Kings Norton Kidney Treatment Centre

Kings Norton Kidney Treatment Centre is operated by Diaverum Facilities Management Limited. The service has 20 dialysis stations which includes four isolation rooms for patients who are or may be infectious.

The service provides dialysis for patients aged 18 and over.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on the 4 February 2020.

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? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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 rate

Our rating of this service improved. We rated it as Good overall.

The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available six days a week.

Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment. When problems were identified with accessing treatment due to third party providers (patient transport) the service worked to monitor and manage this.

Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients to plan and manage services and all staff were committed to improving services continually.

We found areas of practice that required improvement:

The service external clinical waste collection area, and a sharps bin awaiting collection, were not secured. We found this at our previous inspection in 2018 and saw this was still the case in 2020.

We found a procedure relating to the preparation and administration of low molecular weight heparin (LMWH) medicine was unclear and may have left patients at risk of harm. Post inspection, we received an updated version of this procedure and a risk assessment to support this.

The service did not always evidence how they had adapted written material, in particular consent forms, to be accessible to patients who required alternative formats.

The service had one set of scales for patient use. Although another set was available at a clinic nearby; if these were needed this could delay patient treatment sessions.

The patient satisfaction survey results had worsened since 2018 due to various factors. However, we saw action plans and engagement were ongoing to improve this.

Following this inspection, we told the provider that it must make an improvement as Regulation 12: Safe Care and Treatment (Health and Social Care Act) had been breached. In addition, we told the provider it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Midlands)

Kings Norton Kidney Treatment Centre is operated by Diaverum Facilities Management Limited.

It provides haemodialysis services for adult patients living with chronic kidney failure including those with hepatitis B and HIV. The centre has 20 dialysis stations including four isolation rooms.

We inspected the centre using our comprehensive inspection methodology. We carried out an unannounced inspection of the centre on 17 October 2018.

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?

Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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 rate

We rated this service as requires improvement overall.

We found the following issues that the service provider needs to improve:

• Staff relied on familiarity to identify patients instead of prescribed formal checks as outlined in local protocols. Patient records did not always contain a photograph of them to provide an additional form of visual identification to help keep patients safe, particularly when administering medication. Staff should follow local procedures and ensure all patient checks are carried out when administering medication to keep patients safe.

• Staff did not always observe infection prevention control and appropriate use of personal protective equipment to ensure risks of cross contamination were prevented. Staff did not always use aseptic technique practices and procedures, which meant applying the strictest rules to minimise the risk of infection.

• Staff did not always follow best practice to keep everyone safe from harm. For example, they did not always dispose of sharps safely, which increased the risk of needle stick injury and cross contamination. Staff did not always dispose of clinical waste appropriately.

• The service did not always have access to spare equipment, for example, scales to ensure patients received accurate measurements in advance of treatment.

• Fire regulations were not always observed. For example, a fire door was propped open, which did not meet fire safety regulations and presented a safety risk to those in the building.

• Loose leaf patient information was not always stored securely in folders. This increased the potential risk of medication errors and the potential for breach of confidentiality.

• Patients with English as a second language were not always provided with a translator to help them understand information that was being relayed about their treatment. All patients should have access to an interpreter when English is not their first language when providing consent to treatment.

• Managers did not always carry out investigations relating to incidents or make use of them for learning opportunities or to improve outcomes.

• Managers did not always provide timely statutory notifications to the Care Quality Commission following serious incidents.

However, we also found the following areas of good practice:

• There were good systems and processes to ensure staff met mandatory training requirements and oversight of compliance was provided by an onsite practice development nurse.

• Staff were trained to understand the principles of safeguarding both patients and children.

• The premises were clean and tidy and people had access to resources to practice infection prevention control.

• Side rooms were available for patients identified as a high risk of infection.

• There were technical personnel on hand to ensure the environment and equipment were maintained and in working order.

• Patients who were planning holidays were managed to ensure they received appropriate treatment while away. They were safely managed upon return, with special consideration for those patients returning from high risk areas.

• Staff demonstrated a good understanding of the key principles of the Mental Capacity Act 2007.

• Patients told us staff were caring and compassionate and we saw this in practice.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices that affected the service. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals