Frenchay 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

We did not rate effective as this was a focused assessment and we did not cover all quality statements within this key question. We found people were safe and protected from avoidable harm. However, the service was in breach of legal regulation in relation to person centred care. We assessed the delivering evidence-based care and treatment quality statement for the effective key question. Staff worked in a positive culture of evidence-based practice. Speciality teams worked together when assessing people’s needs and educating carers. People were assessed on admission, prognosis was discussed and support was provided at discharge. However, people were not always involved in the development of their own care plans. Rehabilitation goals were not always person-centred.

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.

We did not look at Assessing needs during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

Some people told us that staff discussed their needs with them and their relatives or carers, and were involved in care and treatment planning. People said staff spoke with patients and relatives about their progress during recovery. However, some people were not always clear that their goals were tailored towards them. People said they were given choices and received help at mealtimes. Other people said if they did not like the choices offered then staff would provide alternatives where possible. Water and hot drinks were always available. However, some people did not find the food very appetising and told us there were not always enough staff to assist at mealtimes or to answer call bells promptly. Some people said specific guidance was provided regarding food and drink if they had issues with swallowing.

Staff reported the Speech Language Therapy (SALT) team was responsive to patients and families when concerns were raised. Staff told us all patients were screened by the SALT team at time of admission. However, SALT were not involved with capacity assessments on admission due to a reduction in the team’s staffing levels. These were carried out by Occupational Therapists (OTs) who sought SALT support when required. Staff said there was an ethos of least restrictive practice. Capacity assessments regarding risks were carried out. Staff said there was an improved relationship since the staffing restructure. This had helped with close working between the different teams. Staff said they felt they had appropriate supervision and training to understand people’s individual needs. Therapies staff told us they could improve the inclusion of people, families and carers within goal setting. Staff told us there was a cognitive pathway to ensure information for people with cognitive difficulties was understood. However, care plans did not always clearly show how the cognitive pathway was followed. Staff told us rehabilitation equipment was appropriate. Staff were supported to discuss long term prognosis sensitively with patients. However, some staff said they did not always have enough time to provide optimal rehabilitation for patients. Discharge planning started from the day of a patient’s admission. Processes for discharge were different in each region which posed a risk of delays to discharge. However, this was a system wide issue outside of the service’s control. Staff told us it had been a challenge to involve relatives in the development of patient care plans. However, staff felt the introduction of the carers’ education sessions had improved this. Staff told us there were guidelines to meet patients’ food and drink needs and preferences.

Staff received mandatory infection prevention and control training. Audits were completed to check compliance with standards. Data showed that staff hand hygiene was monitored. Over the previous 3 month period compliance was between 94% and 100% of the 100% target. Staff were trained to carry out electrocardiogram to monitor patients’ heart rates. Response times to call bells were monitored. Urinary catheter care was monitored and data showed that over the previous 3 month period compliance was between 88% and 100%. Therapy staff used the UK Rehabilitation Outcomes Collaborative (UKROC) database to collect outcome measures for patients. The psychological outcome of people’s care and treatment was routinely collected and monitored. This information showed that the intended psychological outcomes for people were being achieved. People were supported psychologically during referral, transfer between services and at discharge. This included looking at their values and what was important to people. Benchmarking data showed the service was comparable with other services in the country who treated adults with acquired brain injuries.

We did not look at How staff, teams and services work together during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

We did not look at Supporting people to live healthier lives during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

We did not look at Monitoring and improving outcomes during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.

We did not look at Consent to care and treatment during this assessment. There is no previous rating for the Effective key question so we cannot yet publish a score for this area.