Stockton Dialysis Clinic

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.

This is the first rated assessment for this service. This key question has been rated Good:

This meant people were safe and protected from avoidable harm.

We assessed 8 quality statements for this key question.

We found that the service had robust systems and processes in place to keep patients and staff safe. The environment was safe, clean and well-maintained, and the staff had the required qualifications, training and skills. Risks were assessed and managed, and there were good processes in place to report and learn from incidents.

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. We saw examples of improvements to processes as a result of learning across the Diaverum organisation and we also saw completed action plans with lessons learned following incidents at Stockton Dialysis Clinic. Staff we spoke to on-site were able to describe shared learning from across the organisation.

Monthly business reviews discussed root cause analyses of incidents, including whether duty of candour had been applied. All incidents were further discussed at governance meetings where opportunities for shared learning were discussed.

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 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 referring trust or calling an ambulance depending on the outcome of the assessment.

We heard from staff how the service had established 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.

All staff completed level one and two Safeguarding of Children and level one and level two Safeguarding of Adults training as part of their mandatory training on a three-yearly basis. Senior staff were trained to level three safeguarding. At the time of inspection, we saw that compliance with safeguarding training was 100%. Most of the staff we spoke to were able to describe how to report a safeguarding incident. However, not all staff were able to describe what a safeguarding incident might look like, and none of the staff we interviewed were able to name the safeguarding lead. The safeguarding policy was clearly displayed on the wall, and all clinical staff interviewed knew how to find it

We reviewed the files of six members of staff and saw that all staff had been checked in accordance with the provider’s recruitment policy. All staff we reviewed had the appropriate disclosure and barring service (DBS), professional registration and reference checks. The provider ensured DBS checks were repeated, to maintain safe staffing. However, this was only required at five yearly intervals.

All staff were allocated a mentor and underwent an eight-week induction. Extra induction time was also available to those staff who required this additional support. Staff were also subject to a six-month probation.

No agency staff were used at Stockton Dialysis unit at the time of our inspection.

The service was supported by a central human resources team, who initiated recruitment processes and held oversight of training. In addition, the team were supported by a health and safety manager who had oversight for quality and compliance training. We saw a digital onboarding system used by human resources to ensure all staff received the necessary checks and a CQC tracker was in place, to ensure the vetting of staff aligned to CQC regulations and requirements.

The provider worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We saw evidence of policies and processes for documenting patient assessment and treatment at each dialysis session. There were also clear policies and processes in place for assessing and managing risk in deteriorating patients, and we heard from staff that they could ask senior clinicians for support. We heard how staff worked with patients who chose to shorten treatment times, informing them of the potential risks and offering compromises when able. The service also demonstrated a robust system for following up patients who did not attend for their appointments. If appointments were missed, staff also attempted to provide alternative appointments that were convenient to patients to ensure continuity of treatment. 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.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

There were effective systems in place for checking the environment and equipment. Whilst we were on site, a new water treatment plant was being installed and we were told about the careful planning that had gone into the replacement process, to ensure that the dialysis service was not interrupted. There was a comprehensive risk assessment, and clear business continuity plan in place in case any problems arose.

There were 19 dialysis machines at the clinic, which included three spare machines in case of any mechanical problems. We reviewed all equipment logs and saw that contracts for the appropriate servicing and maintenance were in place. Dialysis machines were maintained by an inhouse technical team who had taken significant steps to improve the current maintenance systems and develop a robust digital tagging system which could be tracked live across the whole service. We reviewed this system as part of our inspection and there were no outstanding technical tasks required for the service. Staff told us this system enabled them to report any concerns or faults quickly and that replacement items or repairs were carried out quickly.

Dialysis chairs and the calibration of equipment were maintained through a third-party contract.

Instructions for the safe storage and use, cleaning and maintenance of the equipment used in dialysis were readily available for each machine used.

Service level agreements we reviewed were found to be in date and all technical staff had the appropriate skills, knowledge and training to use the equipment safely.

We saw evidence of how the service worked with an external agency to audit water quality and carry out safety checks such as Legionella testing. The clinic conducted monthly domestic water samples and results were clearly displayed through an electronic portal. We saw evidence of how a pseudomonas problem with one sink was identified, and resolved by stripping the tap, changing the tap cartridge, installing filters and changing the piping.

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.

During our visit we observed cleaning of the treatment area between patient shifts.

There was an isolation room available for patients who had communicable illnesses to keep other patients safe

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.

The target staffing ratio for the clinic was one qualified nurse to 4.5 patients, but their preferred ratio, which we observed on site, was 1:4. The health care assistant ratio was 1:8. Senior staff told us that staff rosters catered for 20% overstaffing to allow for sickness cover and to enable staff to have admin days so protected time was provided for mandatory training. Doctors and dieticians from NHS partner organisations also attended the clinic on a regular basis.

All staff files we reviewed were found to have 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, and 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 were provided with a good range of mandatory training. Staff mandatory training compliance at the time of inspection was 94%, which exceeded the provider’s target of 90%. Clinical leads received monthly data to identify which training was required, and staff had access to log on independently to monitor this. Staff told us that they felt well-supported in their roles.

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.

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 and we observed staff sanitising their hands appropriately on our visit. We also saw evidence of regular infection prevention and control audits, and regular 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 inspection, and where improvements were needed we saw clear action plans in place, which were implemented.

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 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.

We saw evidence of waste-management contracts for the safe disposal of clinical waste and sharps.

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

We saw policies which outlined processes and checks to ensure that medicines were safely stored and administered. We checked a range of medicines on-site, which were all appropriately stored and in date. Fridge temperature checks were done daily. ‘Do not disturb’ aprons were worn by nurses during drug rounds.

However, we checked ten medicines administration charts and found that prescriptions for ‘as needed’ medicines, such as paracetamol were not signed in four of these. The provider should ensure that all prescriptions and medicines are appropriately signed for.