Blackheath Brain Injury Rehabilitation Centre

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• 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

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 inspection, we rated this key question requires improvement. At this inspection, while positive developments were observed in care delivery and outcomes, the overall rating remains requires improvement due to the way scores are determined under the Single Assessment Framework (SAF).

The provider had made progress since the last inspection. At our previous inspection, we advised the provider to ensure patients were confident in using mobility aids. At this inspection, staff assessed patients’ physical needs and involved occupational therapy in the care process. Staff had been trained in the use of equipment such as hoists and did not use equipment they were not trained to operate. During our visit, we observed no patients requiring support with mobility aids. The quality of meals had improved, with menus tailored to dietary needs and allergies. Meal planning was strengthened through input from dietitians, kitchen staff, chefs, and speech and language therapists, and patient feedback was gathered through regular catering meetings. Staff completed nutritional screening on admission and supported patients with healthy eating and lifestyle choices. There was also progress in promoting smoking cessation and physical health through personalised activity timetables, including physiotherapy, tai chi, and exercise sessions. Multidisciplinary working was evident through daily handovers, governance meetings, and joint discharge planning with external stakeholders. Staff supported patients throughout their admission and recovery, and there were links with a local GP and therapy providers. Patients received timely physical health support, and staff responded promptly to emerging health concerns.

However, some patients reported that they had not received a copy of their care plan or felt only partially involved in its development. Although records showed patients were offered opportunities to participate, implementation was inconsistent. Access to advocacy services was limited, with most patients unaware of how to access support, despite the provider reporting that advocacy was available. Wards also lacked accessible information about treatment and patient rights, reducing opportunities for patients to engage independently in their care. Therapy services continued to experience staffing vacancies across all disciplines. While this had not yet negatively impacted patient care, recruitment remained ongoing. Some staff also reported challenges in working with other internal teams, although overall collaboration was observed to be effective.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

At this inspection, we found that staff developed individual care plans and involved family members in the process. There was evidence that patients were offered opportunities to be involved in planning their care, although this was not consistent, and some patients told us they had not received a copy of their care plan or felt fully involved.

Some staff we spoke to told us they developed individualised care plans, which were reviewed regularly through multidisciplinary discussions and updated as needed. Some care plans were recovery-oriented, focusing on strengths and goals.

At our previous inspection, we suggested that the service should ensure all patients are shown how to use and feel confident using any mobility aids they are provided with. At this inspection, we found that patients were assessed for their physical needs during the assessment process and had access to occupational therapy.

During the inspection, we did not observe any patients needing assistance with mobility aids.

Staff told us they had been trained to use equipment such as hoists and did not use equipment they had not been trained to use. Staff said there was a full range of activities available during weekdays and the therapy department set weekend activities for staff to carry out with patients.

Staff checked, maintained, and cleaned specialist and adaptive equipment, including hoists. The service was wheelchair accessible and had a range of rehabilitation equipment to support patient care and treatment.

Most patients felt involved in their care, and there was evidence that staff were adhering to relevant legislation. Members of the multidisciplinary team met with patients as part of the admissions process and provided support to patients and their families throughout recovery.

We spoke with members of the multi-disciplinary team as part of the on-site activity, including occupational therapists and psychologists. Staff were able to describe a varied activity timetable that worked towards a defined model of practice, with standardised clinical assessment and treatment pathways. At the time of inspection, there were vacancies in areas of the therapy department.

At our previous inspection, we suggested that the service work with patients to improve the quality of meals. At this inspection, we found that the provider had taken steps to address this. The service had previously worked on improving menus, including considerations for allergies. Patient feedback was now being gathered through regular catering meetings, and the involvement of a dietitian, kitchen staff, chef, and Speech and Language Therapists had enhanced the meal planning process.

Staff carried out a nutrition screening as part of the initial assessment process, and the service had access to a dietitian to support patients in making healthy lifestyle and dietary decisions.

Staff familiarised most patients with the ward within a day of admission. Patients were invited to multidisciplinary team (MDT) meetings and ward rounds, facilitating involvement in their care. Nonetheless, some inconsistencies in communication between teams were identified. Overall, multidisciplinary working was effective, but there remained opportunities to improve consistency in team coordination to enhance patient experience.

Staff told us they met regularly to discuss patient care, and information was shared among multiple disciplines during clinical governance meetings and morning handovers.

However, some staff reported challenges with working effectively with other internal teams.

We observed onsite staff working practices, multidisciplinary meetings, and, as part of the assessment, reviewed care records. These demonstrated effective collaboration across teams and services to support people. We also reviewed discharge planning and liaison with external stakeholders.

The provider had a service level agreement with a local GP surgery and with an organisation that provided music therapy. The allocated GP carried out a weekly ward round and patient assessments.

Staff supported patients with step-by-step cooking recipes and personalised exercise plans, including gym access. 1 patient with a physical health condition said alternative food options were not always available but felt encouraged to eat fruit. Another patient said staff identified a potentially serious health condition, escalated their care, and escorted them to the hospital, staying with them into the early hours to provide support.

Staff ensured patients had access to physical health care, including specialists such as dentists. They assessed and supported patients to improve their physical health by providing information and access to groups aimed at improving health and well-being, such as smoking cessation.

At our previous inspection, we recommended that the service continue working towards promoting smoking cessation and becoming a smoke-free environment. At this inspection, we found continued progress. The provider had supported healthier lifestyles through personalised patient timetables that included physiotherapy, exercise groups, tai chi, and smoking cessation support.

At this inspection, we found that patients were kept informed about their treatment and had opportunities to review their personalised care plans, with at least one patient attending a review after four weeks on the ward. Outcomes measures reports demonstrated that the service monitored patients’ progress.

Most patients told us they were unaware of how to access advocacy support while on the ward. The provider stated that an advocacy service was available through the local authority, and one patient had received support from their social worker.

However, access to advocacy was not consistently understood or experienced by patients, which limited their ability to seek independent support in understanding or consenting to their care and treatment.
There was lack of visible and accessible information for patients regarding their treatment and rights. Notice boards throughout the ward did not display relevant treatment information.