The Care Quality Commission
  • Hospital
  • NHS hospital

Mardon Neuro-rehabilitation Centre

Overall: Good read more about inspection ratings

Mardon House, Wonford Road, Exeter, Devon, EX2 4UD (01392) 402391

Provided and run by:
Royal Devon University Healthcare NHS Foundation Trust

All Inspections

15 January 2019 to 7 February 2019

During a routine inspection

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

3-6, 10 & 16 November 2015

During an inspection looking at part of the service

We inspected Royal Devon and Exeter NHS Foundation Trust as part of our programme of comprehensive inspections of all NHS acute trusts. The trust was identified as a low risk trust according to our Intelligent Monitoring model. This model looks at a wide range of data, including patient and staff surveys, hospital performance information and the views of the public and local partner organisations.

Level 6 is the lowest level of risk which the trust had been rated since march 2014.

The inspection took place on 2 – 6 November 2015 and included Wonford Hospital and Mardon Neuro-Rehabilitation Centre

We rated the trust as good overall and Mardon Neuro-Rehabiliation as requires improvement overall.  

  • The chief executive had been in post for 18 years at the time of the inspection. It appeared that the Chair and Chief Executive had a supportive relationship and worked well together. The board overall had the experience, capacity and capability to lead effectively.
  • The trust culture is strongly focused on quality and safety with patients being the absolute priority. There was tangible evidence of the culture in trust policies and procedures. This was also a consistent theme in the feedback from staff at all levels in the focus groups and drop in sessions held during the inspection.
  • There was an incident review group which reports to the Clinical Governance Committee and reviews all incidents that are categorised as amber or red
  • The trust had no never events since 2013. Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. NHS trusts are required to monitor the occurrence of Never Events within the services they commission and publicly report them on an annual basis.
  • The trust performed well on infection rates having had no incidents of MRSA blood stream infection since 2011.
  • Staffing in wards was reviewed on a regular basis with evidence of skill mix changes and additional posts being created in some areas. Other areas were finding it hard to recruit with some reliance on bank or agency staff.
  • The overall trust target for mandatory training was 75% which had been achieved for topics such as safeguarding. There were some topics which were above the target and some slightly under the target.
  • Staff reported communication was good in their local teams through use of ‘Comm cells’. These took place regularly with discussions including training, complaints incidents and well as feedback of results of audits.
  • For the Mardon Neuro-rehabilitation centre there was a lack of strategy for the provision of a responsive service that delivered care as close to home as possible services seven days a week.

There were areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure medicines are administered to patients safely in line with policy and take into account their rights.
  • Ensure medicines are disposed of and returned to pharmacy in accordance with the trust’s policies and standard operating procedures.

In addition the trust should:

  • Ensure there are sufficient therapy staff deployed in order for patients to receive consistent care and according to their needs.
  • Ensure incidents are investigated and records are available with a robust process for disseminating information to all staff following incidents investigations.
  • Ensure discharge planning processes are pro-active and well co- ordinated to reduce delayed transfers out of the centre.
  • Ensure service strategies are clear and communicated effectively and development plans for the service are identified.
  • Identify a lead to develop the service and provide management support at operational level.
  • Review feedback from patient surveys and develop action plans to improve patient experience.

Professor Sir Mike Richards

Chief Inspector of Hospitals

16 July 2012

During a routine inspection

We made an unannounced visit to the Mardon on 16 July 2012. The centre had 11 rehabilitation beds, one long-term stay bed and one bed reserved for patients from outside of the health authority. Ex-patient out patient clinics and facilities for monitoring people's brain activity whilst sleeping as part of assessment of epilepsy are also provided at the Mardon. On the day of our visit 11 people were staying on the unit and there was an out patient clinic run by a consultant.

We met six people who were staying on the unit and spoke with three of them in private. People told us that the standard of care they were receiving made them feel they were valued as individuals. They also said they were fully involved in the planning and review of their care. They told us if it was their wish that family members be consulted about their care then they were invited to attend to review meetings held at the centre. People said staffing levels at the Mardon were such that they did not feel rushed or pressured when re-learning skills lost as a result of a brain injury.

We found that the staff ensured that communication aids were provided, used and their effectiveness assessed to ensure people could express their views. Staff said that leadership and support was strong on the unit. We found that the tools used by the management to monitor quality were appropriate and effective as they were patient outcome based.