Brainkind Neurological Centre York

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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 assessment we rated this key question as good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

There was a thorough approach to staff assessing the physical and mental health of all patients on admission and involvement of all professionals involved in the patient’s care. The service developed individual care plans which were reviewed regularly through multidisciplinary discussions and updated as and when needed in line with best practice. Outcomes were monitored and reviewed on a regular basis by relevant members of the team to ensure continuous improvement and development. Staff understood their roles and responsibilities under the Mental Health Act, Mental Health Act Code of Practice and the Mental Capacity Act 2005. Staff assessed and recorded capacity clearly for people who might have impaired mental capacity.

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 scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 8 care records as part of the inspection and found that staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after admission. This included a risk review, initial care plans and Mental Health Act and Mental Capacity Act documentation. Staff assessed patients’ physical health needs and, where required, physical health care plans were in place for this.

Staff continued to update care plans and risk assessments dynamically throughout patients’ admissions. There was evidence of multidisciplinary approaches to patient care, with information from speech and language therapists, physiotherapy and occupational therapists to outline holistic needs and goals of each person. Care plans included, where possible, the voice of patients and their preferences. There were clear plans for staff to follow in order to best support patients. All care records reviewed were in date, with evidence of regular reviews by the clinical team.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them.

Staff provided a range of care and treatment interventions suitable for the patient group. There was on site therapy available from the physiotherapy team in a specially equipped gym, and specialist equipment was available throughout the houses, bedrooms and therapy rooms to assist in patients’ recovery journeys. The interventions were those recommended by, and were delivered in line with guidance from, the National Institute for Health and Care Excellence. This included medication which was reviewed regularly and psychological therapies and activities intended to help patients acquire independent living skills following their acquired brain injury.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. There were regular visits by a GP provided at the service in clinical treatment rooms ensuring privacy and dignity. Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration with input from speech and language therapists.

Clinical auditing, benchmarking and quality improvement initiatives were discussed at senior management meetings to identify areas of good practice and areas for improvement. Previously, auditing had identified the need to strengthen staff’s understanding of the application of legislative requirements and best practice standards centred on the Mental Health Act. An audit was then completed by the Patient Safety Incident Response Framework (PSIRF) implementation lead and the service’s MHA administrator which led to improvements in understanding and implementation of legislation.

Staff demonstrated good knowledge around brain injuries and treatment plans and were observed to be very kind, caring and attentive to patients. We completed three structured observations for inspection (SOFI’s) across 2 days and all observations evidenced positive engagement between staff and patients, meaningful interactions and encouragement to participate in activities.

The service had an induction policy and procedures in place which involved shadowing staff across shifts prior to being counted within staffing numbers. Agency staff who were new to the service had an induction checklist. The agency sent staff profiles to be logged which evidenced staff were appropriately skilled and up to date with training.

Mental Health Act

Staff we spoke with were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff understood the restrictions around patients cared for under the Mental Health Act and the legal framework they were required to work within. Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act and Mental Capacity Act lead was and the provider had relevant policies and procedures that reflected the most recent guidance.

Staff could easily access local Mental Health Act policies and procedures and the Code of Practice and there were easy read information leaflets available for patients. Staff ensured patients’ rights were explained and read to them often and provided patients with access to independent mental health advocacy services. Staff also requested an opinion from a second opinion appointed doctor when necessary and Mental Health Act documentation was securely stored both physically and electronically. The responsible clinician had oversight of those detained under the Mental Health Act and processes were in place to ensure people’s legal rights were maintained.

However, staff we spoke with told us they often struggled to ensure that patients were able to take Section 17 leave when they wanted, due to staffing pressures and some patients requiring 2 to 1 observations in the community. The Tell Us What You Think 2025 patient survey also identified that only 2 out of 9 people said that they could go out when they wanted and 3 out of 8 people said that, overall, they were encouraged to be part of the community outside of the service.

We scored the service as 3. The evidence showed a good standard. The service 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.

Staff held regular and effective multidisciplinary meetings to review progress, identify care needs and formulate goals and recovery plans towards discharge. Staff shared information about patients at handover meetings to identify risks, concerns and ensure care between shifts was fluid. Care records showed that staff from different disciplines worked together as a team to meet patients’ needs. There was evidence that staff collectively planned, monitored and made decisions on care and treatment plans as well as updating and amending care plans where needed.

Staff we spoke with fed back that teams had effective working relationships, including good handovers, with other relevant professionals, for example, care co-ordinators, community mental health teams and social workers. Staff also told us that pharmacy and GP support was very good, with effective communication between them. Feedback from family members told us that most felt involved in meetings about their loved ones’ care, although some felt they have had to push to be involved.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives and offered various ways to improve health, such as smoking cessation schemes, healthier options at mealtimes, health- based innovations at the café located in the communal ‘street’ area of the service such as ‘smoothie day’ and providing onsite physiotherapy led gym sessions for patients. Staff assisted patients with attending physical health appointments at both local services and hospital where required. The service had specialised occupational therapy kitchens where staff could engage patients to prepare and cook healthy meals as part of their treatment and recovery journey. We asked people about their access to physical activity and 5 out of 9 people said that overall, they were encouraged to exercise.

However, some family members fed back that their relatives did not receive encouragement to engage in activities and that if they initially declined an activity, alternatives were not offered. Some family members felt there was a decline in their loved one’s social skills due to spending more time in their bedrooms and not meaningfully engaging in enriching activities.

We observed staff encouraging patients to engage in activities in a positive manner, however some patients told us they did not enjoy the activities offered. Patients utilised Section 17 leave to walk to the local shops, go to café’s and get exercise, however staff told us Section 17 leave was not always possible due to needing more staff for community outings.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We reviewed 3 recent discharge reports as part of the inspection. The discharge reports were collaboratively written and included sections outlining needs in relation to neuro-behavioural and psychological needs, occupational therapy recommendations and speech and language recommendations. Reports evidenced that staff used recognised rating scales to assess and record severity and outcomes against admission baselines. These were documented within clinical notes and care plans.

Managers told us that there had been delays in some discharges due to safety concerns, where there had been a need to ensure full wrap around support plans were in place. They also told us that the service at times can find identifying placements to be challenging depending on level of risk or the person’s presentation, therefore a priority was determining which pathway was most appropriate for patients to be discharged into.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff received training on the Mental Capacity Act and Mental Health Act. Staff explained to each person their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the person’s notes each time.

Staff assessed and recorded capacity to consent and best interest decisions were decision specific. Patients were supported to understand when making a decision, and best interests were only used when people were assessed to lack capacity. Care records indicated if patients had given consent to share information and care plans showed detailed relevant capacity assessments and records of best interests’ decisions where relevant. There were rationales documented for decisions made, which included the involvement of the person and their family. Staff could easily access records of capacity decisions using electronic tablets on the wards. Staff made applications for Deprivation of Liberty Safeguards orders only when necessary and monitored the progress of these applications.