Brain injury rehabilitation – Kay’s story

Kay - brain injury survivor

Kay has transformed her life with the help of the MDT and support staff at The Richardson Partnership for Care

When she was only 18 months old, Kay contracted Encephalitis and consequently experienced severe epilepsy. At the age of 13, she underwent surgery on her frontal lobe, which further exacerbated the brain damage. Kay also has a diagnosis of moderate learning disability.

Kay lived at home with her mother and grandmother before moving to specialist residential schools and other settings. At the age of 27, Kay moved to The Mews at The Richardson Partnership for Care. She had previously resided in a private hospital, but the placement broke down due to her risk behaviours and the inability to manage Kay in that environment.

Behaviour on Admission to The Richardson Partnership for Care
Kay’s challenging behaviour was thought to be underpinned by poor impulsivity control and a reactive approach to challenging situations due to her brain injury.

On admission, Kay presented with severe verbal and physical aggression towards herself and others. She also would make false allegations towards staff and other residents, disregarding staff prompts and instructions compromising her and others’ overall safety.

Kay was offered a holistic approach to help her to manage her challenging behaviour and become more self-aware. With the support of the multi-disciplinary team at The Richardson Partnership for Care and her care support workers, Kay has transformed her quality of life.

Read Kay’s brain injury rehabilitation case study in full here

Sad news and tribute to Brian Richardson

Brian Richardson

Brian Richardson

This month we pay tribute to my dad, Brian Richardson, who has died after a short illness: He was diagnosed with Lymphoma in his brain in April this year. Brian was the driving force behind The Richardson Partnership for Care, which he founded with my mum, Jackie, in 1989.

Brian was an amazing man who touched the lives and hearts of so many people. He was born on Christmas Eve 1949 and grew up in humble surroundings in Northampton with his parents and two brothers. His entrepreneurial spirit was evident from a young age when he would devise enterprising schemes, which included repairing motorbikes on the lawn in front of the family home.

After leaving school Brian attended the newly opened Nene College in Northampton and qualified as a teacher, however he didn’t quite fit into the teaching world. Instead he came home with a teenage student who desperately needed short-term foster care and that was the beginning of his career as a carer.

Brian and Jackie started The Richardson Partnership for Care in their own home, caring for people with learning disabilities. In fact, two of the people that they looked after then are still residents in our care homes now, almost thirty years later. They built up the business with love, sheer hard work, determination and dedication; qualities that Brian also displayed in his personal and social life.

Brian and Jackie grew the business by buying up properties in Northampton to enable them to care for more people. They also recognised there was a need for specialist residential care and rehabilitation for people with acquired brain injuries, so extended the services to care for them too. I grew up in the business and have worked full time for The Richardson Partnership for Care since leaving school. Around 15-20 years ago, I was appointed a Director, and Brian and Jackie gradually stepped down from the day to day running of the business, handing over to me and my husband Greg.

The Richardson Partnership for Care is very much Brian’s legacy. He and Jackie established it to feel more like a family than a business. Brian was more than a boss to his employees – he was a true friend and a gentleman. He was known for his generosity, often helping people out when they didn’t expect it and investing in their personal development. He gave them the skills and the freedom to move on, but many of the staff chose to stay. This is still the case today.

Part of Brian’s legacy is also the ethos of The Richardson Partnership for Care and its commitment to providing a warm, friendly and positive environment for people with learning disabilities and acquired brain injuries. They are treated with dignity and respect and we aim to support them to realise their potential and live a fulfilling life.
Brian was a man who lived life to the full. He had many friends and a wide range of interests. As a youngster he would go to the Salon ballroom with his parents where he achieved gold medals for Ballroom and Latin American Dancing, and in later years he would love to Rock and Roll and Salsa with Jackie and Laura. He also loved the outdoors: he enjoyed walking and fishing, but his great passion was stalking and shooting. He was also a confident and extremely competent diver, as well as fast and enthusiastic skier. He was a risk-taker and had a reputation for a having a dare-devil attitude, which is perhaps why he was so much fun.

Brian was a warm and generous host and loved cooking for friends and family. He has been described as kind, caring, friendly, funny, a life-long friend, supportive, great company, interesting, intelligent, daring, obstinate and even, eccentric. We will miss him dearly, but we endeavour to maintain the ethos and vision for The Richardson Partnership for Care that Brian and Jackie established.

Summer holidays and activities

The excitement has been building as the holiday season is now well underway and we’ve had weeks of glorious sunshine. Holidays are planned months in advance and our service users, who have acquired brain injuries, or learning disabilities and complex needs, are supported in choosing where they would like to go.

Wherever possible, we try to accommodate specific requests for holiday destinations and they are financed by accruing a certain amount each month then topped up if someone needs something extra. Service users go away in small groups or individually, depending on their needs and preferences. They are supported by their care workers and they are involved in the decisions on who accompanies them.

Our service users enjoy the activities, atmosphere and the change in environment that a holiday brings. Some people need familiarity and routine so we balance this with the opportunity for enjoying new experiences. This year, some of our service users have been on a boat or seen the sea for the first time. Going on holiday is paramount to their health and well-being and is instrumental in their social inclusion and positive feelings of self-worth. There are also physical benefits of being outside and taking part in new activities.

This year popular holiday destinations include the Isle of Wight, Hemsby in Norfolk and Skegness in Lincolnshire – which is also close enough for a day trip. Billing Aquadrome is a local holiday park with good facilities, which is popular as it combines a change of scene and a relaxed holiday environment with a very convenient location. In addition, one service user has enjoyed a weekend trip to Blackpool, and others have visited their respective families in Malta and Serbia. We’ve also enjoyed day trips to London, the coast, zoos and country parks. Summer activities have also included trampolining and swimming, and one of our service users went to a David Byrne concert in London. We support our service users to lead a fulfilling and active life as possible.

A boat moored off the Norfolk Coast

Importance of location when placing someone in residential care

The front of 2 Kingsthorpe Grove

Location is often one of the first considerations when placing someone in residential care – so that they can be close to friends and family – but it’s not necessarily the most important. It’s usually a combination of factors that contribute to the quality of the care provided that takes precedent over the location. This is especially true of specialist residential care and rehabilitation for adults with acquired brain injuries, learning disabilities, complex needs and behaviour that challenges – there simply aren’t the facilities available across the country to meet local needs.

The Richardson Partnership for Care is located in Northampton – we’re in the centre of the country and have good road and rail links, so easily accessible for families to visit. We welcome visits to our care homes but these are not always practical, especially if family members work full-time, have children to look after or are elderly. Or they may have a long way to travel – our service users come from all over the UK as well Ireland and Eastern Europe.

Supported home visits
We believe that family contact is very important for our service users’ well-being so we include regular supported home visits when devising each individual’s care plan. Our care support staff arrange their transport and accompany them on their journey (overseas if necessary) and often continue to support them in their family home during their stay. If it’s not practical for individuals to stay with their relatives, then we arrange accommodation for them. This provides valuable assistance to the families too, helping them to enjoy the time spent with their loved one.

Video calls
As well as phone calls, we also use online applications and video calls to help service users and their families keep in touch – this can enhance communication for people with speech and language difficulties, making them easier to understand. It also means that their families get to see them and become more involved and reassured about their care.

We also use video calls to enable family members to participate in the review process. Our service users have an external review every 12 months where their care team and case workers review their care plan and discuss their progress. The service user can choose whether or not they take part in the review, but under The Care Act 2014, reviews must be attended by a family member or advocate.

A video call enables family members to take part in a review when they may have otherwise been unable to perhaps due to other family or work commitments. They can contribute fully to all areas discussed, see and hear the review team and ask questions as well as providing their thoughts and feelings on the care package.

If the service user declines to take part in the review, they can still have a video call with their family afterwards and speak with their care manager and review coordinator about what happened in the review.

Local environment
The immediate local environment can have a greater impact on someone’s day to day wellbeing than where they are located in the country. For example, all of our homes are situated in areas within easy reach of the town centre, but with their own communities. This means that we can visit local shops, pubs, cafes and leisure facilities and benefit from the friendly and personal service that they provide. We have found that some service users with acquired brain injuries and/or complex needs, on arrival at The Richardson Partnership for Care, have not accessed local communities for years. We facilitate and actively encourage service users to access local facilities as it is an important part of their well-being, rehabilitation and progress towards independence.

Centre of excellence
Due to historical factors, Northampton has evolved to become a centre of excellence in brain injury rehabilitation. This draws neurological experts to Northampton, which means that we have a larger pool of talented and experienced professionals in the area enabling us to deliver high quality rehabilitation care and support. We work in partnership with other support services if crisis care is required, providing continuity and orientation for service users and improving outcomes.

So, although location may be a starting point when placing someone in residential care or for residential rehabilitation, geographical distances can be overcome. It’s the quality of care, well-being and outcomes for service users that should take priority. We also find that in some cases, after a period of specialist rehabilitation, service users require less intensive support and are therefore able to go and live closer to their families.

Bowls sessions provide a range of benefits

One of the most popular activities that we arrange in-house for our service users is the weekly bowling sessions that we hold in the main hall at The Mews each Monday.

We are fortunate to have Duggie Mitchell on our team, who is an experienced bowling instructor and has played competitive bowls for 35 years with success at Club, County and National levels. Duggie joined the board of Disability Bowls England in 2016 and continues to be inspired by the achievements of people with disabilities. His experience, skill and enthusiasm for the game as well as his empathy with the service users have contributed to the success of the sessions. Duggie is assisted by Lisa Hutchins, the Administrator at 144 Boughton Green Road, who helps with the organisation and keeps the score.

Bowling adapted to suit the players
The format of the game is Short Mat Bowling, which is very similar to Carpet Bowling. A mat 45 feet long and 6 feet wide is laid out in the main hall with guards at either end to stop the bowls running too far. A jack is placed at one end of the mat and each player uses weighted bowls to try and hit the jack. We have adapted the rules to meet the cognition needs and suit the various abilities of the players. They bowl eight balls each and Lisa records the number of ‘strikes’. People from all of our homes join in and we have a league in which around 20 players take part. One of our service users who is blind has mastered bowling very successfully. Other service users come along to watch and support, and it’s a lively, social occasion with lots of cheering.

Key benefits to individuals
What may just look like a leisure activity is actually an important element of our service users’ care. As well as being very enjoyable, the bowling sessions also help to improve:

Physical strength and dexterity
Co-ordination
Cognition and communication
Motivation and self-esteem
Social Skills

Duggie has been running the sessions for around two years and new players can join in at any time. He has noticed significant improvements in some of the participants and says: “I have seen so much change in many of the group since we started: going from little or no eye contact or verbal communication in the early days to total interaction and response. My partner and I went along to the Christmas party recently and it was lovely to have them recognise us and want us to join them dancing.”

Thank you to Duggie and Lisa for their help and commitment to these sessions. They have contributed to some significant improvement and much enjoyment for our service users.

Duggie Mitchell demonstrating short mat bowls

Duggie Mitchell demonstrating short mat bowls

Christmas activities in our care homes

Throughout the year we have a wide range of activities for our service users with acquired brain injuries or learning disabilities to enjoy, but at Christmas this is especially important. While many service users go and stay with their families at Christmas, we want to make the day special for those who remain with us over the festive period.

Christmas activities are discussed and planned with service users in their regular house meetings, so they can decide (with support as required) what they would like to do.

This year, Sallie Maris, our Arts & Crafts lady will be ‘chief elf’ when it comes to making Christmas decorations. She will be supporting her helpers to make Christmas bunting and mobiles. Not only is this very enjoyable, it is an important part of our ongoing support and rehabilitation programme, helping people to improve their concentration and dexterity, learn new skills, give them a sense of achievement and satisfaction and increase their self-esteem. We will be using the decorations in each home, as well as for the joint Christmas party on 20th December.

Making a Christmas star

Having a large hall in The Mews enables us to provide opportunities for service users and staff from all of the homes to get together for social events. We hold short-mat bowls sessions in the hall, usually once a week, and monthly music sessions with Simon the Sax. It’s also a great place to hold the joint Christmas party and we have a travelling theatre group coming to perform The Wizard of Oz here for us.

There are lots of trips to see Aladdin at the theatre in Northampton as well as various Christmas dinners taking place – going out to the local pub for lunch, plus Rock Club (service users get together for social activities from three different organisations) and the Headway Christmas lunch. Also, the staff in each home will be coming in on Christmas Day to cook lunch and a former service user from one of our homes has been invited back to spend the day with some of his old friends.

We’ve also been baking gingerbread and other tasty treats. And our home at 23 Duston Road has a new karaoke machine, so there will plenty of singing, as well as various games to play, watching Christmas films and DVDs and going out for a Christmas Day walk, weather permitting.

From all of us at The Richardson Partnership for Care, we would like to wish you a happy and peaceful Christmas and all the best for 2018.

 

Satisfaction survey: our care home residents

Adults with acquired brain injuries, learning disabilities and complex needs

In addition to surveying the families of service users in our care on an annual basis, we also complete a questionnaire with the individuals themselves, which asks specific questions about different aspects of their lives within the care home. They are asked to respond using a satisfaction rating of 0 – 4 where 4 is the most satisfied. All of our service users have complex needs and some are unable to answer the questions, so staff either help them to answer the questions or observe their behaviours to ascertain their needs.

The results from each individual are combined to give average scores, which are shown below. There are up to five questions in each section, so the totals show an indication of satisfaction in each area.

However, as every person is different, and has different needs, our approach is always individualised, person-centred care.

bar chart showing satisfaction survey results

Service user satisfaction survey results 2017

The following gives you more information about the specific areas covered in the satisfaction survey.

Know how to complain
This question assesses how well the individual knows what to do if they have a complaint. The average overall score across the homes was 3.63 out of 4. It excludes the individuals who were unable to understand the question.

People you live with
This is very important to all of our service users, and satisfaction ratings can vary according to the type of care home as stable populations with long term residents tend to have a higher satisfaction rating. The Mews, which focuses on short-term intensive rehabilitation for adults with acquired brain injuries, naturally has more of a changing population. This can affect the dynamics of relationships between the residents. We work hard to ensure that any incoming service users will not upset the balance in any care home and we continually review our admissions policy to ensure that we receive sufficient information in advance of a full assessment of any potential new residents.

There is very much a family environment within our care homes, and many strong friendships develop between individuals. However, like a family, it doesn’t mean that everyone gets on well with everyone else all the time. Therefore it is important that we focus on relationships between individuals and use mediation and psychology to manage any disagreements. As a last resort, we can move individuals into another of our homes but this is rarely necessary.

Decision making
These questions covered how involved people feel in decisions relating to their care plan and risk assessments as well as making choices in their everyday lives.

Staffing
These questions ascertain how well service users know the support staff in their home and how they feel that they are treated by them: whether the staff are approachable, as well as whether they would like to be involved in the interview process. Many service users said that they would not want to be involved, which has reduced the average score.

Food and drink
As well as being asked about their choice of food and their cultural needs, individuals were also asked about how involved they wanted to be in menu planning and food preparation.

Activities
Many of these questions were qualitative: describing current activities undertaken or potential new ones, so a numerical score was not given. The activities that we provide are very much tailored to the individual and if something is requested but not achievable or affordable then we explore alternatives.

Environment
These questions simply asked how satisfied service users are with the communal areas of the home, the garden and their room.

Homes gain high scores in independent assessments

Headway Approved Providers
Two of our residential care homes for adults with acquired brain injuries – The Mews and 144 Boughton Green Road – have been recently re-assessed by Headway, the brain injury charity. The assessment process requires the home to demonstrate the provision of appropriate specialist care for people with complex, physical and/or cognitive impairment due to acquired brain injury. Headway has identified six key themes, or domains, against which it assesses the level of care provided, as well as issues such choice and dignity of service users. The domains are; Communication, Culture, Development, Governance, Quality, Environment (psychological/emotional) and Environment (physical).

We are pleased to report that both The Mews and 144 Boughton Green Road scored well in all of the domains to retain their Approved Provider Status for a further two years. This is subject to passing unannounced visits from Headway assessors during this time.

Headway Approved Provider

Quality Checkers
2&8 Kingsthorpe Grove, our homes for adults with learning disabilities, were recently assessed by Northamptonshire Quality Checkers. This is an independent assessment by an ‘expert by experience’ who meets residents in the home and performs a standardised quality check from the service users’ perspective. They are then supported by a co-ordinator to produce a report of their visit.

The Quality Checker on this occasion was Paul, who was visiting the homes for the first time. He met two service users with learning disabilities who live in the homes. One of them answered a series of questions and Paul used their answers to form the basis of his report. He gave the homes a top rating of ‘Very Good’ for all of the categories assessed, which were; home and bedroom, support staff, activities, food and drink, friends and people in the service user’s life, the service user’s health and what it’s like to live there.

Paul then asked the support staff and manager questions about procedures and safeguarding. As he was so pleased with the home, he made no recommendations for improvements to be made.

Information about other independent inspections of our care homes click here

Families’ survey results 2017

We encourage feedback from the families of the service users in our care on a regular basis, but once a year we formalise this process by sending them a short questionnaire to complete. It is sent to both the families of service users who have learning disabilities and those who have an acquired brain injury. 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 very pleased that:
100% of respondents strongly agreed or agreed with the statements: “I am happy with the care provided” and “The home has a warm, non-institutional feeling.”

And 100% of those who answered said that they would recommend The Richardson Partnership for Care to others.

We take note of all the feedback and we’re not complacent, making sure that we address any concerns raised. The responses to each question are show below:

graph showing 2017 survey results

2017 Survey results

We would like to thank all of the family members who took the time to complete our annual survey, and we are delighted with some of the comments that we have received. Some of them are shown below with the names removed to protect the identity of the service users.

Comments from families of service users with learning disabilities:

“He has been there over 20 years. Quality of life could not be better.”

“The home is friendly and welcoming, the other residents are pleasant and friendly… They know her so well and it is her second family, and when we visit we are welcomed… She gets help and support from all and she is treated with respect and love… I have no problem recommending your services, they are outstanding.”

“He has progressed so much this year, being able to go on holiday and attend social events… He realises he is cared for well and that he is valued within his community… He is like a new man, he was very dependent on drug therapy when he arrived at Richardson’s. Your care has enabled him to flourish and grow… the social and psychological stimulation helps him make progress. We would like to thank you for all your highly skilled and sensitive work with him.”

Comments from families of service users with acquired brain injury:

“Excellent care that has made a positive difference to my husband and his demeanour… Importantly staff display a warmth, empathy and understanding towards my husband…Thank you. Your care of my husband has made a big difference to his quality of life.”

“I have always been very happy with the care my sister has… Although she is not much of a mixer, there is a good family atmosphere… She has very challenging behaviour but I think she has the best quality of life possible… As long as she has been with the Richardson Partnership, she has only ever got the best care possible.”

 

Summer activities for Service Users

The summer is always a special time of year when, hopefully, the weather allows us to make the most of being outdoors, enjoying the sunshine and fresh air. When it comes to holidays, we make sure that they meet the needs of our service users, who are supported in deciding where they go and who accompanies them. Holidays take a lot of planning, which starts early in the year. But this pays off as they are really enjoyed by the service users who speak fondly of them on their return.

2 & 8 Kingsthorpe Grove – adults with learning difficulties
As many of our service users in these homes have been with us for a long time, they have built friendships and are aware of each others’ strengths, abilities, likes and dislikes. They go away in small groups and are involved in choosing their holiday companions and location. They like familiarity of holiday destinations and routine, so we work to get the balance right, taking into account relaxation and adventure. Destinations have included Yarmouth, Devon, the Isle of Wight and EuroDisney.

Individuals with acquired brain injuries
For our service users with acquired brain injuries, their needs can be more wide-ranging so we tend to organise holidays for small groups of two or three people, and some one-to-one holidays. One of our service users at the Mews had his first holiday since his brain injury 18 years ago when he went to Hemsby in Norfolk with two staff members. He had never wanted to go on holiday previously but had settled in really well since admission, so we offered him the opportunity. He went early in the season before it was too busy and it went really well. He normally mobilises in a wheelchair but he walked whilst in the holiday chalet.

Wherever possible, we try to accommodate specific requests for holiday destinations. The holidays are financed by accruing a certain amount each month then topped up if someone requires something extra. One lady wanted to go to the Eden Project, so with the help of the case manager, we sourced an adapted holiday home and we liaised with a local doctors’ surgery who were able to provide medical support. She went for a week with two carers.

One of our service users went to stay with his family in Serbia, while others shared a caravan at a holiday park in Skegness. Three people went for the first half of the week, three people went for the second half of the week and two joined them for a day trip in the middle. A good time was had by all – they enjoyed the evening entertainment in the clubhouse and daytime activities included going to the amusement arcade, the beach and the funfair, as well as paddle-boating and horse-riding.

In addition, a couple of service users went for a “Revitalise” holiday to Essex, where they joined in with activities such as armchair exercises, bingo and karaoke and had day trips to Clacton and Southend.

Not only is an annual summer holiday an enjoyable experience, for service users with acquired brain injuries, it is also an important part of their rehabilitation programme. It is part of our focus on ‘normalisation’, enabling them to live as close to a normal life as possible and to enjoy things that they may have done before their brain injury, such as having a picnic or fish and chips by the seaside.

The Norfolk Coast

The Norfolk Coast