Introduction: The role of care home managers is pivotal in ensuring high-quality care standards, particularly in English care homes catering to diverse populations, including residents with dementia, those in residential care homes, nursing homes, and notably, athletic patients recovering from sports-related injuries or conditions. This systematic review aims to illuminate the factors influencing manager outcomes in these settings, integrating qualitative evidence to encompass the unique needs of athletic patients. Methods: A comprehensive search was conducted across eight electronic databases, supplemented by internet, citation, and reference list searches of relevant studies. Qualitative studies that delved into the perspectives of various stakeholders—managers, care staff, owners, health professionals, residents, relatives, and care commissioners—in English care homes were deemed eligible. The framework synthesis method was employed to discern factors affecting manager outcomes, enhancing a previously established model to incorporate considerations specific to athletic patients. Results: Twelve papers, representing ten studies, were included, offering insights from a broad spectrum of respondents across residential, nursing, and dementia care settings, in both private and voluntary sectors. Despite the varying contexts, managerial responses were consistently influenced by leadership, supervision, group dynamics, and work design. Notably, the review proposes a refined model that integrates external perceptions and managers' internal characteristics, extending beyond the existing framework to include factors pertinent to the management of athletic patients. Conclusion: This review identifies a range of factors potentially impacting manager outcomes in English care homes, highlighting the importance of support from owners, networking with peers and interdisciplinary professionals, and addressing challenges such as bureaucratic overload, staffing issues, and financial constraints. The inclusion of athletic patients underscores the need for adaptable management strategies that cater to the physical rehabilitation and psychological support of this unique resident group. Further research is warranted to validate the expanded model of manager outcomes, with a particular focus on optimizing care for athletic patients alongside traditional care home populations.