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Baxter Renal Education Centre - Kew Good

Inspection Summary


Overall summary & rating

Good

Updated 16 August 2019

We found the following areas of good practice:

  • All staff we spoke with demonstrated a good understanding of safeguarding children and vulnerable adults. Staff were able to identify the potential signs of abuse, the process for raising concerns and what would prompt them to report a concern.

  • Throughout our inspection all staff were observed to be ‘bare below the elbow’ and adhered to infection control procedures, such as using hand sanitisers after each patient contact.

  • Staff received monthly appraisals and told us they were useful. We viewed appraisal records which showed that all staff had up to date appraisals.

  • The Mental Capacity Act and consent formed part of mandatory training and staff we spoke with showed a good understanding of mental capacity act and deprivation of liberty safeguards.

  • Feedback from patients confirmed that staff treated them well and with kindness. We observed patients training and saw that staff were compassionate and respectful with patients. Staff ensured patients’ privacy and dignity was maintained.

  • Staff spoke highly of the visibility and involvement of the registered manager and told us the registered manager provided hands on training and the manager was part of the staffing numbers. Staff told us they felt supported by the organisation and could approach the registered manager with any issues that they had.

  • Staff spoke of good teamwork, and an open, honest, patient-focused culture within the organisation.

  • Staff we spoke with were knowledgeable about the duty of candour and aware of their responsibility to be open and honest with service users.

However, we also found that:

  • We had concerns around the storage of patients own insulin in the medicine’s fridge and in their own bedrooms at the centre.

  • Dialysis infusion fluids were not always stored appropriately, and we found dialysis infusions in their boxes kept on the floor of the training room and in the store room.

  • The service had a system to record patient own medicines and patient’s self-administration of their medicines including insulin, but we found patients own Insulin (medicines) were not always reviewed and stored appropriately by staff.

  • There was a medicines administration policy and policy for the patient’s self-administration of their medicines whilst staying in the centre. However, these policies had last been updated in October 2017 and did not have a date for review. This meant the provider could not be assured these policies were up to take and took account of any new evidence-based practice.

  • We found the training room was carpeted, and we had no assurance that, the deep cleaning of the carpets in the event of spillage was in line with infection prevention protocol and health building regulation.

Inspection areas

Safe

Good

Updated 16 August 2019

We rated it as Good because:

  • There was a good incident reporting, investigation and feedback system. Staff were aware of their responsibilities in relation to reporting incidents there was evidence that learning took place.
  • Appropriate infection control procedures were in available. The environment was visibly clear, tidy and well maintained.

  • Staff recognised how to respond to patient risk and there were arrangements to identify and care for deteriorating patients. Patients had their individual health risks assessed before using the service.

  • Staff were aware of their responsibility to safeguard vulnerable adults and children from abuse. There were clear internal processes to support staff to raise concerns.
  • Staffing levels were appropriate and planned in line with capacity.
  • Staff received mandatory training and there was an excellent level of completion.
  • Equipment was regularly checked and cleaned in line with best practice guidance.

Effective

Good

Updated 16 August 2019

We rated it as Good because:

  • Staff had a good awareness of Baxter Healthcare policies, which were based National Institute for Health and Care Excellence (NICE) guidelines and other national standards, such as the Renal Association.
  • Staff had undertaken local and national audits to monitor the quality, safety and effectiveness of service.

  • Training, care and treatment was delivered by a range of skilled staff who participated in monthly appraisals and had access to further training as required.

  • The centre had effective processes in place to ensure patient consent for training was obtained.

  • Staff worked effectively and collaboratively with the referring NHS hospitals and renal team to support patient training and their treatment.

Caring

Good

Updated 16 August 2019

We rated it as Good because:

  • We observed patients being treated with compassion, dignity and respect throughout our inspection. Staff were courteous and helpful in all roles. All staff we met during inspection were approachable and friendly.

  • All patients we spoke with told us they fully understood why they were attending the centre and had been involved in discussions about their training, care and treatment.

  • We saw that patients were treated with kindness, respect and compassion whilst they received training at the centre.

  • Patients told us they felt supported and informed about all stages of their training and commented positively about the training provided to them by the staff.

Responsive

Good

Updated 16 August 2019

We rated it as Good because:

  • The service was planned and delivered to meet the needs of various patients from London renal units, and other units within the southern area of England.

  • The centre was established as a stand-alone home from home centre for patients to undergo peritoneal dialysis training.

  • The centre provided a flexible appointment system that ensured patients’ preferred dialysis training were met and adjusted to meet their work commitments or social needs.

  • The centre provided group training on peritoneal dialysis for patients from all parts of the United Kingdom.

  • The service provided care and dialysis training for patients with learning disabilities and mobility, hearing or visual impairments to facilitate their training needs.

  • There was no waiting list during the inspection and no cancellation of the service in the last 12 months.

Well-led

Good

Updated 16 August 2019

We rated it as Good because:

  • There was a well-defined leadership structure with clear lines of accountability.
  • Staff felt valued by their immediate line manager.
  • The leadership team was visible, approachable and staff felt well supported.
  • There was an active risk register and suitable governance system in operation
  • Staff were engaged with the vision and strategy and committed to its delivery.
Checks on specific services

Dialysis Services

Good

Updated 16 August 2019

The purpose of the centre is to provide training to patients referred from the NHS, in a residential home from home setting, to self-manage their treatment on peritoneal dialysis.


We rated this service as good because it was safe, effective, caring, responsive and well-led because;

  • There was a good incident reporting, investigation and feedback system and staff recognised how to respond to patient risk with arrangements to identify and care for deteriorating patients.

  • Appropriate infection control procedures were in place and the environment was clean and utilised well.

  • The feedback we received from people using the service was positive with people describing the care they had received as, “Amazing” and, “First class.”

  • Policies and procedures were developed using relevant national best practice guidance and patients had access to appropriate nutrition and hydration including specialist advice and support.

  • Patient access and flow was seamless and without delay and staff were aware of their responsibility to ensure patients’ individual needs were met.

However;

  • Although patients were self-medicating during their stay at the centre, we had concerns around the storage of patients own insulin in the medicine’s fridge.

  • Peritoneal dialysis infusion fluids were not always stored appropriately, and we found peritoneal dialysis fluid in their boxes kept on the floor of the training room and in the store room.

  • The service had a system to record patient own medicines and patient’s self-administration of their medicines including insulin, but we found patients own Insulin (medicines) were not always reviewed and stored appropriately by staff.

  • There was a medicines administration policy and policy for the patient’s self-administration of their medicines whilst staying in the centre. However, these policies had last been updated in October 2017 and did not have a date for review. This meant the provider could not be assured these policies were up to take and took account of any new evidence-based practice.

  • We found the training room was carpeted, and we had no assurance that, the deep cleaning of the carpets in the event of spillage was in line with infection prevention protocol and health building regulation.