Mardon Neuro-rehabilitation Centre

Updated 30 April 2019

The Mardon Neuro Rehabilitation Centre is part of the Royal Devon & Exeter NHS Foundation Trust. The unit is managed by the trust’s neurology service and is part of the medicine directorate. The Centre was built in 1993 and has been part of the Royal Devon & Exeter NHS Foundation Trust since 2000. The unit has 14 beds and cares for subacute patients with a variety of neurological conditions. In this case sub-acute means patients are not severely ill but need rehabilitation help and support. One of the beds is used for a long-term resident and one bed is also used to accommodate sleep studies over 48 hours. This is managed by the neuro physiology team in the acute hospital. The unit is a specialist rehabilitation unit for patients who need prolonged specialist treatment and is led by a consultant accredited in rehabilitation medicine. The centre does not provide care to patients who are under 18 years. The unit provides care and services to adult patients in Exeter, North, East and Mid Devon and to patients who may be out of county. There was a total of 78 admissions for the previous year (January 2018 – December 2018) and 89 discharges in the same period. The length of stay is usually between two and six months. Before the inspection we reviewed a range of information we hold about the service and asked other organisations to share what they knew. We carried out an announced visit on 15 and 16 January 2019. One CQC inspector carried out the inspection of Mardon Neuro Rehabilitation unit with the support of a CQC mental health inspector and a CQC pharmacist. During our inspection we spoke with five patients and two relatives. We observed how people were being cared for and reviewed six patients care records. We also spoke with 18 staff including doctors, nurses, therapists, psychologists, health care assistants, domestic/ housekeeping staff and the maintenance/ driver for the unit. We previously inspected the Mardon Neuro Rehabilitation unit in November 2015. The unit was rated as requires improvement for safe and well led with ratings of good for effective, caring and responsive. Since that time, work has been undertaken by the staff on the unit and the medicine division to meet some of the previously identified shortfalls. The ratings have improved. Some areas of development are in their infancy and so cannot yet evidence the sustainability of the improvements.

Updated 30 April 2019

Our rating of services improved. We rated it them as good because:

• Each patient was assessed to ensure their needs were identified and managed. The needs of each patient were considered when planning and delivering the service, working collaboratively with other health professionals and across health care disciplines to ensure individualised care for patients. Patients were treated as individuals with treatment and care being offered in a flexible way and tailored to meet their individual needs.

• Mandatory training was completed by nursing, medical and non-clinical staff. The trust set a target of 75% for completion of all mandatory training modules which had been exceeded for both nursing and therapy staff.

• Safeguarding systems, processes and practices were used to keep patients safe. Staff were trained in the recognition of different types of abuse. Staff had a good understanding of consent, mental capacity act and deprivation of liberty safeguards and had access to further supporting information on the trusts intranet.

• The service controlled infection risk well and the environment was visibly clean. The maintenance and use of facilities, premises, and equipment generally kept people safe. Refurbishment was taking place to ensure the environment of the unit was in good repair.

• Nursing and therapy staff were aware of their responsibilities to report incidents and were confident to do so.

• There have been improvements in how medicines are managed at the Mardon centre

• Nursing staffing levels and skill mix were planned, implemented and reviewed to keep patients safe. There were sufficient nursing staff available to meet the needs of patients. Should the dependency of patient need increase, further staff could be requested.

• Policies and guidelines had been developed in line with national policy including the

• National Institute for Health and Care Excellence (NICE) guidelines.

• Patient records were well completed and were seen to be legible, signed and dated. All patients had their nutrition needs and hydration needs met and staff assessed and managed patients’ pain effectively.

• Standard and non-standard assessments were undertaken and monitored to show that sufficient therapy support was provided and that the rehabilitation service met patient’s needs.

• Patients had access to information about how to make a complaint and complaints were taken seriously by the trust.

• Ward leaders had the skills, knowledge and experience to lead teams effectively.

• Considerable work had been undertaken to develop inclusivity between the acute hospital and the Mardon unit. There had been a greater visibility of senior management and improved links with the acute hospital.

• Staff could tell us about the visions and values of the trust and of the Mardon unit. The staff we spoke with during the inspection said they were proud to work on the unit and were passionate about the care they provided. They told us they felt the care provided was proactive with positive outcomes for patients.

• The trust and the Mardon unit together had processes to manage current and future performance. Staff from Mardon centre took part in clinical governance arrangements and felt that the unit had a voice at divisional level of the trust.

• There was a process being developed to identify, monitor and address current risks. The risk register was under development but the content was available.

• There were systems to engage with the public to ensure regular feedback on services. This was used for and learning and development. However:

• Registrar cover was not consistent and impacted negatively on the time provided to the unit’s patients.

• Occupational therapy and psychology staff numbers were lower than the British Society of Rehabilitation Medicine (BRSM) guidelines. This meant there were not sufficient therapy staff available to support patient rehabilitation.

• Access to new wheelchairs was not always timely with delays. There was a problem of an 18-week waiting time from referral to assessment and delivery of new wheelchairs.

• Mardon took part in the UK specialist Rehabilitation Outcomes Collaborative (UKROC) which was setup in September 2008 through a Department of Health initiative to develop a national database for collating case episodes for inpatient rehabilitation. Data had been collected monthly but senior staff told us that the data was not reliably inputted and so the collective figures were not truly representative of the service provided. Work was underway to ensure that data collected was input correctly.

• Mental capacity assessment for one patient had not been fully completed. This means that the correct and legal paperwork was not all in place to safeguard the patient.

• Mardon House received an appraisal, less than the trust target of 80%. This may mean that staff were not reviewed and supported to ensure updated practice was maintained.

• There was a process being developed to identify, monitor and address current risks. The risk register was under development and so the management of the trust could not provide us with the current completed template version.

• The results of the safety thermometer were not publicly displayed to enable patients and staff to see the results

Updated 30 April 2019