variable dose for example, 1 or 2 tablets, there was not always information to support staff to know which dose to give. There was a risk people might not have been given the most appropriate dose when they needed it.

When people were prescribed a topical cream, the records of the application of the cream did not always include the necessary information. Therefore, we were not assured people’s skin was care for properly. The service did complete audits regularly, however a number of the issues found on the audits were identified during this assessment. Therefore, the actions taken to rectify issues on the audits, were not effective or sustained. Records showed staff completed medicines training and had their competency assessed. Staff told us they received training to administer medicines safely.