North Devon Satellite Dialysis Unit

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

At our last inspection we rated this key question as requires improvement. The service was in breach of Regulation 12, safe care and treatment. The service had made improvements since the last inspection. However, a new regulation 12 breach was found. We found staff did not fully assess and manage risks to patients as care plans did not include information about patients’ co-morbidities. We have requested an action plan from the provider to address this issue. Despite this breach, at this inspection, we rated this key question as good. We saw the service followed safe recruitment practices. Patient areas were safe, clean, well equipped and fit for purpose. Staff understood how to protect patients from abuse and avoidable harm and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer and record medicines. The service managed patient safety incidents well.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard.Staff were confident to report incidents and knew what to report and when. Staff had effective systems to raise concerns both formally and informally. We reviewed incidents and found these were reported and investigated as necessary. Staff saw incidents as an opportunity to learn and improve. Following being involved in an incident, staff completed reflective practice and were offered additional training to support their learning. Learning from incidents was shared at the daily safety huddle.

Staff understood the duty of candour regulation and the need to be open, honest, and transparent with people when things went wrong with their care. We saw evidence from incident reports that duty of candour was followed.

We scored the service as 3. The evidence showed a good standard. The service 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 was a satellite dialysis service where people who required treatment were referred to the service by the local NHS Trust. These patients were reviewed and deemed appropriate for the satellite service by the local NHS Trust. We saw the service worked with the trust to ensure there were regular and safe systems for reviewing the people who used services care and treatment. Patients were referred back to the local hospital should their condition de-stabilise.

People who used the service were seen regularly by the same staff members. We observed patients were comfortable talking to the nurses during their treatment. The service was in the process of bringing in a named nurse system for patients. This would support patients to know who to approach if they had any particular questions about their care and treatment.

We found patient care plans did not always include information about patients’ comorbidities. However the registered manager was aware of this gap and was working on improving patient care plans.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

Staff training was suitable for their roles and had access to specialist support if they needed it. Clinic Managers were appointed as Local Safeguarding Leads and provided with level 3 safeguarding training for both adults and children. We saw that 2 members of staff were trained to level 3 for adult safeguarding and 1 member of staff was trained to level 3 for children’s safeguarding. Seventy nine percent of staff had completed safeguarding level 2 training at the time of the inspection. The clinic had a target of 95% of staff to complete this training and we saw staff were regularly reminded to complete mandatory training. All staff we spoke with understood how to recognise adults and children at risk and their responsibility to report safeguarding incidents. Numbers of who to contact in the event of a safeguarding were clearly displayed on a notice board for all staff to see.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well 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 found patient care plans did not always include information about patient’s comorbidities. We reviewed 3 patient care records and found 2 patients did not have a care plan, which would detail specific individual needs. The clinic manager explained to us the implementation of care plans was ongoing and acknowledged there was work to do to make them more holistic.

We observed staff communicating well with patients so they understood their care and treatment. One of the areas of opportunity from the last patient survey in 2024 was around the metric, ‘my care team explains things clearly to me’. The unit was about to introduce a system of named nurses for patients. This would mean patients had a clear point of contact so they knew who to approach should they wish any aspects of their care explained.

Staff enabled patients to give feedback on the service they received. Patients we spoke with said they felt supported by staff. We saw evidence that patient choice was respected when patients wanted to make advanced decisions about their care when appropriate.

If there was a medical emergency the protocol was to phone 999 and wait for an ambulance to transfer the patient to the local trust. Staff were aware of this policy and we reviewed incidents where this policy was implemented in a timely manner.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment.They made sure equipment, facilities and technology supported the delivery of safe care.

The unit was purpose built for dialysis patient. There were 20 treatment stations, with a mixture of beds and chairs, as well as 4 isolation rooms. There was plenty of space between the treatment stations and patients had the option of drawing privacy curtains if they wished. Patients had access to TV’s throughout their treatment time, although sometimes had to share the TV remote controls.

The unit was visibly clean and tidy throughout; stock was stored securely and safely. Fire exits were clearly marked and clutter free. There were copies of the emergency preparedness plan for staff to take, if necessary, at all exit points.

We scored the service as 3. The evidence showed a good standard.The service 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.

We reviewed recruitment files for employees and found the service was compliant with Schedule 3 of the Health and Social Care Act. This was an improvement from the previous inspection.

Managers had calculated the number and grade of staff required. There were 5 registered nurses, 5 dialysis assistants, one healthcare assistant as well as the manager and deputy manager of the clinic. At the time of the inspection, the service was one registered nurse short. However, we were told this position had been filled and the new member of staff was due to start in the forthcoming weeks. All unfilled shifts were filled using flexi-bank staff or overtime.

Staff had received and were up to date with appropriate mandatory training. At the time, 91% of staff had completed mandatory training.

There were link 3 nurses, 2 for vascular access and one for Hepatitis B. Link nurses are practicing nurses with an expressed interest in a specialty and a formal link to specialist team members.

Staff completed annual appraisals. In January 2025, 90% of appraisals had been completed or scheduled. We reviewed 6 staff appraisals and saw these documented a meaningful conversation between the manager and the staff member. Managers provided new staff with appropriate induction processes. A new member of staff confirmed they had received a 2-month and a 6- month appraisal as per the providers policy.

The service had some staff who were on long term sick, which affected the sickness rates. Reasons for absence were monitored and return to work interviews were completed to ensure staff were able to fulfil their roles.

We scored the service as 3. The evidence showed a good standard.The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff wore personal protective equipment in line with regulations. Staff observed good hand hygiene practice. We saw the registered manager had been auditing hand hygiene practice regularly and was using the audit results to embed good practice. In March 2025 staff compliance with good hand hygiene practice was at 92%. Staff had access to Fresenius IPC polices on the computer system.

We observed staff using appropriate aseptic non touch technique to reduce the risk of infection spreading from staff to patients. Infection prevention control was also audited and the service reported high compliance over the last year.

There were suitable furnishings which were able to be easily cleaned between patients and were well-maintained. The areas we visited in the unit were visibly clean at the time of the inspection. In the last patient survey, the unit scored high marks for the cleanliness of the centre.

Hazardous and clinical waste was responsibly managed.

We scored the service as 3. The evidence showed a good standard.The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff followed good practice in medicines management. Staff stored medicines appropriately. Medicine errors were identified and learning was shared and further training and support provided should staff require this. Fridge temperatures were monitored daily. However, some staff members were unaware of the process to notify the clinic manager should the temperature exceed the recommended levels. We told the clinic manager on the day who confirmed a reminder would be sent to staff about the correct processes to follow should the fridge temperatures exceed the recommended levels.

Staff followed current national practice to check patients had the correct medicines. Consultants at the referring trust updated prescriptions every month for each patient. If changes were required sooner than this following blood tests, the consultants actioned these and shared the information with the staff at the monthly quality meeting.

The resuscitation trolley was checked daily and opened weekly for a more thorough check.

Prescribed fluids were stored off the floor, in a clean and secure storeroom.

The service had a hypoglycaemia box available to staff should a patient’s blood sugar (glucose) levels drop to low. However, we found there was no intramuscular glucagon stored on site. Intramuscular glucagon is used for the immediate treatment of hypoglycaemia/ This is recommended by national guidance. The Fresenius diabetes management policy contained clear instructions for the immediate treatment of hypoglycaemia, which can be serious if left untreated. In severe cases, the policy involved calling for an ambulance and administering intravenous dextrose (a simple sugar that is identical to glucose). Although national guidance states that intramuscular glucagon (a hormone that helps regulate blood sugar levels) should also be available in case intravenous access is not possible, the Fresenius Country Medical Director UK Ireland explained this guidance had been purposefully adapted to better reflect the circumstances of the outpatient setting.