acquired brain injury Archives

Three new rooms are now available at The Coach House – our newest home for adults offering brain injury care and rehabilitation. This is following the completion of a second staircase, bringing the number of rooms to 11. Further rooms are likely to be released later in the year.

“Despite the difficulties that the pandemic is causing, we are still receiving a lot of referrals for our specialist brain injury care”, says Gill Ayris, Admissions & Referrals Manager, “so we’re very pleased that our residential capacity is increasing.”

The Coach House is situated in the grounds of The Richardson Mews in Kingsthorpe, Northampton. Both are listed buildings, full of character with large social spaces as well as generous ensuite bedrooms. The Coach House was significantly refurbished and extended, enabling a bespoke residential care home to be created. This meant that the home could meet the specific needs of people with acquired brain injury, while retaining the character of a listed building.

Richardson Care design philosophy

We have a clear design philosophy at Richardson Care: We believe that every home should feel like ‘home’, and that providing the right environment helps our service users to engage in their therapy and rehabilitation, and improves their quality of life.

We spoke to architect Chris Cheater, Design Director at McLaughlin & Harvey Limited, who has been an important part of the design team at Richardson Care for over 15 years:

“Working with Richardson Care has been a sharing of ideas and experience. The Directors, Laura and Greg, have always been clear in their desire to develop an architectural expression that seeks to draw out the unique character of each care setting. This gives a distinct sense of place and identity that service users can call ‘home’.

The essence of home

“Central to my role in the process of creating wonderful and supportive spaces is weaving the essence of ‘home’ throughout a scheme. This has had to be undertaken whilst ensuring the internal environment is supportive to people with very specific, varied and complex needs. By combining my professional training and sharing knowledge, we have evolved a clear design language for Richardson Care over time. Central to this ethos is spaces which are uplifting, naturally lit and allow all occupants to move freely in and around the home.

“In The Coach House we have had the opportunity to provide these elements within a new bespoke building, unrestricted by pre-existing constraints. This building is specifically designed knowing the need for space, circulation and light is central to the successful function of the home. Designed around a central ‘meeting place’ and connected via ‘The Street’, we have created a care setting placing service users at the heart of the home. We believe naturally lit communal spaces are foremost in the assistance of rehabilitation. Our wide movement spaces allow for contemplation, and the extensive use of glazing allows connection to the outside, which assists in a feeling of convalescing.

“The interior design is an intrinsic part of the design philosophy and has been developed with Laura to ensure it remains as non-institutional as possible whilst ensuring its functionality. All of the support functions of the home have been incorporated within the building fabric to provide robust but discrete safe and secure environment befitting the vulnerability of the occupants.

“The design of The Coach House doesn’t for me signal the conclusion of a design philosophy, but rather an expression of an ongoing evolution of care provision, of which I’m proud to be a part as it progresses into the future.”

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After the most challenging year that many of us can remember, we look forward to 2021 with hope. We will be ready to offer our service users the Covid-19 vaccine as soon as it’s available to them. In the meantime, Christmas preparations are well underway.

Christmas in our care homes is usually a lively time with much excitement. This year is no exception. We have adapted to staying at home and finding ways to keep our service users active, engaged, safe and happy. They are supported to take decisions on what happens within the home, and we have a wide range of festive activities going on, including:

The summerhouse at 8 Kingsthorpe Grove has been converted into a beautiful grotto ready for Santa to visit
The team at The Richardson Mews had a fun, Australian-themed Christmas barbecue with a visit from ‘Kenny the Kangaroo’ to distribute presents!
Saturday nights in December are Christmas movie nights at 144 Boughton Green Road
Christmas karaoke is always popular at 23 Duston Road
There’s also mince pie making, cookie decorating, making cards, decorations and Christmas wreaths, carol singing, Christmas bingo and much more…

We would like to thank the staff teams in each home, who have come together and supported each other to ensure that we provide the best possible care for our service users. It’s been incredibly tough and we’re very proud them.

With best wishes for Christmas and the New Year,

Laura & Greg Richardson-Cheater
Directors

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The importance of communication is the subject of the fourth blog post in our series about what we’ve learnt so far during the pandemic. It may sound obvious, but it’s easy to get it wrong. The situation was changing on a daily basis and the pressure and expectation on the management team was extraordinary. Never had the responsibility of being a Registered Homes Manager been so great. Here we share some of their thoughts and experiences.

Open communication channels

We learnt the importance of honesty, with ourselves, with our staff, with our service users, with our families and with each other as a management team. Had it not been for the openness that we have adopted in all our communications then this period would have been more challenging. It brought a sense of togetherness, a shared experience and an opportunity to change the way in which we build our relationships both professionally and personally.

None of us had ever experienced anything like this before so we were all learning together. We didn’t pretend to know all the answers, but we listened to WHO advice and took decisions swiftly in the interests of our service users. We reduced risks as much as possible to make our homes as safe as we could – both for our service users and our staff. We didn’t have all the answers but we did what we thought was best with the information that we had available at the time. We didn’t want to look back and wish we’d acted sooner.

We had to be honest about our fears and anxieties so we could support each other in finding ways to overcome them. It was important to maintain a positive attitude as we knew our response would affect the atmosphere within each home and impact our service users. They need to feel safe and secure within their home.

Our management meetings moved online. Although we couldn’t meet in person, we all took part in weekly management meetings, which were crucial in ensuring the smooth running of the homes. Facing the crisis together and being open and honest with each other has given all of us a better understanding of each other’s role and greater respect for each other. Together we worked out solutions to difficulties that arose, assessed risks, made contingency plans and boosted morale. It was vital to keep all communication channels open.

We managed staff teams so that there was no movement of staff between the homes. This had the positive effect of more continuity for service users. They had more 1:1 time with support workers so bonded more with staff. In some cases this has improved their communication skills, and some have demonstrated more empathy towards each other.

We’ve realised the importance of open communication, showing how we value, support and appreciate each other, talk more, respect and, most importantly, listen to each other. We’ve learning that praising and valuing people is so important in these difficult times.

We’re hugely grateful for the support of service users’ families, who have been unable to see their loved for long periods of time. We explained the difficult decision to close our doors to them and they understood that we had the service users’ interests at heart. We kept in touch as much as we could, getting to grips with new technologies, until they were able to meet in person again. They showed a lot a love and appreciation for all the staff, working under very difficult circumstances.

As the pandemic continues for longer than many of us expected, reflecting on how far we’ve come helps us to remain positive. We have protected our service users, kept them engaged and happy, and supported their families. We know we have the strength and resilience to continue.

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As we’re always supporting our service users with acquired brain injury or learning disabilities to move forward, we rarely reflect on how far we’ve come. Our short series of blog posts looks at the views and experiences of our management team during the pandemic: what we’ve learnt so far about ourselves and how we manage our specialist residential care services. Although we have never experienced anything like this in our 30-year history, we have always focussed on the needs of the individual service users in our care. Every individual, whether they have a brain injury or learning disabilities is different. Therefore in order to deliver person-centred care, we often have to be creative in our approach.

Finding innovative solutions

For many service users, routine is a major part of their life. When their usual activities are no longer possible – no home visits, day services, community activities – we need to support and reassure them, creating new routines and structure in their lives. We have promoted health and exercise as well as bringing joy and laughter.

Although the service users have missed going out, we have had plenty of scope and opportunity to develop in-house activities. Our large gardens and outdoor spaces have been used for gardening: we’ve grown our own vegetables for the first time. We’ve had al fresco lunches and barbecues with a disco, played sports and games, done trampolining and completed treasure hunts. The in-house ‘coffee shops’ have been a great success, giving service users an opportunity to relax and build relationships between each other – often finding that spending more time together enables a greater understanding and appreciation of each other.

Restricting family visits was really tough, but we’ve maintained family contact through Skype, WhatsApp, Facetime and Zoom, as well as phone calls and letters. We even managed to track down a service users’ mother who had lost contact with her son several years ago. We were able to reunite them virtually using Skype, and this lead to seeing other family members too. This was a very positive and emotional experience for all.

At The Richardson Mews (inspired by Joe Wicks) the day now starts with ‘Morning Motivation’ – exercising to music every day to improve fitness, flexibility and well-being. We’re also making more use of our in-house gym equipment. One service user who has a brain injury thrived during lockdown: he was in a wheelchair in February and now he can walk 70 lengths of the parallel bars.

Staff have stepped into new roles – organising craft activities, baking sessions, quizzes or film nights. Some service users have also found new roles within the home too – one of the guys has become the house DJ!

We’ve celebrated birthdays with gifts, parties and barbecues. We’ve maintained structure when needed, providing mental stimulation, social interaction and fun, while supporting well-being and skills development.

We have always strived to create a relaxed family environment within each home. Facing the challenge of coronavirus together has brought everyone closer. The whole team and service users have felt and behaved even more like a family – there are good friendships and strong bonds. As we approach Christmas we maintain our focus on keeping everyone happy, safe, healthy and secure.

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The second in our series of blog posts reflecting on the experiences of our management team during the coronavirus pandemic looks at our use of resources. We may have some way to go, but our team’s resilience, strength and adaptability means that we can face the challenges ahead.

Rethinking our use of resources

We wanted to minimise the impact of any changes on our service users, who have learning disabilities or an acquired brain injury. Although we had made the difficult decision to close our doors to family and friends, we knew that we needed to protect our service users, many of whom are vulnerable.

We found different ways to communicate and share experiences. We have all become much more tech-savvy, using the internet, apps, photos and video calls as well as phone calls so service users can keep in touch with their family and friends.

We learnt that many elements of our jobs can be completed using technology, so this can save us time for the things that matter. Regular management meetings went online in early March. These were crucial to keep up with the evolving situation and navigate the way ahead. They provided support, boosting morale when needed, an opportunity to share insight and experiences and to check in with each other.

We’re completing assessments for new referrals using online video tools, which means our admissions team no longer spend hours on the road.

The majority of our service users, whether they have an acquired brain injury or learning disabilities usually take part in a wide range of activities, accessing the community on a regular basis. Coronavirus restrictions meant that more activities would take place in-house.

We deployed central staff to various homes, so each home had enough admin and maintenance support and there was no movement of people between homes. The admissions team stepped in to support the care staff, running a wide range of activities from physical exercise to craft projects, keeping the service users engaged and happy. We also allocated care staff to specific homes, ensuring we had enough staff to operate safely if staff numbers were reduced due to increased sickness levels.

With members of our in-house maintenance team allocated to different homes, it’s meant they have been able to form closer relationships with the service users. Some service users have been helping out with maintenance jobs – developing their fine motor and cognitive skills while completing meaningful activities, they feel valued and gain a sense of satisfaction.

By reducing risk we’ve also found more efficient ways of operating. For example, instead of going out to the shops several times a day, there’s just one trip per day. This means planning ahead, so service users have been helping to plan the menus, write shopping lists and prepare for their daily needs. All these activities are helping to develop their cognitive skills.

The service users remain at the centre of what we do. By rethinking our resources, we have maintained the active, positive, safe and caring community within each home. We have ensured wherever possible that we meet each service user’s individual needs and minimise disruption to their lives.

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As we approach the winter, coronavirus cases rising again and another lockdown, it’s important to acknowledge how far we’ve come and what we’ve learnt. Our experience in supporting people who are rebuilding their lives after brain injury or living with learning disabilities means that we are problem solvers. We support people to overcome challenges every day. Never has this been more important and we’re proud of the way that our management team and staff have responded.

We asked our Homes Managers for their personal views and experiences of the pandemic – from their initial reactions to plans for the future. In a series of blog posts, we highlight what we’ve learnt and how some of the changes we’ve made will continue past the pandemic.

We’re more resilient that we thought

Resilience is defined as: “The capacity to recover quickly from difficulties; toughness” and it’s been demonstrated by our team throughout the pandemic.

We had to deal with something that no one had ever experienced before: a real virus, in real time with real people. Government guidance was changing almost on a daily basis and everyone reacted differently. The initial fear demonstrated by some staff left others having to broaden their shoulders, taking on extra activities within their daily routines. The responsibilities of the management teams have never been greater, we needed to be clear, decisive and robust in our response. We didn’t know all the answers, but we were learning together.

Jane Payne, Operational & Clinical Officer (pictured above), takes us back to earlier this year: “On February 18^th 2020 we informed staff that there was a new virus, and preventative measures were put into place including hourly touch point cleaning, increase in hand washing and an increase in awareness. Ahead of government guidance on March 12^th 2020, we took the very tough, necessary decision to close our doors to family and friends to protect service users. We made sure that all staff worked only in one home, so in the event of an infection, it would not be transferred from one home to another by our staff.”

“The Management team have become incredibly solid; working as one in supporting each other, as and when each has needed, as we live and work through the rollercoaster that is Covid-19. I am proud to lead; and be part of such a strong group of individuals displaying a sole purpose of ensuring the care, welfare, safety and security of our service users and staff. Richardson Care has shown we are more than resilient, we have become stronger through experience. Care: it’s in our DNA.”

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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:

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.

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.

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!

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!

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.

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Activities of daily living require a huge range of cognitive skills, which we develop from childhood as we grow. However, someone who has an acquired brain injury has to re-learn many of these skills. At Richardson Care we take an holistic approach, where members of our clinical team work with each service user to develop the skills they have lost. These include communication and cognitive skills, physical abilities and mental well-being.

In addition to the therapeutic interventions from the clinical team, our service users take part in a wide range of daily activities, depending on their personal preferences. We aim for these activities to be fun and inclusive, catering for a wide range of skill levels and tastes so the service users enjoy the activities and engage in them. These activities support the work of the therapists, without actually feeling like therapy, and can have a positive and lasting effect.

During the coronavirus pandemic, we have had to be more resourceful and creative as our service users have not been able to access the local community for their usual range of activities. This has meant providing a varied schedule within the home, and these ‘science experiments’ were an imaginative way to support cognitive skills in a group setting.

Experiment 1: Travelling Rainbow Water
This simple experiment shows colours travelling through kitchen roll and mixing together to make new colours. We started with three cups of water, one red, one blue and one yellow. We separated the cups of coloured water with empty cups and connected them all with kitchen roll. It takes a bit of time for the magic to happen, but the group were very patient with the experiment and the results were definitely worth the wait.

Experiment 2: Storm in a Cup
With water, shaving foam and food colouring, we recreated the science of the rain clouds! We half-filled our cups with water and added a layer of shaving foam, ensuring it floated flat above the water. We then added coloured water, drop by drop to the shaving foam. When the water became too heavy for the foam, the sudden swirling clouds of colour sparked plenty of gasps and giggles.

Experiment 3: DIY Lava Lamps
We made our own lava lamp reactions using vegetable oil, water, food colouring and an Alka-Seltzer tablet – the contents of the cup bubble around together mimicking the reaction of a lava lamp.

This activity lasted for over an hour and all service users who took part were engaged for the entirety of the session and helped to clean up afterwards. This activity promoted cognitive skills such as reading and following instructions, patience, coordination, listening to direction, creativity and curiosity. Members of the group were also encouraged to think about how the reactions worked. A number of them commented on the difference weights of the materials in the Storm in a Cup activity, how the materials separated in the DIY Lava Lamps and how the tissue paper absorbed the colour to make the Travelling Rainbow Water.

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Older Posts

New Rooms Released for Brain Injury Care

Richardson Care design philosophy

The essence of home

Christmas Activities in our Care Homes

Management During a Pandemic: What We’ve Learnt #4

Open communication channels

Management During a Pandemic: What We’ve Learnt #3

Finding innovative solutions

Management During a Pandemic: What We’ve Learnt #2

Rethinking our use of resources

Management During a Pandemic: What We’ve Learnt #1

A Neuropsychiatrist’s View on Acquired Brain Injury Rehabilitation

CQC Concludes all Services are Managing Covid Risks Effectively

Everyone’s a Winner at The Richardson Games!

Fun Ways to Promote Cognitive Skills