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Baxter Renal Education Centre - Kew Good

Reports


Inspection carried out on 28 May & 10 June 2019

During a routine inspection

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 carried out on 23 May 2017 and 5 June 2017

During a routine inspection

Baxter Renal Education Centre – Kew is an independent healthcare location operated by Baxter Healthcare Limited. The service has five beds which include two double bedded rooms, two twin rooms and a single room. The double and twins rooms are allocated to patients and their relatives, or carers that are admitted into the centre for training. Facilities include a training room and relaxation room.

The centre offers education in renal replacement therapy in peritoneal dialysis (PD) and home haemodialysis (HHD) to patients nationally in the UK. The service also offers home based training to patients that lived outside London and were unable to attend the centre. The centre also offers home haemodialysis and home parenteral nutrition training for hospital staff. The centre is a self-contained residential unit where patients and their relatives or carers are trained and supported on how to perform and manage their dialysis treatment effectively at home. Training usually lasts approximately two to four days. The service provides dialysis training for patients and their relatives over the age of 18 years on home based therapies.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 23 May 2017, along with an unannounced visit to the centre on 5 June 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate dialysis services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • There were effective systems in place to ensure patient safety. All staff were aware of their roles and responsibilities in ensuring patient and their relatives or carer safety. There were effective cleaning schedules as well as maintenance and fire drill programmes in place.

  • The centre was visibly clean and there were arrangements in place for infection prevention and control.There was no reported incidence of infection.

  • Patients’ records were written legibly, secured and stored appropriately by staff. Staff had access to relevant patients' records which ensured patients training and education was planned and not delayed.

  • Staffing levels were maintained by management to ensure patient safety and care.

  • The centre had a business continuity plan in place in the event of major incidents.

  • There were training, induction and competency assessments in place.Staff training compliance was 100%.

  • 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.

  • Patients training and care were provided in line with evidence-based guidance, national and local policies.

  • Staff participated in a journal club where new evidence was discussed and shared with colleagues.

  • Staff received annual appraisals and competency assessments.

  • Staff treated patients with respect, dignity and compassion and ensured their privacy was maintained.

  • Patients spoke positively about the service, staff and training received.

  • Staff were trained to support patients and this included having difficult conversation with them.

  • Patients were provided with comprehensive information and had access to support networks including Kidney Patients Association and peer support.

  • Staff understood the impact of dialysis treatment and worked especially hard to make the patient and their loved ones training experience as pleasant as possible and meet individual patient needs.

  • The service was planned and delivered to meet the needs of various patients in the local community and UK.

  • The location of the current non-clinical, Baxter Renal Education Centre – Kew was established as a stand-alone centre from the hospital setting in response to patients' feedback. As patients previously felt they were coming to the acute hospital setting for their training and would prefer to train in a non-clinical environment that was similar to their home setting.

  • The unit provided a flexible appointment system that ensured patients’ preferred dialysis training needs were met and could be adjusted to meet their work commitments or social needs. Training was available for patients at the centre or in their own home. Training was available at the centre on a one to one or group session basis.

  • The service had the facilities to provide care and education on dialysis treatment for patients with learning, mobility, hearing or visual impairment to facilitate their training needs.

  • Patient transport was organised by the centre through their taxi services.

  • There was no waiting list at the time of inspection and there were no cancellations of the service within the last 12 months.

  • There was evidence of strong local and national leadership, with accessible managers.

  • The service sought feedback and engaged effectively with patients and staff.

  • There were various innovations by the services to improve patient outcomes and their dialysis training. This included the development of an assessment tool and use of the confidence thermometer to aid patients training.

However, we also found the following issues that the service provider needs to improve:

  • Incidents reported at the centre were not investigated effectively.

  • There was no infection control lead at the centre. Staff we spoke to were not sure who their infection prevention and control lead was. Following the inspection, the provider told us that the centre manager was the infection control lead.

  • Staff did not always monitor the medicine fridge temperatures to ensure they were not outside of the normal range.

  • There were no effective processes in place for audits of medicines management within the centre. Medicines were not always reviewed and stored appropriately by staff. We found expired dressing packs during the inspection.

  • The risk register was not updated to reflect identified risks.

  • Staff were not always informed of the outcomes from the clinical governance meetings.

Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 5 June 2013

During a routine inspection

People using the service told us that they were satisfied with the way the centre was run and the service that was provided.

They said "I'm very pleased with the service, staff are really knowledgeable and I feel confident I can use the equipment in my own home". Others told us "We are all from different backgrounds, age groups and states of health. Staff communicated with all". "Overall the set up was excellent and staff were accomodating and very helpful". Further comments included "Fantastic - brilliant" and "Can't fault it".

People also said they had the course and its purpose fully explained to them.

They told us they were treated with dignity and respect by staff and felt comfortable using the service.

They did not comment on the centre's staffing numbers, infection control or quality assurance systems.

They did tell us they thought the centre was kept clean, tidy and observed their right to privacy.

We saw that people were treated with dignity and respect during our visit.

They received sufficient information about the service and their progress during the course and were enabled to operate the equipment in their own homes.

The centre was kept clean, equipment checked and maintained and there were sufficient numbers of qualified staff to meet people's needs.

There were also effective infection control and quality assurance systems in place and records were up to date and well maintained.

Inspection carried out on 8 October 2012

During a routine inspection

People who use the service were not present during our visit. We spoke to them on the telephone and they had commented in testimonials.They told us that they were satisfied with the way the centre was run and the service that was provided. People told us "The staff, training and accommodation were very good". Others said "Each and everyone of the team was welcoming and made us feel at ease". Further comments included "Excellent course" and "Good environment". People also confirmed they had the course and its purpose fully explained to them. They told us they were treated with dignity and respect by staff and felt comfortable using the service.

They did not comment on the centre's safeguarding or quality assurance systems. They did tell us they thought the centre was kept clean, tidy and observed their right to privacy.

Inspection carried out on 6 January 2012

During an inspection to make sure that the improvements required had been made

We did not talk to people who use the service during this review.

This review involved us looking at evidence received from the provider following a

Compliance Action we imposed on the service during our last review of the service, in March 2011. This was in relation to Outcome 7 - safeguarding people who use services from abuse.

Inspection carried out on 17 March 2011

During a routine inspection

People told us that they enjoy their stay at the service, and that the staff are very approachable and professional.

Staff conveyed a good understanding of peoples’ individual needs and of their preferences in relation to the support they require.

We observed the staff interacting respectfully with the people who use the service and supporting them to make choices about what they wanted to do.

The environment of the home was well maintained, and the atmosphere calm and relaxed.

Reports under our old system of regulation (including those from before CQC was created)