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.

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 wasused 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.