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Stockport NHS Dialysis Unit Good

Inspection Summary


Overall summary & rating

Good

Updated 20 February 2019

Stockport NHS Dialysis Clinic is operated by Fresenius Medical Care Renal Services. Nephrocare is the service brand of Fresenius Medical Care. Stockport NHS Dialysis Clinic has been operating since July 2013. Patients attending the clinic are referred by their local trust to the specialist renal and dialysis services provided by the service’s commissioning NHS trust . The clinic functions as a satellite clinic for the dialysis services provided by the commissioning trust, and treats patients in the Stockport area. Stockport NHS Dialysis Clinic is purpose built and is located close to Stockport centre. The clinic is a nurse led clinic, comprising of a manager, deputy manager, a team leader, 6.2 registered nurses ( a further registered nurse was undergoing pre employment checks), 3.1 dialysis assistants and one clinic secretary 0.53 whole time equivalent (wte). The manager, deputy manager and team leader also provide clinical care. The clinic has 20 haemodialysis stations and provides two treatment sessions per station per day, Monday to Saturday (240 appointments per week). The service provides dialysis services for adults aged 18 years of age and over. At the time of our inspection the unit facilitated treatment for 80 patients per week. There are no services provided to children and young people. Facilities include a patient waiting area with two disabled access toilets, two consultation rooms, a patient resource room, technicians workshop, linen room, reception office, centre managers office, patient treatment and weighing area, two single rooms that could be used as isolation rooms, one double room for patients to self dialyse, a consultation room, office, clean utility room, waste utility, staff changing room, staff rest, kitchen, storeroom, water treatment plant and a seminar/meeting room.

We last inspected this service on 22 June and 3 July 2017 but did not have a regulatory duty to rate the service at that time. However, we told the provider the actions that they need to undertake to improve the service.

Action the provider MUST take to improve

• The provider must implement a system that ensures in the event of a patient death, notifications are routinely notified to CQC in accordance with Regulation 16 of the Care Quality Commission (Registration) Regulations 2009 (part 4).

• The provider must take action to ensure mortality reviews are undertaken to review whether there are any lessons to be learned or any omissions in the care and treatment of that patient.

• The provider should take action to provide staff with procedures and training with regards to the identification, process, and management of patients with sepsis.

Action the provider SHOULD take to improve

• The provider should undertake reviewing its compliance with the Workforce Race Equality Standard evaluation in accordance with the NHS standard contract.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 28 November 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 Stockport NHS Dialysis Unit as Good overall.

We found examples of practice that had improved since our last inspection such as:

  • Since the last inspection we had seen an improvement in the reporting of statutory notifications to the CQC in accordance with the legislation.

  • We saw evidence that mortality reviews were being undertaken to review whether there were any lessons to be learned or any omissions in the care and treatment of patients.

  • We saw that all staff had been trained in the identification, process, and management of patients with sepsis.

  • We saw evidence that the provider was complying with the Workforce Race Equality Standard evaluation in accordance with the NHS standard contract.

We found the following areas of good practice:

  • All staff had completed mandatory training and knew how to protect patients from harm or abuse.

  • Staff understood their roles and responsibilities in relation to consent and the mental health act.

  • Staff treated patients with care and compassion.

  • There were high patient satisfaction scores.

  • Staff supported and met the needs of individuals.

  • There was a positive culture and staff engagement was good.

  • There was a clear governance structure.

  • We saw evidence of a comprehensive audit programme that was used to drive improvements and provide assurance.

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

  • We were not assured that the procedure for dispensing and administering Tinzaparin sodium intravenously was robust enough to prevent medication errors.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North region).

Inspection areas

Safe

Good

Updated 20 February 2019

We rated safe as Good because:

  • All staff had completed mandatory training.

  • Staff had the skills and experience to protect patients from harm or abuse.

  • Staff followed infection control policies and the areas we visited were visibly clean and tidy.

  • There were systems in place to identify and respond to patient risk.

    However:

  • We were not assured that the procedure for dispensing and administering tinziparin sodium

  • Intravenously was robust enough to prevent medication errors.

Effective

Good

Updated 20 February 2019

We rated effective as Good because:

  • Staff provided evidenced-based care and treatment.

  • Staff had had their annual appraisals and up to date competency files.

  • Staff understood their roles and responsibilities around consent and mental capacity.

  • We saw evidence of multidisciplinary team working.

Caring

Good

Updated 20 February 2019

We rated caring as Good because:

  • Staff treated patients with care and compassion.

  • Staff were proud of the work they did and committed to providing a quality service.

  • Patients felt supported by staff and there were high patient satisfaction scores.

Responsive

Good

Updated 20 February 2019

We rated responsive as Good because:

  • Stockport NHS Dialysis Unit met the needs of individuals, supporting patients to make decisions about their care and treatment.

  • There were no patients waiting to commence dialysis at the unit.

  • We saw evidence of learning from complaints and incidents.

  • Staff within the clinic had access to language line (a telephone translation service) to enable communication between patients and carers.

Well-led

Good

Updated 20 February 2019

We rated it as Good because:

  • There was positive staff engagement and culture within the service.

  • The service sought a full and diverse range of people’s views and used these to shape the service.

  • The leadership was visible and accessible.

  • There was a clear governance structure with distinct reporting lines.

  • Staff felt supported and there was evidence of staff development.

  • Stockport NHS Dialysis Unit had systems in place to ensure that clinical staff had the rights skills, experience and qualifications to provide a safe service.

  • The service had developed a robust and comprehensive audit programme to help provide assurance to the leadership team.

Checks on specific services

Dialysis Services

Good

Updated 20 February 2019

Incidents were reviewed appropriately and we saw evidence of learning from these.

The clinical equipment was visibly clean and clinical equipment had been serviced.

We observed and were told of good multi-disciplinary team working. Staff also provided evidence-based care and treatment, and there was a comprehensive audit programme to ensure compliance with relevant policies and guidelines.

Patients we spoke with were happy with the care provided and this was supported by positive patient satisfaction scores. The service met patients’ needs in a timely manner.

Staff told us about the positive culture within the organisation. There was a clear governance structure within the organisation.

There were sufficient staff to provide safe care and treatment and all staff had completed mandatory training and responded well to patient risk.

Care and treatment was evidenced-based, and staff understood their responsibilities around consent and capacity.

Staff were caring and compassionate, and responded well to the individual needs of patients.