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Crawley Kidney Treatment Centre

Inspection Summary


Overall summary & rating

Updated 24 August 2017

Crawley Kidney Treatment Centre is operated by Diaverum UK Ltd. The centre provides haemodialysis for stable patients with end stage renal disease and failure. Dialysis units offer services which replicate the functions of the kidneys for patients with advanced chronic kidney disease.

The centre opened in 2001 and has been in its present location since January 2015. The facility is a standalone unit within an industrial park operating 24 dialysis stations (comprised of 20 stations in the general area and four side rooms which can be used for isolation purposes).

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 7 June 2017, along with an unannounced visit to the centre on 16 June 2017.

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

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.

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 keep patients safe. This included appropriate management and reporting of incidents, effective cleaning schedules and maintenance programmes. All staff were aware of their roles and responsibilities in ensuring patient safety.

  • Effective processes were in place for the provision of medicines. These were stored and administered in line with guidance and staff completed competencies according to Diaverum UK policy to administer medicines correctly.

  • Patients’ medical and nursing records were secure. Staff had access to all relevant records ensuring patients’ care was as planned and not delayed.

  • Staff worked collaboratively with the referring NHS trusts to monitor and assess patients regularly. Patients received a verbal explanation. Patients and their GP’s were provided with written updates on their condition and treatment plans. These were provided to them a minimum of monthly.

  • Staffing levels were maintained in line with national guidance to ensure patient safety. Nursing staff had direct access to a consultant nephrologist who was responsible for patient care. In emergencies, patients were referred directly to the local NHS trust and the emergency services called to complete the transfer.

  • Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident. Patients were able to continue their treatment at alternative centres.

  • All policies and procedures were based on national guidance and compliance was monitored through an effective audit programme.

  • Patients’ pain and nutrition were assessed regularly and patients were referred to appropriate specialists for additional support as necessary.

  • There was a comprehensive training and induction programme in place to ensure staff competency.

  • There were processes in place to ensure effective multidisciplinary team working, with specialist support provided by the referring NHS trusts.

  • There were effective processes in place for gaining patient consent for treatment.

  • Patients were treated with respect and compassion. Staff took care to maintain patient dignity and confidentiality when delivering care and treatment.

  • The service met the needs of the local population and the needs of individuals attending for dialysis.

  • The centre encouraged patients to self care through the ‘shared care’ programme.

  • Staff were familiar with and worked towards the organisational vision of providing the best possible care for renal patients.

  • There were effective processes in place to monitor risks associated with the service and individual patients. Quality assurance meetings occurred regularly and included the referring NHS trusts and specialists.

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

  • All staff and patients were positive about the service.

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

  • No staff had received specific training to recognise sepsis in patients despite the patients being a high risk group. This was not in line with national guidance.

  • Best practice guidelines advise two registered nurses check at the point of administration of intravenous medicines. We saw the sodium chloride (0.9%) prepared by staff was not checked by a second nurse.

  • The provider did not have plans in place to implement the Workforce Race Equality Standard (WRES) requirement.

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 one requirement notice that affected Crawley Kidney Treatment Centre. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Updated 24 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • There were effective systems in place for recording and escalating incidents both internally and externally. There was a positive safety culture, which was inclusive of all staff.

  • Staff were compliant with mandatory training and there was a reliable system to monitor this.

  • Staff were aware of their roles and responsibilities in the escalation of safeguarding concerns.

  • The centre and equipment used were visibly clean, with evidence of effective cleaning regimes and schedules in place. Audits were completed to ensure compliance with local policy and procedure. All staff were observed using effective precautions to maintain patient safety and reduce the risks of infection.

  • All equipment was maintained according to the manufacturer’s guidance. Equipment was standardised across the organisation with an adequate supply to cover maintenance or breakages.

  • There were systems and process in place to safely manage the ordering, storage and administration of medicines.

  • Patients’ medical and nursing records were held securely, with direct access to all relevant records at each area where treatment was provided.

  • Staff worked collaboratively with the referring NHS trusts to monitor and assess patients regularly. Staff completed regular risk assessments and patient reviews to ensure they were suitable to continue treatment at the centre.

  • Medical advice was available during opening times, with direct access to the appropriate consultant or renal team at the referring NHS trust.

  • Nursing staffing levels were maintained in line with national guidance to ensure patient safety.

  • Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident. Patients were able to continue their treatment at alternative centres.

However, we also found the following issues that the service provider need

to improve:

  • No staff had received training to recognise sepsis in patients despite the patients being a high risk group. This was not in line with national guidance.

  • We saw the sodium chloride (0.9%) prepared by staff was not checked by a second nurse. Best practice guidelines advise two registered nurses check at the point of administration of intravenous medicines.

Effective

Updated 24 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • All policies and procedures were based on national guidance.

  • Patients’ pain and nutrition were assessed regularly and patients referred to appropriate specialists for additional support as necessary.

  • The unit had a comprehensive annual audit schedule with clear actions taken as a result.

  • The service monitored key performance indicators. These demonstrated the service performed similarly to other dialysis centres.

  • All staff completed a detailed competency pack on commencement of post. Staff had the skills, knowledge and experience to ensure safe patient care.

  • There were processes in place to ensure effective multidisciplinary team working, with specialist support provided by the referring NHS trusts.

  • All staff had access to all relevant information for patient care and treatment.

  • The mental capacity of patients and, in addition, the equality and diversity of patients and staff were respected and monitored.

  • There were effective process in place for gaining patient consent for treatment.

Caring

Updated 24 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • Patients were treated with respect and compassion.

  • Nursing staff gave patients adequate time to ask questions and provided written information regarding patients’ conditions, treatment plans and support networks.

  • Nursing staff provided patients with information and contact details of support networks, which included the Kidney Patients’ Association and social care.

Responsive

Updated 24 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • The centre had been built to provide local dialysis patients with a treatment centre nearer to their home. Patients were assessed for suitability to attend the centre and had the opportunity to visit before finalising the placement.

  • Patients’ initial treatments were commenced at the NHS trusts and once stabilised patients were transferred to the centre. This process varied according to the patient’s response to treatment.

  • The centre had 10 patients on the waiting list at the time of inspection.

  • The centre was fully equipped to provide safe treatment for patients with translation needs, or those living with mobility, hearing or visual impairment needs.

  • The centre encouraged patients to self care through the ‘shared care’ programme.

  • The centre received 51 complaints in the past year. There were systems to ensure that patient complaints and other feedback was investigated, reviewed and appropriate changes made to improve treatment of care and the experience of patients and their supporters.

Well-led

Updated 24 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

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

  • Staff felt valued and there was a positive culture. We observed team working and staff respecting each other.

  • Staff were familiar with and worked towards the organisational vision of providing the best possible care for renal patients.

  • The centre had effective systems in place to monitor risk and quality, using a dashboard to evidence performance and identify trends or areas of development.

  • Staff and patients were positive about the service.

However:

  • The provider did not have plans in place to implement the Workforce Race Equality Standard (WRES) requirement.
Checks on specific services

Dialysis Services

Updated 24 August 2017

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

.