DaVita (UK) Ltd - Hamilton

We carried out an inspection of Renal Services (UK) Ltd -Hamilton using our comprehensive inspection methodology on 21 July 2021. The inspection was carried out due to concerns raised during routine engagement carried out with the service. We inspected the five key questions of: safe, effective, caring, responsive and well led. This is the first inspection for this service.

During the inspection we found several areas of concern in relation to Regulation 12. Following this inspection, we wrote to the provider and told them that we required them to provide us with assurance that they would make immediate and ongoing improvements, otherwise we would use our powers under Section 31 of the Health and Social Care Act 2008. Section 31 of the Act allows CQC to impose conditions on a provider's registration. The provider responded to us and provided an action plan that told us what they would do to address our concerns.

In addition, following our inspection and review of evidence we issued a Section 29 Warning Notices for a breach of Regulation 17. We also issued Requirement Notices for a breaches of Regulation 13, Regulation 15 and Regulation 18.

As a result of our inspection findings, this service has been placed into special measures'.

This was our first inspection of the service. We rated it as inadequate because:

• We observed poor practice from staff in relation to infection prevention and control, medicines management and equipment checks. Safeguarding procedures were not comprehensive and did not refer to up to date legislation and guidance. Staff skill mix did not always meet the national standard. Patient records were not always comprehensive or stored in line with guidance. Staff did not report incidents consistently.
• Staff did not demonstrate understanding of the legal requirements or processes to asses a patient’s best interest. Staff did not demonstrate competence when observed during our inspection. Health promotion for patient was not comprehensive. Appraisal and supervision had not been completed.
• Resources were not available to meet information and communication needs of patients with a disability or sensory loss. Staff told us they did not have access to information leaflets in languages spoken by the patients and local community. Learning from complaints was not always shared consistently.
• Local leaders did not demonstrate understanding of the priorities and issues the service or the skills to address these. The providers’ vision and values were not embedded. Staff did not feel respected, supported and valued and could not raise concerns without fear. Staff were not always focused on the patient’s needs or demonstrate good practice in care giving. Staff were not clear about their roles and accountabilities. Staff did not demonstrate understanding of the risks face by the unit or of policies in place to manage significant issues that could affect the service.

However:

• Pain relief was administered in a timely and appropriate way. We were told the multi-disciplinary team worked effectively across the providers.
• Multi-disciplinary teamwork between the service and the NHS provider who commissions the service was effective
• Patient told us staff were caring, kind and maintained their dignity at all times.
• The service planned and provided care in a way that met the needs of local people and communities served. People could access the service when they needed it and received care promptly Facilities and premises were appropriate for the services being delivered. Managers monitored and took action to minimise missed appointments. Staff made reasonable adjustments to help patients access services.
• The service would actively support research which was undertaken by its partners.