The Care Quality Commission
  • Hospital
  • Independent hospital

Sparkhill Dialysis Unit

Overall: Requires improvement read more about inspection ratings

Studley Street, Sparkhill, Birmingham, West Midlands, B12 8JB (0121) 766 0470

Provided and run by:
Fresenius Medical Care Renal Services Limited

All Inspections

03 August 2021

During a routine inspection

Sparkhill Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The service has 24 dialysis stations including four isolation rooms. There are three rooms for consultations and one meeting room. Dialysis units offer services which replicate the functions of the kidneys for patients with advanced chronic kidney disease. Dialysis provides artificial replacement for lost kidney function.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit to the unit on 3 August 2021.

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.

We rated it as requires improvement because:

  • Staff did not complete risk assessments when using bed rails with patients. Not all staff were fully compliant with infection prevention and control processes. Staff did not respond to one dialysis machine alarm, although they could see the patient from their location. We observed once instance where medicine administration was not done safely.
  • Staff did not support patients who did not speak English to give informed consent to treatment.
  • Staff did not always follow provider policies when delivering care and treatment.

However:

  • 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 mostly controlled infection risk well. Staff kept good care records. They mostly managed medicines well. 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 and advised them on how to lead healthier lives. Key services were available to suit patients’ needs.
  • Staff treated patients with compassion and kindness, mostly 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.
  • Leaders ran services well using reliable information systems. 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.

30 May and 12 June 2017

During a routine inspection

Sparkhill Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The service has 24 dialysis stations including four isolation rooms. There are three consulting rooms and one meeting room. Dialysis units offer services, which replicate the functions of the kidneys for patients with advanced chronic kidney disease. Dialysis provides artificial replacement for lost kidney function.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 30 May 2017, along with an unannounced visit to the unit on 12 June 2017.

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.

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 issues that the service provider needs to improve:

  • The process of incident reporting, investigation, escalation and learning from incidents was not consistent with a lack of understanding of the process.
  • The unit did not meet the duty of candour requirements.
  • We found medicines management processes including patient identification were not in line with safe medicine standards and national guidance.
  • There was not a formal process to detect deteriorating patients and those with signs of sepsis to safely and appropriately manage them in line with best practice guidance and national standards.
  • We found variable staff competency to correctly perform aseptic non-touch technique. There was insufficient action taken to reduce the risk of infection and monitor compliance with infection prevention and control procedures.
  • We found staff training records to be incomplete and clinical outcome data such falls and infection rates to be conflicting.
  • We found that staff did not understand and correctly follow safeguarding procedures and comply with the Mental Capacity Act and Deprivation of Liberty Safeguards.
  • The risk register did not identify all the unit risks and therefore not appropriately managed or action taken.
  • The overall leadership and governance of the unit required strengthening to improve.

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

  • Staffing levels were maintained in line with national guidance to ensure patient safety.
  • Nursing staff had direct access to a consultant 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.
  • Overall, the unit achieved effective outcomes for their patients.
  • All patients at the unit received high flux dialysis. High flux dialysis is the most effective type of haemodialysis; it is better quality dialysis with shorter dialysis times.
  • Flexible staff worked over their hours when needed for the interests of patients.
  • Staff were overall caring and friendly who knew their patients well and looked after them with compassion and understanding.

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 four requirement notices with details are at the end of the report.

Post-inspection, the provider provided an action plan in response to our findings to demonstrate action to address our concerns.

The action plan referred to improvements for the following:

  • Mental capacity assessment
  • Detection of the deteriorating patient
  • Sepsis management
  • Falls assessments
  • Central venous access device assessments and escalation 
  • Infection prevention and control practices
  • Monitoring of patients at high risk of infection (including those with central venous access devices).

Full information about our regulatory response to the concerns we have described in this report will be added to a final version of this report we will publish in due course.

Heidi Smoult

Deputy Chief Inspector of Hospitals

12 December 2012

During a routine inspection

During our visit to Sparkhill Dialysis Unit we spoke with seven people who were receiving dialysis treatment. We also spoke with six members of staff and reviewed documents that were made available to us.

The people we spoke with were generally satisfied with the care and treatment they received and had confidence in the staff delivering their care. People told us, 'The staff try and help you in anyway they can and try and make you comfortable.' Another person told us, The staff are cheerful and professional. They put you at ease, if they can't talk straight away they will come back.'

Staffing levels were adequate to meet the needs of people and were representative of the diverse range of people who used the service. This enabled people who did not speak very much English to communicate their needs.

We found the premises were clean and practices in place supported infection prevention and control. Feedback available on the quality of the services since the unit opened one year ago was positive.