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The Coach House is our newest specialist residential care home and our third dedicated to adults with acquired brain injury. It is adjacent to The Richardson Mews and under a joint CQC Registration. It is a self-contained home and run by Registered Homes Manager, Jo Wilkins.

We launched The Coach House on 24th January 2019 and the CQC registration process was completed last summer. The first service users arrived in August and after just six months, we’re pleased to report that one of them was able to be discharged earlier this month.

Goal setting and care plan

Andrew* had sustained an hypoxic brain injury following a cardiac arrest 14 months prior to his arrival at Richardson Care, and came to us from a hospital neurological rehab setting. Members of our multi-disciplinary team (MDT) assessed Andrew and prepared a care plan for him. Goals were set for Andrew at the point of admission, with the aim of enabling him to move to a location closer to his family.

Andrew’s goals included:

  • Increasing his independence with personal care
  • Maximising his engagement in community access
  • Reducing his frustration in relation to his limitations
  • Reducing his wandering at night
  • Participation in elements of meal preparation

A small consistent care team supported Andrew on a daily basis, reinforcing the therapies implemented by the MDT. He built a good rapport with some of the members of the team, which was instrumental in his support and rehabilitation.

Gains achieved

Andrew made good gains in personal care and in mobility. He has been receptive to daily walking practice and he has been supported to access the community every day, which he does using a wheelchair due to stability and fatigue issues. He can also transfer more independently. Although The Coach House is located in private grounds, it has a wide range of shops, cafes, etc. in the immediate vicinity. Richardson Care has a good relationship with local businesses, which enhances the experience of service users when accessing the local community.

Although Andrew still presents with challenging behaviour, he has been able to reduce his frustrations and manage his behaviour more effectively. He engaged well with his care team, who found that distraction and diversion techniques were effective in reducing Andrew’s agitation due to his cognitive deficits.

Regarding elements of meal preparation, Andrew now actively participates in selecting menu choices every day with the support of staff. He will also initiate helping himself to a drink left on the table beside him without prompts from staff. These make important contributions to his overall well-being.

Positive outcome

Within six months, Andrew had made sufficient gains in all of his goals to enable him to be discharged to a residential setting closer to his family. It is hoped that with continued close supervision and increased family contact, he will be able to continue his rehabilitation from his brain injury.

*We have changed the name of the service user to protect his identity.


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100% of Respondents Would Recommend Richardson Partnership for Care

We always welcome visits from the family members and friends of the service users in our care. As well as contributing to the service users’ well-being and their family relationships, it also helps to encourage feedback from family members about the care that their loved one is receiving. In addition, we send out an annual questionnaire so that we can formalise the feedback process and identify any changes that are needed. Our service users have acquired brain injuries or learning disabilities, so everyone’s requirements are different, but this process helps us to see the overall picture, identify trends and flag up any issues.

The questionnaires can be anonymous and they are optional, so we may only receive a relatively small number of responses. However, we are very grateful to the family members who complete them. Once again, we have received some very positive feedback and some lovely comments, but we are never complacent. We regularly step back and review our services and are always looking to improve.

We ask all families whether they strongly agree, agree, don’t know or disagree with the following statements:

  1. I am happy with the care provided for my relative
  2. The home has a warm, non-institutional feeling
  3. The home provides an inclusive or family environment
  4. Staff are friendly and approachable
  5. I am regularly updated with information
  6. I feel that my relative is treated with dignity and respect
  7. I feel that their quality of life has improved since they arrived at The Richardson Partnership for Care
  8. I feel that my relative takes part in meaningful and/or enjoyable activities
  9. Would you recommend The Richardson Partnership for Care?

We are pleased that:

100% of respondents said that they would recommend the Richardson Partnership for Care

100% of those who answered said that they strongly agreed or agreed with the statements:
“I am happy with the care provided for my relative”
“The home has a warm, non-institutional feeling”
“Staff are friendly and approachable”
“I feel that my relative is treated with dignity and respect”

89% strongly agreed or agreed with the statement: “The home provides an inclusive or family environment”

And 83% felt that the quality of life of their family member had improved since they arrived at The Richardson Partnership for Care.

All of the 2019 families’ questionnaire results are shown in the graph above.

 

Below are some of the comments from families who completed the questionnaires.

“I know my daughter is safe and cared for with love, respect and kindness, so would recommend the services to everyone…My daughter has been with you a very long time. She loves the staff dearly and has had great support, as have we as a family. I count my daughter to be very lucky to be with you.”


“My son obviously has a very full and happy life. I feel the staff like him and enjoy working with him. They seem well able to cope when he is difficult. Staff seem to stay a long time, which makes for a stable environment.”


“The home maintains adequate standards of care and the carers demonstrate respect and care.”


“Our son is so happy, and to him, you are his family. We wouldn’t want him anywhere else.”

We would like to thank all of the family members who took time to complete the questionnaires.


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Fatigue is one of the most common effects of brain injury, but it’s experienced differently by everyone. People may feel exhausted, lacking in energy and motivation, and feel weak or sleepy. Fatigue may also worsen existing difficulties associated with brain injury, such as memory problems, speech and language difficulties, frustration, irritability or low mood.

Pathological fatigue may be present most of the time and this excessive tiredness may not necessarily be alleviated by rest. As fatigue is different for everyone, and caused by a range of factors, there is no single cure or treatment. However, it can be managed and gradually alleviated by focusing on each individual’s specific needs.

Below are some of the factors that affect fatigue and some of the ways that we help our service users with acquired brain injury to manage their fatigue.

  1. Cognitive Behaviour Therapy (CBT) – Regular CBT sessions with members of our psychology team help our service users to increase their understanding of their brain injury, including the fatigue that they experience, what the triggers are and how they can respond.

  2. Relaxation Therapy – weekly group relaxation sessions aim to teach relaxation methods, including progressive muscle relaxation exercises and guided imagery, which can help to reduce fatigue. In addition, our service users enjoy regular hand and foot massages from our massage therapist, which helps to reduce tension and aid relaxation.

  3. Mental well-being – low mood, anxiety and depression are all factors that can make people with acquired brain injuries more vulnerable to experiencing fatigue. These are addressed by a combination of therapies and activities in each individual’s rehabilitation plan. For example, our Consultant Neuropsychiatrist prescribes medication and monitors how an individual is affected by it, and the psychology team help them to deal with the psychological aspects of their brain injury. Our holistic approach to medication and psychology support aims to reduce the reliance on drug therapy over time, when possible, which also reduces side effects – another potential contributory factor in fatigue. In addition, our focus on providing opportunities for social inclusion and community participation also help to improve mental well-being and motivation.

  4. Neurological Physiotherapy – regular physiotherapy sessions help individuals to gradually increase their muscle strength and mobility, which helps them to manage their fatigue. These sessions are carefully controlled to ensure sufficient rest breaks.

  5. Neurological Speech & Language Therapy – enabling service users with acquired brain injuries to improve their communication skills helps to reduce frustration and building strength and co-ordination in their facial and vocal muscles also contributes to alleviating fatigue.

  6. Environment – the home environment that we provide is calm and relaxed, with a choice of social and quiet spaces so that each service user can decide when they spend time with others and when they have some time out. Also, the decoration within the homes is attractive, but not over-stimulating, and everyone has access to the garden and outdoor spaces, which is also important.

  7. Diet – we support all service users to have a healthy diet and maintain good hydration. As well as being important for their general health and well-being, it can also help to alleviate fatigue.

As with all aspects of brain injury rehabilitation, everyone is different and there is no single solution. Neurobehavioural factors are often interlinked, so our dedicated person-centred interventions, delivered by our experienced multi-disciplinary team, work together to deliver effective rehabilitation and positive outcomes for our service users.


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The psychology team at The Richardson Partnership for Care plays a crucial role in the care and support of our service users, who have complex needs and acquired brain injuries or learning disabilities. Dr Pedro Areias Grilo, Consultant Clinical Neuropsychologist, heads up the team and is supported by three Assistant Psychologists: Julita Frackowska, Olivia Ferrie and Joseph Szablowski. The Assistant Psychologists are assigned to specific service users according to their needs and the homes in which they live.

Person-centred care
The ethos of the psychology team is the one that runs through the organisation as a whole: the service user is at the centre of everything we do. We are committed to providing individualised care to effectively support the nuanced needs of each service user. We take a person-centred approach and offer interventions to service users based on cognitive behavioural models, dialectical behaviour skills and operant conditioning. All of the interventions offered are evidence-based and follow NICE guidelines.

Psychological reviews
All service users receive an initial psychological review, which includes neuropsychological assessments, a review of clinical presentation, assessment of stability of mood and suggestions for future interventions. This review is then repeated on a regular basis to assess the effectiveness of the therapies and interventions delivered. In addition, we have an ‘open door’ policy at The Richardson Partnership for Care, so all members of the psychology team, and the Assistant Psychologists in particular, can develop close working relationships with the service users. This means that their well-being can be monitored closely on an informal basis and we have found that this helps to maintain their mental health, so any problems can be addressed early, preventing the need for crisis care.

Positive Behaviour Support
Positive Behaviour Support (PBS) is a key part of the psychological support that we provide and an emphasis on positivity is one of our main philosophies. PBS Plans are person-centred and designed with input from the service user to promote positive behaviour. They are supported to set their own goals and to achieve them.

In addition, Pedro and the team are working on an innovative Positive Behaviour Tool to more effectively monitor and encourage positive behaviour. This runs alongside the traditional techniques of reducing negative behaviour.

Multi-Disciplinary Team
The psychology team works closely with the other members of the multi-disciplinary team. (This comprises a consultant neuropsychiatrist, homes managers, service manager, physiotherapist, speech & language therapist and occupational therapist.) Pedro and Consultant Neuropsychiatrist, Dr Seth Mensah, work closely together to balance the use of drug therapies and psychosocial therapies. Where possible, we aim to focus on psychosocial approaches and gradually reduce the reliance on drug therapy to achieve better outcomes for service users over the longer term.


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The Richardson Partnership for Care, The Richardson Mews, Kingsland Gardens, Northampton NN2 7PW

T: 01604 791266.
E: welcome@richardsoncares.co.uk.

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