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The effects of brain injury are complex and varied, causing a range of physical, psychological and mental health difficulties. A brain injury can affect someone’s personality and behaviour as well as their cognitive abilities and mental health – and all of these aspects can be inter-related, creating additional challenges.

Consultant Neuropsychiatrist, Dr Seth Mensah, is a key member of our team, supporting service users by treating and managing a range of mental health conditions. Here he gives his view on acquired brain injury rehabilitation.

“It has been widely established that acquired brain injury can result in significant and lifelong psychiatric and neuropsychiatric complications, which are responsible for at least as much disability as the associated physical symptoms.

These psychiatric effects of ABI: (i) interfere with rehabilitative interventions, (ii) are often associated with risks such as family disintegration, loss of accommodation, reduced access to rehabilitation or community facilities and conflict with the law, and (iii) more importantly, affect the survivor’s ability to function autonomously following their discharge from structured medical rehabilitative settings and place untold limitations upon their attempt to reintegrate into family and community life.

Neuropsychiatric disability, as sequelae of acquired brain injury, often limits participation in post-acute neurorehabilitation, which consequently leads to failure to exploit and attain the full potential for recovery for the survivor of brain injury. For families, this poses difficulties in terms of acceptance and adjustment.

Hospital-based and community-based rehabilitation, the goal of which is to help the survivor of brain injury achieve the maximum degree of return to their previous level of functioning, is therefore particularly crucial for those who develop neuropsychiatric disability.

Richardson Care blends an enabling and safe environment together with a very highly skilled and experienced specialist multidisciplinary clinical and care team where the service user, the survivor of acquired brain injury, is at the centre of all care, treatment and rehabilitation. This sets Richardson Care apart from many other community-based acquired brain injury health and care providers across the United Kingdom.”

Dr Seth Mensah MB ChB, MSc, DPM, MRCPsych
Consultant Neuropsychiatrist


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The CQC Emergency Support Framework (ESF) was launched on 1st May, running until 30th September. Due to the coronavirus pandemic, routine inspections of residential care homes and other providers were suspended, so the ESF offered a structured framework for regular conversations between the CQC and care providers. Although they were not inspections, the ESF provided a source of intelligence the CQC could use to monitor risk and identify where providers needed extra support to respond to emerging issues, and to ensure they delivered safe care which protects people’s human rights. It was also designed to aid understanding of the impact of coronavirus on staff and people using care services.

The ESF covered the following four areas:

  • Safe care and treatment
  • Staffing arrangements
  • Protection from abuse
  • Assurance processes, monitoring, and risk management

During this period the CQC contacted our specialist residential care homes for adults with acquired brain injury at The Richardson Mews, The Coach House and 144 Boughton Green Road and our specialist residential care homes for adults with learning disabilities at 2 & 8 Kingsthorpe Grove.

For all of the homes contacted, the CQC concluded:

  • Infection risks to people using the services are being thoroughly assessed and managed.
  • The services have reliable access to the right personal protective equipment and C-19 testing for both staff and people who use the services.
  • The locations’ environments support the preventing and containing the transmission of infection.
  • Working arrangements and procedures are clear and accessible to staff, people who use the services, their supporters, and visitors to the services.
  • Medicines are being managed safely and effectively.
  • Risks to the health of people using the services are being properly assessed, monitored and managed.
  • There were enough suitable staff to provide people with safe care in a respectful and dignified way.
  • There were realistic and workable plans for managing any staffing shortfalls and emergencies.
  • People were being protected from abuse, neglect, discrimination, and loss of their human rights.
  • Safeguarding and other policies and practice, together with local systems, are properly managing any concerns about abuse and protecting people’s human rights.
  • The provider is monitoring and protecting the health, safety and wellbeing of staff.
  • The provider’s systems and methods for monitoring the overall quality of the service and for responding to business risks and issues as they arise are effective.
  • Staff are supported to raise concerns and give feedback about the service.
  • Care and treatment provided to people is being properly recorded.
  • The provider is able to work effectively with system partners when care and treatment is being commissioned, shared or transferred.

In addition, the summary from 2 & 8 Kingsthorpe Grove reported:

You had encouraged anyone with symptoms to self-isolate in their rooms. Staff engage all people with activities and help them make video calls to family and friends. You are supporting people to understand the risks associated with COVID 19 and to wear appropriate PPE as required. You are kept updated regarding COVID 19 through newsletters and government updates. You are sharing good practice, offering and gaining support from other care homes.

With regard to The Richardson Mews and The Coach House, the ESF summary reported:

From our discussion and other information about this location, we assess that you are managing the impact of the COVID-19 pandemic. You have systems in place which have ensured you have remained up to date with all relevant guidance. Management plans are in place to manage the assessed risk around COVID 19. To date there have been no confirmed cases of COVID 19 in either home.

With regard to 144 Boughton Green Road, the ESF summary reported:

You have enough staff on duty and have a contingency plan in place if staffing becomes a concern. You support staff by completing risk assessments, team meetings, providing specialised PPE and through supervisions.

As we are moving into the next phase of this pandemic, we want to thank our dedicated teams of managers and staff as well as our service users. They have all demonstrated strength, reliance, creativity and patience during this very challenging time.


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Once again, Admissions & Referrals Co-ordinator Ebony has come up with a novel idea to engage our service users, who have acquired brain injuries, in a range of activities. With the usual activities restricted due to the Coronavirus safety measures, we have been finding new ways to keep service users active and engaged, supporting their mental well-being, physical health and cognitive skills. This time we present The Richardson Games!

We are fortunate to have a large hall at The Richardson Mews, which we use for a wide range of activities. On this occasion, we set up a range of activity stations where service users worked on a one-to-one basis with a staff member. Each pair then worked their way around the hall.

Having various games and activities happening at once boosts a variety of skills such as adapting to change (stopping the activity they are doing and moving on to something else) orientation (to the new task at hand) and, of course, provided some healthy competition, exercise and fun!

Each pair had to read the instructions of the game/activity upon arrival to the activity station. The activity stations were:

  1. Balloon Tennis

Balloon tennis is the same as table tennis, but we use a balloon instead of a ball. This allows us to slow down the game, ensuring all our service users have an equal opportunity to play and join in the fun. It’s a favourite amongst our service users and it’s sometimes difficult to encourage them to come away from the game to have a rest or do something else. So it was great to have this as part of The Games, making it easier to encourage service users to move on to another task.

  1. Pairs

A simple game of pairs, using colours: turning two cards over with the aim of making a colour pair. Everyone enjoyed this game, which works on short term memory skills by encouraging our service users to remember the placement of the cards in order to match and make pairs.

  1. Cups

With little instruction, our service users were given plastic cups and were asked to make a tower using all of the cups. This encouraged cognitive skills such as planning (the structure of the tower) along with other skills like coordination and balance. It was just as fun knocking down the towers at the end as it was to build them!

  1. Bowling

Who doesn’t love bowling? Our service users really enjoy this activity as it is inclusive of all presentations with minimal support. We were all very surprised when our service user John, got several strikes in a row with complete ease. He had kept his bowling talents a secret from us!

  1. Rest

This was the least popular station, but it was important to include the opportunity to have a rest alongside lots of games and exercise.

The Richardson Games were a great success, bringing everyone together in a fun activity, boosting morale and supporting skills development.



In supporting service users with learning disabilities and acquired brain injury, we are used to helping people face challenges and finding ways to overcome them. This means that our brilliant management team and care staff are well-placed to meet the challenges that the Coronavirus is posing right now. They are finding solutions to reduce the risks in our homes while maintaining the quality of life and well-being that we strive to achieve for the people in our care.

We have always enabled our service users to lead happy, healthy lives and fulfil their potential by providing person-centred care. We recognise that each person has individual needs and adapts to situations in different ways. Some people are finding the current situation particularly difficult as they require routine and stability. We are supporting all of our service users with clear communication and reassurance so that they understand, and are not fearful of the changes we are making. We are doing what we can to maintain a sense of normality and structure within each home, while changing activities to keep everyone safe.

Reducing Risk

These are some of the steps we are taking to reduce risk:

  • Cleanliness within the homes is always important, and we have stepped up our cleaning and disinfecting protocols to increase safety.
  • Care staff are following clear handwashing and other hygiene procedures and we have clear procedures in place should we suspect that there is a case of Covid-19 within a home.
  • As many of our service users require frequent orientation due to short-term memory problems because of an acquired brain injury, we are supporting them to wash their hands on a regular basis.
  • All service users are staying within their own home and garden.
  • Care staff rotas are managed so that staff only work within one home and office staff are being redeployed to cover external providers or those self-isolating, so we can minimise the number of different people coming into each home.
  • All non-essential visits to the homes have been suspended.

Community

Creating a feeling of belonging and participation in the local community are among our key principles. Unfortunately, the wealth of community activities in which our service users took part is not possible at the moment. However, each home is a community in itself, with service users and staff creating a family environment. This has never been as important as it is now. We have been so impressed with the staff morale and the way our service users are embracing some of the changes.

Our care support staff, administrators and admissions team are all coming up with creative ideas to keep our service users active, engaged, calm and happy during these difficult times. Activities are wide and varied so that there is plenty to suit everyone. They include: ‘pub quizzes’, bingo, craft activity, yoga, relaxation and meditation, table tennis, football, PE with Joe Wicks, gardening and lunches in the garden. You can find more information about these activities on our social media channels and blog posts over the coming weeks.

Family Support

The families of our service users are naturally concerned, so we have been communicating with them in various ways to demonstrate that life in the homes goes on with minimal disruption. We’re using Whatsapp, Skype, Facetime, emails and letters, sending messages and photos to keep in touch and reassure them. This is some of the feedback we have received.

“Thank you so much for keeping in touch with us all and thank you to all the staff there who are doing a wonderful job keeping things going through this.”

“Thank you so much for passing on our note and for your reassurance.”

“We are living in a difficult time and we hope you and your staff are doing all you can to look after yourselves. My thoughts are with you all.’

We are hugely grateful to our staff and management for their hard work and commitment during this challenging time and we are very proud of them all.


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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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