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Frenchay Brain Injury Rehabilitation Centre Good

Reports


Inspection carried out on 9 to 10 October 2018

During an inspection to make sure that the improvements required had been made

Frenchay Brain Injury Rehabilitation Centre is operated by Huntercombe Properties (Frenchay) Limited. It is a private hospital in Bristol and contains 52 beds. The hospital primarily serves the communities of the Bristol, North Somerset and South Gloucestershire. It also accepts patient referrals for level one beds, from the whole of the South West. Level one beds are for patients who need specialist intensive care and therapy from a specialised and multidisciplinary team. Arrangements existed with a local NHS trust to provide medical staff to undertake medical care and treatment.

This service specialises in the assessment, treatment and rehabilitation of patients with complex physical and cognitive impairments, challenging behaviours and neuropsychiatric disorders resulting from a brain injury. The centre can care for patients detained under the Mental Health Act 1983 or on a Deprivation of Liberty Safeguard Order (DoLS). The centre can also care for patients aged 16 years or above, although patients aged 16 to 17 were rarely cared for.

The service treats NHS patients who have a period of care commissioned by their local commissioning body. It can also provide care to privately funded patients. Patients are usually admitted from an acute hospital following medical stabilisation and either discharged home, to permanent community placements or supported living.

The hospital has had a registered manager, Alison Woods, in post since 2001. Frenchay Brain Injury Rehabilitation Centre is registered to provide the following regulated activities: Treatment disease, disorder or injury; Diagnostic and screening procedures and Assessment of medical treatment for persons detained under the Mental Health Act 1983.

Frenchay Brain Injury Rehabilitation Centre has been inspected three times since their registration. The most recent inspection was in February 2016 where the service met all CQC national standards it was assessed against. It was previously inspected under CQC mental health methodology and was issued no requirement notices and three service improvement recommendations. This inspection was carried out under CQC acute hospitals methodology. Additionally, because we only inspected against the safe and well led domains, we cannot aggregate ratings against previous inspections. This means we cannot provide an overall location rating from this responsive, focussed inspection.

Inspection carried out on 2-3 February 2016

During a routine inspection

We rated Frenchay Brain Injury Rehabilitation Centre as good because:

The centre was set out in a way that patients with high dependency needs were closest to the nursing station. The area was clean and staff had ensured equipment was maintained appropriately. Two of the patient bedrooms were adapted to reduce ligatures and staff assessed patients risk and allocated rooms accordingly. The centre had nurses from a variety of specialties and had a large pool of bank staff to cover shifts if need be. Staff had completed physical health checks and all of the eight care records we reviewed contained up to date risk assessments. Staff were aware of what incidents to report and prior to inspection we saw evidence that they had acted in accordance with their duty of candour.

In the eight care records we reviewed, we found that staff had put in place holistic and patient centred care plans. These care plans had clear goals and were recovery focused. Patients had access to a variety of different therapeutic professions and had access to psychological therapies recommended by the Nation Institute for Health and Care Excellence. The centre had been involved in a national research project. Staff had access to external, specialist training and reported receiving regular supervision, and when we reviewed the records 90% of staff had received regular supervision and an appraisal. The use of the Mental Health Act was limited at Frenchay Brain Injury Rehabilitation Centre and there was no-one detained under the Act at the time of inspection. Staff held appropriate multidisciplinary meetings and also had strong links to local healthcare providers.

We observed staff treating patients with kindness and respect and all of the 17 comment cards we collected had a positive comment about the service. Staff were praised by patients and carers for being caring and supportive. Patients had access to advocacy and held patient forum meetings where they could share their concerns, although there had been gaps in the frequency of the meetings previously.

Due to the nature of the service and the funding by NHS England, there were clear discharge pathways and the hospital had an average bed occupancy of 100% in the 6 months prior to inspection. Patients had access to facilities such as a hydrotherapy pool to aid their recovery, as well as private spaces to meet their family. The building allowed access for people in wheelchairs and mobility aids and there was information available for patients on how to access advocacy or make complaints. Patients had access to meals that could meet their dietary requirements and staff facilitated access to spiritual support.

Staff at the centre were aware of the organisations vision and values. We found that there were appropriate governance systems in place to ensure that actions were taken following incidents and that the majority of shifts were covered. We found that staff had the chance to feed back to the service and suggest improvements and that the provider had set up a reward scheme to recognise staff achievements. Staff morale was high and staff we spoke with spoke highly of the service and their colleagues. The service had engaged in national research and also tracked their performance via a national clinical outcomes group they participated in.

However:

We also found that staff had stored equipment in the patients bedroom corridors due to the building work that was ongoing. This had not been risk assessed and could have formed a trip hazard. We informed the manager of this at the inspection and they had arranged the risks to be assessed and a plan to be put in place to manage them. We also found that the space where patients may have been restrained and de-escalated (should they become a danger to themselves or others) was visible from the corridor and this could have impacted on the patients privacy and dignity. We raised this with the manager at inspection and they arranged for a privacy screen to be put in place.

Inspection carried out on 12 August 2013

During a routine inspection

We spoke with seven patients and 10 staff. We received positive comments from patients and staff demonstrated their dedication and professionalism in their respective roles.

Patients were assumed to have capacity unless factors indicated otherwise. A high proportion of patients lacked capacity when first admitted and their abilities were kept under review. Patients received the care and support they needed. Patients told us �I am well looked after, treated well and involved in making decisions about my care� and �I have to attend for a lot of therapies but it is paying off�.

The centre was clean and hygienic and we found high standards of cleanliness. The provider had procedures in place to protect patients and staff from the risks of infection. The centre was well-maintained, well-equipped and spacious. Bedrooms were for single occupancy and some had en-suite facilities. Each patient wing had a large communal dining area and lounge. The centre had a small gymnasium and hydrotherapy pool.

Staffing levels were kept under review and adjusted dependent upon the needs of the patients at the centre. The centre was well-staffed with therapy staff, nursing and rehabilitation staff.

Patients were made aware of the complaints process and said �The staff would listen to me if I had any concerns and I am sure would act accordingly�, �I would complain if I needed to but I am very satisfied� and �I have been told I must tell someone if I am unhappy with anything�.

Inspection carried out on 25 October 2012

During a routine inspection

Because of the nature of the patients' injuries, it was difficult for them to tell us about how they were treated and whether they were involved in making decisions about their care. One patient said �I am very well looked after� and �I am involved as much as I can be in making decisions�. One person who was an ex-patient and was visiting the centre to see the doctor said �At the time I did not realise how well I was looked after�.

Patients and their families were given information about the service and facilities available at Frenchay Brain Injury Rehabilitation Centre. Information was also displayed in several areas throughout the home about the therapy services. Prospective patients and or their family members were given the opportunity to visit the unit and ask questions about the services and the rehabilitation programmes provided.

Patients received the care and support they needed. This was because the assessment, care planning and treatment delivered took account of each patient�s rehabilitation needs, and their individual limitations due to other injuries. Review reports were written after six weeks of treatment and repeated at three months and six months. These reports were shared with the funding health authority.

Patients were supported by a team of medical staff, nurses, occupational therapists, speech and language therapists, physiotherapists, clinical psychologists, rehabilitation technicians and assistants.

Reports under our old system of regulation (including those from before CQC was created)