Bath Kidney Care Centre

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 assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This means we looked for evidence that people were protected from abuse and avoidable harm.

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 service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had policies and procedures that gave staff guidance about reporting, managing investigating and learning from incidents. Staff knew what incidents they needed to report and how to report them on the electronic incident reporting system. Although the corporate incident policy did not reflect or detail the National Patient Safety Incident Response Framework, staff understood the framework and the registered manager described how incidents were assessed and investigated in line with this framework.

The Patient Safety Incident Response Framework is a framework for services to respond to patient safety incidents for the purpose of learning and improving patient safety. All services which provide NHS - funded care are required to use this framework.

The service had reported 21 incidents in the 12 months preceding this inspection. All were reported as low harm and staff made changes in response to learning from the incidents. This included changes to the diabetes policy, a revised staff meeting and huddle template, and a named nurse checklist.

Multiple processes were used to share incidents and learning from incidents with staff. This included daily huddles and staff meetings.

Staff demonstrated in conversation a good understanding about their roles and responsibilities with regard to the duty of candour legislation. Duty of Candour is a legal obligation for UK health and social care providers to be open and honest with patients when they experience significant harm due to care or treatment, Staff had access to a Duty of Candour policy that gave clear guidance about their roles and responsibilities in relation to Duty of Candour.

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.

Bath Kidney Care Centre provided renal dialysis for NHS patients. The service worked with the renal service at the local NHS trust to ensure continuity of care when patients transitioned from the trust’s dialysis service to Bath Kidney Care Centre.

The service’s admission criteria set out the types of patients they could accept for dialysis. This ensured patients care needs could be met at Bath Kidney Care Centre. Patients living with mild dementia and patients who had a learning disability were accepted at the centre for dialysis.

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.

Most staff received training about how to recognise and report abuse. This included adults and children’s safeguarding training.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. Staff had access to a safeguarding policy that gave clear guidance about actions they needed to take to safeguard both adults and children. This included working in partnership with other agencies. There were safeguarding pathways on display clearly instructing staff on how to raise safeguarding concerns. Staff gave examples which demonstrated their understanding about safeguarding.

Patients were supported to understand their rights, including their human rights, rights under the Mental Capacity Act 2005 and their rights under the Equality Act 2010. Staff understood the importance of supporting equality and diversity and ensured care and treatment was in accordance with these Acts. Staff gave examples which demonstrated their understanding and showed how they had considered the needs of patients with protected characteristics.

The service had a defined recruitment pathway and procedures to help ensure relevant recruitment checks had been completed for all staff. These now included all required checks, including a disclosure and barring service (DBS) check, occupational health clearance, references, qualifications and professional registration checks.

It was not evident the provider had fully considered national guidance when determining the level of adult safeguarding training staff at the centre should complete. The provider’s safeguarding policy detailed that all care delivery staff must complete safeguarding adults’ level 2 training. This was not in line with national guidance. The intercollegiate document “Adult Safeguarding: Roles and Competencies for health care staff” second edition 2024 detailed that all registered healthcare staff should complete level 3 adult safeguarding training. However, Bath Kidney Care Centre went above and beyond the provider’s policy, with 5 of the 11 registered nurses having completed level 3 adult safeguarding training and all staff had completed level 2 adult safeguarding training.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff had access to policies and procedures to support them with assessing risk of harm and deterioration in patients’ condition. Staff completed risk assessments for each patient. Risk assessments included the level of assistance required in the event of an urgent evacuation of the building, pressure ulcer risk assessment and falls risk assessment. Patient care plans detailed the actions staff and the patient needed to take to reduce the risk of any harm from identified risks. Discussion with patients showed they were involved in the assessment process and agreed with any actions to be taken in response to risk assessments.

Staff used a nationally recognised tool to identify deteriorating patients and escalate their conditions to medical staff. The National Early Warning Score (NEWS2) was used in the service to identify patients at risk of deterioration. Our review of documents showed staff completed scores correctly. Staff demonstrated a good understanding about the use of NEWS2 and when and how to escalate a deteriorating patient.

Staff followed process to monitor patients access lines for dialysis. This included monitoring for potential infection and sepsis.

Although there were no medical staff on site. staff had remote access to the renal physicians at the local NHS trust for advice and guidance if they identified a patient’s condition was deteriorating. In the event of urgent situation, the process was to transfer a patient the NHS services using the NHS ambulance service. The service had access to an automatic defibrillator in the event of a patient having a cardiac arrest.

Patients were well informed about their conditions and possible risks to their health. They felt able to raise any concerns about their health to staff.

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.

Facilities, premises and equipment were purpose-built and used to meet the needs of patients who used the service. The building was modern and located on the ground floor. Annual fire risk assessments and annual disability access assessments ensured the environment was safe and accessible for all who used it.

There was restricted access to the building and clinical area. The centre had a large waiting area with suitable seating for patients prior to and after their dialysis. In the treatment area there were 16 dialysis stations, including 2 side rooms. The stations had a mixture of beds and extending chairs. Curtains around dialysis stations provided privacy for patients. Each station had a television to provide patients with entertainment.

Each station had a dialysis machine that staff cleaned and carried out checks to ensure safe working prior to each patient treatment. There were an additional 3 spare dialysis machines that staff could use in the event of equipment failure. Staff made individualised dialysis packs for each patient, using a list to ensure the right dialysis equipment was available. Dialysis assistants and nurses checked the dialysis equipment met each patient’s individual prescription when the equipment was set up prior to treatment.

Staff had access to a maintenance and servicing policy that gave guidance about the maintenance of equipment. This included guidance about reporting faulty equipment. Staff evidenced in conversations they knew how to report faulty equipment. Staff said faulty equipment was attended to quickly. The provider’s renal technicians attended the centre regularly to check equipment and carry out any maintenance and repairs that could be done on site. Records for equipment we reviewed showed they were up to date with servicing and safety checks. This included daily checks on emergency resuscitation equipment and checks and calibration of all blood sugar monitoring equipment.

Staff carried out daily checks on the water plant in line with national guidance. A dialysis water treatment plant (often a Reverse Osmosis or RO plant) is a specialised, multi-stage water purification system designed to remove chemical and microbiological contaminants from tap water. Because haemodialysis patients are exposed to large volumes of water that comes into direct contact with their blood, this water must meet extremely high purity standards to prevent infection, chemical intoxication, or serious illness. Staff had access to clear escalation plans to follow in the event of there being a concern or issue with the water plant. This included access to relevant professionals outside of normal working hours.

Staff said they had enough equipment and consumables to provide safe care and treatment to patients. All consumables we looked at were in date.

Staff ensured the designated cupboards for substances hazardous to health were locked.

Staff disposed of clinical waste safely. Clinical and general waste were separated and disposed of safely. Clinical waste bins were locked and stored securely in a padlocked compound.

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.

Staffing rotas showed and staff said the recommended number of 1 nurse to 4 patients was met. Each shift there were 4 nurses, plus 1 manager, 1 health care assistant and 1 dialysis assistant. The service was open Monday to Saturday. Monday, Wednesday and Friday there were 3 shifts, morning, afternoon and twilight, with 3 dialysis sessions during the day. On Tuesday, Thursday and Saturday there were 2 shifts, morning and afternoon, with 2 dialysis sessions during the day.

Staff had received and were up to date with mandatory training. The training was appropriate for the patient group using the service. Training compliance data showed 99% of mandatory training had been completed, which was above the providers 95% target.

Staff received training and development to meet the needs of the service. The provider’s Care Delivery Manual set out the training available to staff, the training staff were expected to complete and provided a clear structure for staff development. New staff completed a comprehensive 8-month induction programme. As part of the 8-month induction programme, staff spent 8 weeks in a supernumerary role. The 8-week supernumerary plan was a structured yet flexible plan for integrating new starters in the centre. It ensured they receive the necessary support from other staff as stipulated in the provider’s competency framework and professional growth workbook. All staff completed competencies appropriate to their role, and these were reviewed annually.

Staff were encouraged to apply for specialist training. Provision of specialist renal training had improved, and 4 nurses had either commenced or were due to commence the specialist renal course in 2026.

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.

All areas within the service were visibly clean and had furnishings that were well-maintained and easy to clean. There was a provider level infection prevention and control (IPC) policy that gave staff clear guidance to all staff for a wide range of IPC scenarios including those specific to renal dialysis.

Staff disinfected and cleaned equipment between each patient dialysis session.

All staff followed Aseptic Non-touch Technique (ANTT) when connecting and disconnecting patients from dialysis machines as outlined in the provider’s guidance. Aseptic techniques are a set of practices that protects patients from healthcare-associated infections and protects healthcare workers from contact with blood, body fluid and body tissue. All staff washed their hands before and after each patient contact.

Most staff wore personal protective equipment (PPE) in line with national recommendations when connecting and disconnecting patients from dialysis machines. However, out of 12 members of staff observed, 1 did not wear a visor when disconnecting a patient from a dialysis machine. We escalated this at the time of the inspection and the member of staff then wore a visor for their remaining interactions when connecting and disconnecting patients from dialysis machines.

Some patients were in the process of learning how to carry out dialysis themselves, in preparation for home dialysis. As part of this process, they staff advised them about infection prevention and control principles for dialysis. We observed this small group of patients followed infection control principles when setting up and stopping their dialysis.

The service carried out infection control audits. Hand hygiene audits for January to August 2025 showed a range of 83 % to 93% compliance with hand hygiene practices. The records showed that in response to these results, hand hygiene practices were discussed with staff in safety huddles and team meetings and individual staff were given additional guidance about hand hygiene practices. Infection prevention control audits which included cleaning of the environment, scored 98% to 100% during the period January to June 2025.

Although there were no medical staff on site, staff followed a process to access the on call renal registrar at the NHS trust if they were concerned that a patient’s access line for dialysis was infected. Staff said they got a good response and help from the NHS trust.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. They involved people in planning, including when changes happen.

Staff followed good practice in medicines management in line with national guidance. The service always made sure medicines and treatments were safe and met patients’ needs.

Staff had access to the provider’s Medicines Management policy. This gave staff guidance about ordering, storage, administration and disposal of medicines. It also included guidance to staff about supporting patients who brought their own medicines into the service.

Medicines were stored securely following national best practice. Oxygen cylinders were stored securely. Medicines we checked were in date and inspection of the medicine cupboards showed there was no overstocking of medicines. Staff checked the temperature of medicine fridges daily and records showed the temperature recording was carried out correctly.

All staff completed mandatory training about the safe management of medicines. Staff administered medicines and recorded the administration of medicines in line with national guidance including the guidance from professional bodies such as the Nurse and Midwifery Council. For patients receiving training and support with the aim to transfer to home dialysis, staff supported them to self-administer dialysis specific medicines following safe practices.

Medicine for dialysis treatment were prescribed by the NHS renal physician. This included the prescribing of oxygen and paracetamol to be administered to patients if they needed it. Multidisciplinary meetings included the NHS trust renal physician and staff from Bath Kidney Care Centre, these reviewed patients’ dialysis prescriptions to ensure they met each patient’s individual renal needs.

Medicine management audits showed staff fully complied with the medicines management policy and processes.