Diaverum Dialysis Clinic - Rotherham

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

We inspected the service in 2017 but at the time we did not rate dialysis services.

This key question has been rated Good however, we identified a breach of 1 regulation, Regulation 12, Safe Care and Treatment:

This meant people were not always protected from avoidable harm.

We assessed 8 quality statements for this key question.

Risks were not always assessed and managed, however there were good processes in place to report and learn from incidents.

We found that the service had robust systems and processes in place to keep patients and staff safe. The environment was safe and clean, and the staff had the required sills, qualifications and training to meet people’s needs.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There were robust systems in place for the reporting of incidents, and monitoring of health and safety through a structured audit programme. Staff saw incidents as an opportunity to learn and improve, and we saw this learning disseminated through meetings. A trend of patient falls had been identified and the management team had investigated and shared learning with staff to prevent any further falls.

Staff understood about duty of candour and the need to be open, honest, and transparent with people when things went wrong with their care.

The provider 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’s referral and admission process ensured all essential information about the patient was recorded to ensure their needs could be safely met. Staff could access Trust records to obtain essential information such as monthly blood results.

Patients’ records were clear and complete and contained up to date care plans and medication information.

The service had clear processes in place for identifying and escalating when patients were unwell. This included using a recognised clinical scoring system for assessing patients and either contacting the physician from the Trust or calling an ambulance depending on the outcome of the assessment and severity of deterioration.

Staff told us how the service had good relationships with NHS partners and could escalate concerns to consultants in a timely way. We saw acceptance criteria and criteria for identifying when patients were not suitable for dialysis on the unit, with a process for how to act on this.

The service had a process in place for managing missed appointments, which included phoning the service user and if there was no response, working with emergency services to initiate well-being checks to ensure that the person was safe.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The clinic manager was the local safeguarding lead and had undertaken level 3 safeguarding training for adults and level 2 for children. All staff had completed mandatory safeguarding training for children and adults to level 2. The manager could access support from the Diaverum safeguarding lead and the trust safeguarding team should they need to. The unit also held an aide memoire of useful numbers including community contacts, refuges, and third sector support services.

All staff we spoke with understood their responsibility in relation to safeguarding as well as how to report safeguarding incidents. The telephone numbers of who to contact in the event of a safeguarding concern were easily accessible for all staff. Staff said they could access safeguarding information and policies on the electronic system if they needed confirmation about what actions to take. We reviewed the safeguarding policy and this was in date.

The unit had strict rules about who could access the unit, particularly the clinical areas and discouraged children visiting unless they were accompanied by an adult, closely supervised and only visited for a short period of time.

The provider 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. However, risk assessment were not always fully completed and in some cases were not in place.

Risk assessments were carried out and reviewed regularly for each patient. These included but were not limited to: assessing moving and handling requirements; risk of falls; risk of needle dislodgement; and frailty. However, these were not always fully completed with some having gaps in information. Further, risk assessments and care plans for people with additional health needs such as epilepsy were not in place. This is a breach of Regulation 12 – Safe care and treatment. After the inspection we received assurance that all risk assessment had been completed and bespoke care plans put in place.

If there was a medical emergency on site, staff knew to phone 999 for an ambulance to transfer the patient to the local hospital. There was also a flowchart in place for staff to follow including information about when to administer oxygen and other life support measures. Staff had been trained in immediate life support (ILS) which they would carry out until ambulance support arrived. Staff told us they understood what they had to do and were supported afterwards by colleagues and leaders.

The unit also used the National Early Warning Score (NEWS) tool when appropriate to monitor patients for signs of deterioration.

Clinical risk was managed through regular multidisciplinary team meetings (MDT) between local consultants at the NHS Trust and the provider. The service discussed and documented risks to patients in care plans.

Staff told us how they worked with patients who chose to shorten treatment times, informing them of the potential risks and offering alternatives when possible.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There were processes for maintaining clean water supply to the unit, including how the water was extensively tested to make sure it was appropriate for dialysis, actions to take if problems were identified and how dialysis equipment was tested, maintained and repaired. We were assured that there were robust processes in place to keep patients safe.

The service had clear guidance on the criteria for replacement of equipment, with a replacement schedule in place to ensure that equipment always supported the delivery of safe treatment.

All equipment we reviewed was stored and managed safely. Stock items were stored appropriately, with effective housekeeping policies and processes. This included the control of substances hazardous to health (COSHH).

We saw evidence of clear processes in place for the treatment and storage of blood samples prior to being collected.

We reviewed the clinical areas in the unit and found these to be appropriate for their use. We identified two individual bed spaces in separate rooms off the corridor which were for patients who needed to be isolated or barrier nursed. We noted that there was no clear signage to indicate why the two patients using the rooms were isolated. This could lead to staff not following the correct infection prevention and control procedures when entering rooms. Additionally, the room doors were left open.

We reviewed the resuscitation equipment held on site and identified no concerns. We noted that regular checks of this equipment were carried out. We also noted that the unit had an emergency call system in place, for any urgent clinical need.

The provider 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.

The service had robust recruitment processes in place to ensure that staff were appropriately qualified, checked and vetted, and we saw evidence in staff files that these processes were followed.

There were sufficient staff deployed to meet the needs of patients with only slightly less whole time equivalent (WTE) nurses than required (0.32 WTE less) but more (0.3WTE) than required health care assistants (HCAs). When we asked patients if they felt there were enough staff when they attended for dialysis, all told us they thought there were.

All staff had the necessary training and skills that were required for the role. Training was role specific across the service. Clinical staff had completed all required training modules relevant to their roles, which included speciality-specific training such as a holistic approach to caring for frail patients in the renal setting, blood borne viruses in the renal setting, and more generic skills such as basic life support and prevention and management of falls. Non‑clinical staff, such as reception teams, also received training appropriate to their duties, including safeguarding, General Data Protection Regulation (GDPR) compliance, and records management.

Staff received a comprehensive induction and ongoing training and support, including end of year appraisals. Some staff had started as support workers and described how the unit had supported them to access further education including funding to access training and qualifications.

There were no medical staff based at the unit however, doctors did visit regularly to review their patients, and we saw them during our on site assessment. Staff told us medical staff were easily accessible, if there were any queries about patient wellbeing or needs.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. There were policies and procedures for infection control and the service assessed and managed the risk of infection.

During our visit we observed cleaning of the treatment area between patient sessions. We observed good infection prevention and control practices during our visit. There were plenty of hand gel dispensers around the clinic, which were all functional. Staff wore personal protective equipment (PPE) in line with regulations. Staff were observed to follow good hand hygiene practice and hand hygiene was tested using a UV lamp at least once each year for each staff member. We observed staff using the appropriate aseptic non touch technique to reduce the risk of infection spreading from staff to patients. This was also subject to annual competence review. At the time of the assessment compliance was at 78%, which both CQC and the provider agreed, needed to improve.

We also saw evidence of regular monthly infection prevention and control audits, and hand hygiene audits, with evidence that any areas of non-compliance were promptly escalated. We looked at cleaning audits for the three months leading up to our assessment and identified no issues.

There were suitable furnishings, which were easily cleaned between patients and were well-maintained. The areas we visited in the unit were visibly clean at the time of the assessment.

Processes were in place to screen and isolate patients who had been on holiday to high-risk destinations, and we saw evidence of this being done in person and in patient records. All patients were screened for blood-borne viruses every three months. We also saw documented processes for assessing and managing patients who were unwell whilst attending dialysis.

Hazardous and clinical waste was disposed of safely and responsibly managed which included a programme of recycling to minimise the impact of generating too much waste in a service which had a high usage of consumables.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

We reviewed medicine storage areas, spoke to 3 members of staff and looked at

11 care records. We reviewed policies and procedures on site.

Medicines were stored safely and securely on the unit. There were processes for stock rotation and receipt of patient’s own medicines. Staff monitored storage temperatures to ensure medicines remained within the manufacturer's recommended limits. People reported positive experiences receiving treatment on this unit, when we spoke to them.

There were systems in place to support them accessing their treatment and managing it around holidays. Staff administered medicines as prescribed and completed treatment charts in line with local policy. We witnessed new patients on the unit receiving support thorough counselling on their treatment and regular checks by staff to ensure they were comfortable during the dialysis process.

Staff completed care records, ensuring each person had required consent forms and up to date medicine histories. This allowed medical teams to review care records regularly with the most accurate medical information available during rounds. Emergency medicines were prescribed where required to prevent delays in treatment and people reported feeling well supported by their medical team with the management of their other conditions, such as haematology and diabetic care.

Staff had access to training and development opportunities, including non-medical prescribing. They used non-medical prescribing effectively under the supervision of the medical team. Staff were 100% compliant with medicines management training, and they demonstrated a good awareness of medicine-based procedures and audits to support people’s care effectively.