Mardon Neuro-rehabilitation Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service undertook a comprehensive assessment of each patient’s needs to determine whether they would benefit from the specialist skills and interventions provided by the rehabilitation team. There was clear admission and exclusion criteria to refer patients to the service. These criteria included confirmation the patient was medically stable, their rehabilitation needs could be safely and effectively managed within the service, and their neurological condition was non-progressive. This allowed realistic rehabilitation goals to be achieved and maximised the potential for successful outcomes. Patients were visited by medical staff prior to admission if possible, otherwise patients were assessed prior to admission using information provided by emails or conversations with referring clinicians.

Patients were seen on their first day within the service and provided with any equipment required to support their rehabilitation. A comprehensive assessment was then completed within 24 hours of admission, enabling the multidisciplinary team to identify the patient’s strengths, needs and rehabilitation potential. Therapy was delivered on an ongoing basis over the following weeks, with interventions tailored to the individual’s goals and progress.

Goal-setting meetings were undertaken collaboratively with the patient and carers, and goals were formally reviewed every 4–6 weeks to ensure they remained relevant, achievable and focused on meaningful outcomes. Therapists invested time in getting to know each patient, including understanding their previous lifestyle, roles and interests, to support the development of person-centred goals that reflected what was important to them.

Each patient was allocated a key worker who acted as the main point of contact throughout their rehabilitation journey, providing support, coordination and continuity of care. With the patient’s consent, staff also maintained regular communication with family members and carers, ensuring they were informed of progress and involved in care planning. All assessments, interventions, goal reviews and communications were recorded within the electronic patient record system. Carers we talked with confirmed they were involved in goal setting meetings. There were clear processes and guidelines for the key worker process which set out the requirements of the role.

Care plans were personalised and holistic. We looked at 11 care records during the assessment and saw staff had completed the necessary risk and health assessments.

There was a process to carry out mental health assessments and Deprivation of Liberty Safeguards. Medical staff referred the patient for an assessment if required.

We scored the service as 3. The evidence showed a good standard. The service always planned and delivered people's care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Functional assessment measures were used to evaluate individuals’ rehabilitation progress, with assessments completed on admission, throughout their inpatient stay, and at discharge. Outcome data was submitted to the UK Rehabilitation Outcomes Collaborative, this is the national clinical registry for specialist inpatient rehabilitation services in England.

Staff followed current policies and standard operating procedures to support the planning and delivery of safe, effective and high-quality care in line with best practice guidance. During the inspection, we reviewed a standard operating procedure that provided staff with clear instructions on the actions to take should a patient’s percutaneous endoscopic gastrostomy (PEG) tube become dislodged. A PEG tube is a flexible feeding tube inserted through the abdominal wall into the stomach to enable the delivery of nutrition, fluids and medication, when oral intake is not sufficient or safe.

In addition to having a clear standard operating procedure, the service had proactively provided staff with additional training on the management of feeding tubes. This helped to ensure staff had the knowledge, skills and confidence to respond to potential complications and to support patients requiring enteral feeding safely and effectively.

The service performed well when compared with similar rehabilitation units, demonstrating positive functional outcomes across key indicators. These included improvements in functional improvement measure and functional assessment measure scores, strong motor and cognitive efficiency outcomes, and significant reductions in projected care costs at discharge, reflecting the effectiveness of the rehabilitation programme in promoting independence and reducing long-term care needs.

Staff assessed and met patients’ nutritional and hydration needs, including any specialist dietary requirements. Feedback from patients indicated the menus provided sufficient variety and choice to accommodate a range of dietary preferences and needs. Individuals also had access to specialist dietetic support from both acute and community dietitians, ensuring nutrition and hydration requirements were assessed, monitored, and managed throughout their care.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different hospital services.

Staff held regular and effective multidisciplinary meetings. Staff worked together well to provide care. The service held a weekly multidisciplinary meeting during which each patient was discussed along with potential patients who were due to be admitted and patients who were due to be discharged.

Staff effectively shared information about patients during handover meetings to ensure continuity and safety of care. A 15-minute overlap between night and day staff was built into the staffing rota, allowing sufficient time to discuss any changes in patients’ conditions, updates to care plans, or individuals requiring enhanced levels of observation. Several staff members reported they would frequently remain beyond the allocated handover period to ensure all relevant information was communicated accurately and comprehensively. Although this meant working additional time beyond their scheduled hours, staff demonstrated a strong commitment to maintaining safe, high-quality patient care and ensuring important information was not missed.

There was a positive team culture. All staff including housekeeping attended a daily huddle at 2pm. At this meeting staff had the opportunity to discuss concerns and feedback. Staff we spoke with told us this was a collaborative environment, and they felt comfortable raising concerns.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were involved in planning their treatment and care and were able to choose options for care and treatment.

On admission people were asked about their nicotine use and offered nicotine replacement and support and advice on stopping smoking.

People were encouraged to eat and drink what they wanted. Patients’ dietary needs were catered for and individual meals prepared when required.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Care and treatment was regularly monitored and audited. The service utilised a quality assessment tool measuring compliance using Gold, Silver and Bronze ratings. They also used national tools to measure how independent a person was and how much they help they needed in everyday life throughout their care journey.

The service benchmarked their performance against similar rehabilitation units.

The service's referral-to-assessment and referral-to-admission times consistently performed better than those of comparable rehabilitation units, according to national audit data. There were clear referral pathways to support timely access to the service. However, the service recognised further collaboration and support from the acute trust was needed to increase trust staff awareness and understanding of the rehabilitation services available. This would help ensure all eligible patients were identified and referred.

The service recognised patients admitted to the unit often had more complex rehabilitation and discharge needs than those cared for in comparable rehabilitation services. Evidence from the patient categorisation tool supported this, demonstrating the service routinely admitted patients with higher levels of complexity than the national average for similar units.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Staff made sure patients consented to treatment based on all the information available. Staff we spoke with said they would obtain consent from patients before involving family or friends in care planning meetings. Documentation reviewed showed consent was obtained for medical interventions and treatments.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.