Frenchay Brain Injury Rehabilitation Centre

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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This key question has been rated as 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 service made sure people’s care and treatment were effective and discussed people’s health, care, wellbeing and communication needs with them. However, care documentation was not always consistent across digital and paper records. Staff were not always clear on patient’s positive behavioural support plans.

There was an admission, transfer and discharge policy which included information on pre admission decisions, assessments, medication and discharge planning. There was an inclusion and exclusion criteria for admission of patients. A face to face assessment was carried out prior to admission to ensure suitability for patients and toidentifyanyadditionalcare requirements people may have.

There was a process to carry out mental health assessments and Deprivation of Liberty Safeguards (DOLs). Medical staff would refer the patient for assessments if required.

We saw evidence of discussions with patients and the multi-disciplinary team about their care and making lifestyle choices. There was a section in patient notes to document what the patient wanted to achieve and care plans were developed around these wishes. Patients’ independence and choices were included, such as cognitive competencies, physical needs, behaviours, sensory, communication, activity needs such as watching TV and looking at photos.

Risk assessments such as risk of falls, skin integrity, wound care, nutritional needs, oral hygiene, and pain management were assessed and documented daily in line with best practice. We saw NEWS2 and intentional rounds were completed in patient notes.

The service used a combination of paper and electronic records for patients. However, because these were not updated simultaneously, this created confusion with timings for intentional rounding. There was a lack of consistency between care plans on people’s electronic care notes, paper notes in patients’ blue folders and in the care information on the boards of patients' rooms.

On admission a physiotherapy assessment would be carried out on day 1 and repeated after 2 weeks. This included falls risk assessment, moving and handling and mobility.

Staff told us they would use the least restrictive restraint for patients for the minimum amount of time and with least force necessary. Assessments were carried out and staff discussions on methods to be used, these included the use of bedrails, mittens and belts. Staff had training every year in theory and practice on restraints. However, staff were not always aware of who had a Positive Behaviour Support plan.

Staff were aware of patients who may be at risk of absconding and this was discussed at handovers. There were 2 locked doors to prevent this and reception staff monitored who entered and left.

Patient and family needs meeting were held to discuss patient care needs and development. These included patients, patients’ families where appropriate, therapy, nursing and medical staff. Patients’ psychological needs were assessed and referred to a psychologist when required.

The service planned and deliver people’s care and treatment in line with what was important and mattered to them.

Patients were involved in setting rehabilitation goals and where they lacked capacity, the service worked with patients’ families to ensure goals reflected personal values. These were documented within patients’ recovery and independence care plans. We were told by staff these were updated monthly and reviewed within multidisciplinary meetings and treatment reviews.

Intentional rounding was not always completed consistently and documentation on paper and electronic records was not always clear. This meant there was a risk to patients if staff did not follow the most up to date documentation. Following our assessment the provider told us they were working to align documentation.

Staff followed up-to-date policies and standard operating procedures (SOP) to plan and deliver high quality care according to guidance. We saw a SOP and checklist for tracheostomy services which included staff responsibilities, management and equipment required.

The service had a Neuro-palliative pathwaywhich was in line with national guidance for prolonged disorders of consciousness following sudden onset brain injury (2020).

There was a pressure ulcer risk assessment tool which included screening assessment and decision. Not all staff delivering therapies, for example Rehabilitation Assistants, had their competencies assessed to deliver care and treatment in line with the assessments. The provider had an action plan due for completion in October 2025 to address this.

Staff had access to the adult safeguarding decision guide, body map and concern proforma which is an evidence-based framework for staff to identify, assess, and report potential neglect or abuse, particularly regarding pressure ulcers.

The service generally 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.

Nursing and therapy staff with meet on a Monday morning to discuss the workload for that week and plans for that day. Discussions include new admissions, daily flow, training and meetings planned for the week. Senior staff met every Thursday.

MDT meetings were held with nursing and therapy staff to discuss patient care needs and developments. We attended a patient review meeting where discharges were discussed, this included the discharge coordinator, mental health team, social worker and local integrated care board.

Handovers between shifts shared information about patients’ care and progress, including mobility, communication, medication, wound care, sleep status, behaviors, any challenges and one to care. Staff had suggested a communication book was implemented to share information between shifts.

Staff briefing occurred twice daily with hot topics discussed and shared via emails and online chat groups. We saw staff briefing document that included information about each patient’s care, cleaning and equipment.

Staff could refer patients to specialist services such as tissue viability, speech and language therapy (SALT) and physiotherapy.

We observed the therapy team meeting where discussions included staffing, recruitment and audits. Staff meetings included action to be taken and who was responsible.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to promote the best quality and end of life possible.

Patients were involved in planning their treatment and care and were able to choose options for care and treatment.

On admission patients were asked about their nicotine use and offered nicotine replacement and support and education from a smoking cessation lead.

People were encouraged to eat and drink what they wanted. Patients’ dietary needs were catered for and individual meals prepared when required.

Patients were offered optician and dental appointments when required and staff assisted with transport and escorting patient to appointments using a local transport service.

Wellbeing walkstook place. Staff offered all patients whowere able touse wheelchairs or mobilise the opportunity to join in.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There was an audit schedule with audits carried out monthly, quarterly and 6 monthly. These included hand hygiene, mattress audits, pressure ulcers and falls. There was a Stop the Pressure Group meeting that reviewed all pressure ulcers, potential causes such as splints and action plans included additional training.

We saw a variety of audits were carried out, including care planning and record keeping. Care plan audits were carried out quarterly. Results for care planning and record keeping for May and August 2025 were 94% and 98%. Following our assessment, the provider told us that care plan audits were due to be carried out monthly and would include evidence that consent had been obtained.

We saw patients were referred to tissue viability nurses for advice about care needs.

The service had a respiratory muscle strength training clinic for patients to improve respiratory muscles. Between October 2024 and August 2025, 20 patients had attended the programme. Outcomes included improved respiratory pressures, strength when swallowing and talking, and reduction in breathlessness. Further Multi Disciplinary Team training had commenced and the service was sharing the programme and audits with other providers.

Following an audit on NEWS2, a new process was implemented to reduce unnecessary observations and escalations. This resulted in a reduction in the number of observations carried out and a reduction in disturbing patients sleep.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Patients understood their rights around consent to the care and treatment they were offered. However, staff did not always follow the legal framework to obtain consent for people who lacked capacity.

Some staff had attended recent workshops and upskilling sessions relating to consent and most staff were now clear on the importance of seeking consent before delivering care. The service had made improvements and most staff documented consent clearly in care notes.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients consented to treatment based on all the information available. Staff told us that if patients could not give verbal consent, they would use other methods such as patients blinking and communication cards.

There were systems and practices to ensure patients understood the care and treatment being recommended. This helped them make an informed decision. However, some staff were unsure about systems and process when patients did not have capacity to consent. They did not always understand the Mental Capacity Act and their responsibilities when assessing capacity to consent. Some staff felt this was the role of the doctors.

There were hospital policies to request Deprivation of Liberty Safeguards (DOLs) for a patient. Staff did not always understand their responsibilities around DOLs. Following our assessment the provider told us they had carried out additional staff training, reviewed their process and sought advice from the local DOLs team. Monthly audits were planned to review the process and compliance.

Positive Behaviour Support (PBS) plans did not include capacity assessments in relation to care. Plans did not include information around consent and had no reference to capacity assessments, best interest decisions or legal frameworks to work under. This meant there was a risk of physical abuse to patients’ who had capacity to consent if the plan was viewed in isolation during an incident.

The provider had an action plan due for completion in October 2025 to address this.