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Mardon Neuro-rehabilitation Centre Good

Inspection Summary


Overall summary & rating

Good

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 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.
Inspection areas

Safe

Good

Updated 30 April 2019

Effective

Good

Updated 30 April 2019

Caring

Outstanding

Updated 30 April 2019

Responsive

Good

Updated 30 April 2019

Well-led

Good

Updated 30 April 2019

Checks on specific services

Rehabilitation services

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 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.