DaVita (UK) Ltd - North Poole

Updated 8 June 2021

Renal Services (UK) Ltd – Poole provide regular dialysis to patients living in Poole and the surrounding area. Renal Services (UK) Limited, an independent healthcare provider, has operated Poole dialysis centre since October 2019. This was the first inspection of the service since its registration with the CQC.

The location has a waiting area, clinic rooms, 24 treatment stations including three side rooms with bathroom facilities and two self-care stations for use in the future. It offers each patient three dialysis treatments in each week and can treat up to 120 patients a week. The unit is open Monday, Wednesday and Friday from 7am to 12 midnight and Tuesday, Thursday and Saturday from 7am to 6.30pm. The local NHS trust commissions the dialysis service for patients who are established on regular dialysis. Consultants from the NHS trust lead the care and treatment for their patients and use the dialysis service at Poole. The consultants prescribe treatments and there is a contract of what the trust commissions from the dialysis service.

The service is registered to provide the regulated activity of treatment of disease, disorder and injury.

The service has had a registered manager since its registration.

There was an outbreak in January 2021 of COVID-19 in the Dorset region which affected 40 dialysis patients and four staff. This caused concern about safe management of infection and potential risks to patients who used the service. This prompted an inspection of the service.

Updated 8 June 2021

This was our first inspection of this service. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff were supported to complete training in key skills and understood how to protect patients from abuse. Staff assessed risks to patients, acted on the assessed risks and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients opportunity to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available to suit patients’ needs.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders had skills and abilities to run the service. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. All staff were committed to improving services.

However:

• The service did not always operate an effective system to ensure they met duty of candour requirements after a notifiable incident.
• The control of systems and processes for governance was limited by the contractual arrangements with the commissioning NHS trust.
• Leaders and teams used systems to manage performance but actions for improvement were not clearly identified.
• Staff did not always follow systems and processes to safely prescribe, administer, and record medicines. Staff were observed preparing, checking and administering the medicine at the same time, increasing the risk of error. Storage for medicines was not well organised and we found expired medicines.
• Staff compliance with mandatory training had been delayed due to the COVID-19 pandemic and was below target levels. However, the service had a strategy to improve training compliance.
• The service did not always control infection risks well. There had been some potential infection control risks during COVID-19. The service had learnt from the incident and practices had been improved as a result.
• Staff did not use a standardised tool to identify when a patient’s general condition was deteriorating. They did not record and manage patient risks from deteriorating conditions other than sepsis. Actions staff took relied upon their knowledge and experience. However, the service had a plan to introduce a standardised tool to assess general deterioration.
• Not all staff followed the policies of the service in some clinical procedures. We saw examples of staff carrying out an aseptic non touch technique and insertion of a vascular access device which did not follow the standard operating procedure of the service.
• There had been reduced patient feedback options for over 12 months because of the COVID-19 pandemic and there was no evidence actions had been identified based on patient feedback surveys.

Updated 8 June 2021

This was our first inspection of this service. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff were supported to complete training in key skills and understood how to protect patients from abuse. Staff assessed risks to patients, acted on the assessed risks and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, gave patients opportunity to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available to suit patients’ needs.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders had skills and abilities to run the service. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. All staff were committed to improving services.

However:

• The service did not always operate an effective system to ensure they met duty of candour requirements after a notifiable incident.
• The control of systems and processes for governance was limited by the contractual arrangements with the commissioning NHS trust.
• Leaders and teams used systems to manage performance but actions for improvement were not clearly identified.
• Staff did not always follow systems and processes to safely prescribe, administer, and record medicines. Staff were observed preparing, checking and administering the medicine at the same time, increasing the risk of error. Storage for medicines was not well organised and we found expired medicines.
• Staff compliance with mandatory training had been delayed due to the COVID-19 pandemic and was below target levels. However, the service had a strategy to improve training compliance.
• The service did not always control infection risks well. There had been some potential infection control risks during COVID-19. The service had learnt from the incident and practices had been improved as a result.
• Staff did not use a standardised tool to identify when a patient’s general condition was deteriorating. They did not record and manage patient risks from deteriorating conditions other than sepsis. Actions staff took relied upon their knowledge and experience. However, the service had a plan to introduce a standardised tool to assess general deterioration.
• Not all staff followed the policies of the service in some clinical procedures. We saw examples of staff carrying out an aseptic non touch technique and insertion of a vascular access device which did not follow the standard operating procedure of the service.
• There had been reduced patient feedback options for over 12 months because of the COVID-19 pandemic and there was no evidence actions had been identified based on patient feedback surveys.