Bridgwater Satellite Dialysis Unit

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This is the first assessment for this service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff were confident to report incidents and knew how to report them. We reviewed incidents and found these were investigated and learning was shared with staff and across different Fresenius sites. Staff were debriefed and received support after a serious incident. There had been no serious incidents in the last 12 months.

Managers participated in governance audits and shared learning across Fresenius sites after action reviews every 3 months. A recent example involved an instance of needle dislodgment at another location, which was shared and learning discussed.

Duty of candour was applicable for incidents classified as moderate harm or above and if it had resulted because of the regulated activity. We reviewed 13 incidents from December 2025 to April 2026. Themes included delayed transport and unwell patients. None of these incidents had been as a result of dialysis treatment. Therefore, duty of candour had not been required for these events. However, staff we spoke with described instances where they had been open and honest with patients and their families.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

The service was a satellite dialysis service where people who required treatment were referred to the service by the local NHS Trust hospital. The service worked with the trust to ensure there were regular and safe systems for reviewing the people who used services care and treatment. Patients were referred to the local hospital should their condition de-stabilise. However, the service had clinical IT links with an NHS trust which was 1 hour drive away. The local hospital was a 30 minute drive away and when patients were transferred from the local hospital information was not always visible in the system.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. There was specific referral criteria for patients accessing the service.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. Not all staff had been trained in safeguarding.

Not all staff had been trained in safeguarding according to the policy. The policy stated all staff in patient contact roles should be trained to safeguarding level 2 adults and children. Clinic managers should be trained to level 3 adult safeguarding. We requested safeguarding training data. Out of 13 patient facing roles, 6 members of staff had completed level 3 safeguarding adults training. We did not see evidence the remaining 7 staff had received level 2 safeguarding adults. We did not see evidence 13 staff had received level 2 safeguarding children.

The provider’s safeguarding policy was not in line with national guidance. The intercollegiate document “Adult Safeguarding: Roles and Competencies for health care staff” second edition 2024 detailed that all registered healthcare staff should complete level 3 adult safeguarding training. However, 6 of the 13 staff had completed level 3 adult safeguarding. Staff we spoke with said they knew how to report concerns.

Clinic Managers were appointed as local safeguarding leads and there was a named contact at the NHS trust for guidance or advice. Numbers of who to contact in the event of a safeguarding were available.

The service did not frequently raise safeguarding concerns. There had been no reported safeguarding referrals in the last 5 years. It was unclear how the provider assured themselves there had been no safeguarding concerns needed to be raised.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff had access to policies and procedures to support them with assessing risk of harm and deterioration in patients’ condition. Staff completed risk assessments for each patient and included pressure ulcer and falls risk assessments. Patient care plans detailed the actions staff and the patient needed to take to reduce the risk of any harm from identified risks.

Staff used a nationally recognised tool to identify deteriorating patients and escalate their conditions to medical staff. The National Early Warning Score (NEWS2) was used in the service to identify patients at risk of deterioration. Our review of documents showed staff completed scores correctly. Staff demonstrated a good understanding about the use of NEWS2 and when and how to escalate a deteriorating patient.

Staff followed process to monitor patients access lines for dialysis. This included monitoring for potential infection and sepsis.

Although there were no medical staff on site, staff had remote access to the renal physicians at the local NHS trust for advice and guidance if they identified a patient’s condition was deteriorating. In the event of medical emergency, the process was to transfer a patient the NHS services using the NHS ambulance service. Staff were aware of this policy and we reviewed incidents where this policy had been implemented effectively.

Patients were well informed about their conditions and possible risks to their health. They felt able to raise any concerns about their health to staff.

Staff enabled patients to make advance decisions. Doctors had conversations with patients regarding resuscitation status.

Patients’ time on the dialysis machines was prescribed by the local NHS consultant. Patients who wished to end dialysis time early had the risks explained to them and staff completed an early termination form. Having less dialysis time than prescribed for a patient could be dangerous which is why the unit followed procedures to document this activity, if it was what a patient with capacity wished.

The service made plans to manage risks for less mobile patients. We were told an increased number of patients were now wheelchair users, staff had received manual handling training and patient emergency evacuation plans had been updated.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The unit was purpose built for dialysis patients. There were 16 treatment stations, with 2 isolation rooms. There was plenty of space between the treatment stations and patients had the option of privacy screens if they wished. Patients had access to televisions throughout their treatment time.

Each station had a dialysis machine that staff cleaned and carried out checks to ensure safe working prior to each patient treatment. There were additional spare dialysis machines that staff could use in the event of equipment failure.

Staff carried out daily checks on the water plant in line with national guidance. A dialysis water treatment plant (often a Reverse Osmosis or RO plant) is a specialised, multi-stage water purification system designed to remove chemical and microbiological contaminants from tap water. Because haemodialysis patients are exposed to large volumes of water that comes into direct contact with their blood, this water must meet extremely high purity standards to prevent infection, chemical intoxication, or serious illness.

The unit was visibly clean and tidy throughout; stock was stored securely and safely. The resuscitation trolley was checked daily and opened weekly for a more thorough check. Fire exits were clearly marked and clutter free.

There was a spreadsheet for calibration and portable appliance testing which was overseen by staff at the unit. However, not all machines and equipment were in date for calibration or service. There were 2 dialysis machines in patient use on the unit which were out of date for their service. Another 4 machines which were stored in the technical room were also overdue their service. A transonic device (a transonic device evaluates vascular access flow) on loan to the unit was also out of date its calibration. We raised this during our inspection and were told technicians had oversight of the equipment servicing. There was a lack of oversight at clinic level to ensure servicing of dialysis machines was timely. However, since our inspection, leaders told us the servicing and calibration schedule for dialysis machines had changed from annual to a 2 yearly frequency and therefore machines were within their service window. Service stickers were being updated to ensure they were visible and accurate.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing rotas showed and staff said the recommended number of 1 nurse to 4 patients was met. Managers had calculated the number and grade of staff required. There were 13 staff in total and no vacancies. There were 6 registered nurses, 2 dialysis assistants, 3 healthcare assistants as well as the manager and secretary of the clinic. The manager also completed clinical hours within a 4 week rota. There was rare use of bank cover, but this was available if required.

Staff had received and were up to date with mandatory training. At the time of our inspection, 97% of staff had completed mandatory training.

Staff received training and development to meet the needs of the service. The provider’s Care Delivery Manual set out the training available to staff, the training staff were expected to complete and provided a clear structure for staff development. New staff completed an induction programme. As part of the induction programme, staff spent time in a supernumerary role. The supernumerary plan was a structured yet flexible plan for integrating new starters in the centre. They received support from other staff as stipulated in the provider’s competency framework and professional growth workbook. All staff completed competencies appropriate to their role.

Staff received appraisals which included conversations about career development and how it could be supported. The service were 90% compliant with staff appraisals. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Managers ensured that staff received the necessary specialist training for their roles. Recruitment processes were thorough and evidence showed all the required documents were present.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff wore personal protective equipment and adhered to infection control principles (IPC). Staff followed Aseptic Non-touch Technique (ANTT) when connecting and disconnecting patients from dialysis machines. Aseptic techniques are a set of practices that protects patients from healthcare-associated infections and protects healthcare workers from contact with blood, body fluid and body tissue. We observed staff washed their hands before and after each patient contact. Staff disinfected and cleaned equipment between each patient dialysis session.

The service carried out infection control audits. Hand hygiene audits for February to April 2026 showed a range of 86% to 93% compliance with hand hygiene practices. The records showed that in response to these results, hand hygiene practices were discussed with staff in safety huddles and individual staff were given additional guidance about hand hygiene practices. Infection prevention control audits which included cleaning of the environment, scored between 95% and 98% during the period February to April 2026.

There were suitable furnishings which were able to be easily cleaned between patients. The areas we visited in the unit were visibly clean at the time of the inspection.

Hazardous and clinical waste was responsibly managed.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Staff mostly demonstrated good practice in medicines management across key areas in line with national guidance. However, we did not see evidence of fridge temperatures being monitored daily and some medicines were out of date, or due to go out of date, highlighting oversight arrangements were not fully effective.

We found 3 boxes of anti-sickness medication which had expired in March 2026 and 6 boxes of water for injections which expired in February 2026. There was also adrenaline (used in life saving treatment), antibiotics (used for treating infections) and a synthetic vitamin D (used to regulate calcium levels for patients with bone disorders related to kidney failure) which were within 3 months of expiry. There was an accompanying ‘expiry date check medication form’ which stated medication within 3 months of expiry needed to be returned to pharmacy and new stock ordered. We did not see evidence of this. We raised this during our inspection and were sent the ‘medicines management audit tool’ which had been completed in May 2026, since our inspection. Expired drugs were removed from the cupboard, and pharmacy had been informed to collect expired drugs on next delivery. As a result, monthly monitoring of medication was to be implemented.

Staff followed current national practice to check patients had the correct medicines. Consultants at the referring trust updated prescriptions every month for each patient. If changes were required sooner than this following blood tests, the consultants actioned these and shared the information with the staff at the monthly quality meeting.

Prescribed fluids were stored off the floor, in a clean and secure storeroom.