Frenchay Brain Injury Rehabilitation Centre

Updated 19 January 2023

Frenchay Brain Injury Rehabilitation Centre, known locally as BIRU, provides a regional rehabilitation service for adolescents and adults with a brain injury. Care is provided for a range of acquired neurological conditions such as traumatic brain injury, sub-arachnoid haemorrhage, complex stroke, anoxic injuries, and infection-related injuries such as meningitis and encephalitis.

Located within the grounds of the former Frenchay Hospital in Bristol, the service specialises in the treatment of individuals with complex physical and cognitive impairments, challenging behaviours and neuropsychiatric disorders resulting from a brain injury.

The residential service has 52 beds split over two buildings, Frenchay BIRU South and Frenchay BIRU North. Each building is divided into three wards. Some bedrooms include private showers, and all include private toilet and sink. The service categories beds using NHS England (NHSE) guidance for people with a brain injury. It has 29 beds for patients needing intensive rehabilitation care, which NHSE define as level one. The service has 23 beds for level two patients, who need rehabilitation care. NHSE levels relate to the level of clinical acuity and need of each patient.

The service is registered with CQC to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Diagnostic and screening procedures
• Treatment of disease, disorder, or injury

A registered manager is in post.

We last inspected the service in October 2018. We rated safe and well-led as requires improvement and rated effective, caring, and responsive as good. We rated the service requires improvement overall. At that inspection we told the provider they must improve:

• The storage of chemicals subject to the Control of Substances Hazardous to Health (COSHH) Regulations
• The monitoring of resuscitation trolleys
• Staff knowledge of the national early warnings scores system (NEWS2)
• Secure storage of confidential records.

At this inspection we found the service had improved all four areas and these were no longer of concern.

Updated 19 January 2023

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service had persistent challenges with recruitment and relied on agency staff to maintain the service, particularly out of hours. There were significant challenges and risks around this, which resulted in a deterioration of service for patients and their relatives during these times.
• Training completion rates for positive behaviour management, which was an important to maintain safety, were low and required immediate improvement.
• While staff managed incidents well, the categorisation and investigation of incidents was questionable, which meant learning and mitigation did not always receive adequate focus. This created a risk of future incidents that could potentially be avoided.
• While managers monitored the competence of substantive staff, there was no similar assurance for agency staff. Completion rates for positive behaviour management training did not meet safe standards.
• Patient records overall were of a good standard but there were inconsistencies such as missing Waterlow documentation and varying practice in managing pain scores.
• Fire safety records did not provide assurance of consistent standards of practice.

However

• Staff had training in most expected key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and adhered to them when delivering care. Staff managed medicines well.
• Staff mostly provided good care and treatment, checked that patients ate and drank enough, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff mostly treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of people, took account of patients’ individual needs, and made it easy for people to give feedback. The service offered a referral to admission time that was better than comparable services in the region.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 15 January 2019

Medical care services were the main hospital activity.

We rated this service as requires improvement in the safe and well led domains. We did not inspect the effective, caring or responsive domains.

Updated 19 January 2023

We rated this service as requires improvement because it was effective, caring, responsive, and well led although some areas of safe requires improvement.

Updated 16 June 2016