DaVita (UK) Ltd - North Poole

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• 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

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

At our last assessment we rated this key question as requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of regulation for safe management of medicines.

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 evidence showed a good standard. 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.

The service had policies which provided guidance about reporting and learning from incidents. Staff knew how to report incidents using an electronic incident reporting system and incidents were reviewed and graded to promote safe care. Themes included patients failing to attend dialysis treatment, falls at home or patients requesting early termination of treatment sessions with most incidents graded as low harm.

Incidents were assessed and investigated for the purpose of learning and improving patient safety. For example, the circumstances of a patient’s fall had been reviewed by the senior clinical team to check whether effective action had been taken at the time of the incident. Where there was a discrepancy between action taken and the organisation’s policy, learning had been shared with the local team and action taken to improve record-keeping systems across the service. However, the organisation had not reviewed its incident policy and it was overdue for updating. The policy referred to guidance issued in 2015 and did not reflect the current Patient Safety Incident Response Framework (PSIRF) which NHS commissioned services are expected to follow.

The service promoted open and honest communication with patients and their families in line with Duty of Candour legislation. Duty of Candour is a legal obligation for health and social care providers to be open and honest with patients when things go wrong with their care and treatment. Duty of Candour was used following incidents with patients being given information about the review process, its outcome and an apology. This meant patients could be assured that the organisation took incidents seriously and were committed to improving patient safety.

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 worked collaboratively with partner organisations to ensure people experienced safe, coordinated care and effective transitions between services. Staff worked closely with the local NHS renal service when patients transferred from the trust’s dialysis provision to DaVita, helping maintain continuity of care. Information was shared between services and patients’ progress was regularly reviewed to meet their needs.

Systems made sure people received care in the most effective setting. The service had clear admission criteria outlining the types of patients whose needs could safely be managed within the service. Staff demonstrated a good understanding of this and knew when to seek specialist advice or arrange transfer to NHS services if their needs could no longer be met. Records showed staff sought advice from hospital teams and referred patients to their GP which supported joined-up care across acute, community and primary care services.

The service had effective processes for responding to deterioration and ensuring timely escalation of care. Staff understood the actions required if a patient became acutely unwell during dialysis treatment including accessing emergency services. Incident records demonstrated that patients who experienced sudden deterioration received prompt assessment and escalation. This ensured changes in patients’ health needs were acted upon.

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. The service shared concerns quickly and appropriately.

Staff received training in safeguarding adults and children, enabling them to recognise potential signs of abuse and understand their responsibilities in raising concerns. The service followed the safeguarding policy of the local NHS trust which provided clear guidance on safeguarding processes and escalation pathways. While not all staff could describe the reporting process in detail, they felt confident in seeking support from the nurse in charge or clinic manager to ensure concerns were acted upon.

The service identified and responded to patients who raised concerns about their welfare. They made safeguarding referrals and communicated with external agencies to ensure patients received emotional and practical support. Patients were given opportunities to discuss concerns in a safe environment and staff made sure patients knew who to contact if they felt at risk of harm. Safeguarding contact details were made available to patients through patient forum meetings and a patient newsletter to support them in raising concerns.

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.

Patients were involved in understanding and making decisions about risks associated with their care and treatment. Patients told us they were well informed about their condition and potential risks to their health which allowed them to make informed choices about their care.

The service was taking action to ensure they discussed treatment plans with patients including risks associated with missing dialysis sessions. For example, when patients did not attend for treatment, staff informed them about potential consequences of missing sessions and provided alternatives such as attending a later session or receiving treatment the following day. Patients were also given advice about who to contact if they experienced a deterioration in their health. This allowed patients to make informed decisions about managing risks to their health and wellbeing.

The service worked collaboratively with patients to reduce risks and support continuity of care. For example, where patients planned to go on holiday, discussions took place about continuity of treatment which helped minimise risks associated with interruptions to dialysis treatment. Patients told us they could discuss any risks or difficulties in relation to their treatment with their named nurse or through patient forums.

Patients received ongoing assessment at each dialysis session. Staff used the National Early Warning Score (NEWS2) system, a recognised clinical assessment tool, to monitor, record and respond to signs of acute illness or deterioration. NEWS2 assessments were completed for each patient so that deterioration could be recognised early.

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 service provided care in an environment that was accessible and designed to meet the needs of people receiving dialysis treatment. The premises were located on the ground floor supporting ease of access for patients including those using wheelchairs or other mobility aids.

Fire safety arrangements, including a fire risk assessment, were completed by an external specialist and there was an action plan to address identified risks. A practice fire evacuation had taken place in March 2026 which involved nine staff, a bed and bed/chair but no patients due to operational requirements. This simulation did not reflect the reality of a situation where up to 27 patients may be receiving dialysis treatment and require assistance with evacuation. Recommendations were made by the fire safety specialist for the service to improve its emergency evacuation procedure. Training was provided to staff and a repeat fire drill was scheduled within six months. The importance of fire safety was reflected in DaVita’s patient newsletter which highlighted it as a high priority.

The environment was well maintained and supported people’s wellbeing while receiving care. Patients had access to a spacious waiting area before and after treatment. The service provided 27 dialysis stations, including 3 side rooms, and each station was equipped with facilities and furnishings to enhance patients’ comfort during treatment. Where patients had raised issues about facilities not functioning effectively, such as remote controls for using their television, these were reported and repaired. Staff monitored the safety of the external environment and addressed concerns through maintenance and repair works.

There were arrangements to ensure equipment was safe, fit for purpose, and maintained. Maintenance and servicing records showed equipment was subject to regular inspection, servicing, and calibration within required timescales. Staff used an electronic reporting system to identify faulty equipment and told us repairs were carried out promptly, with regular visits from specialist renal technicians. Records demonstrated ongoing safety checks of equipment including weighing scales, blood pressure monitoring devices, suction equipment, and emergency resuscitation equipment.

Equipment was routinely monitored. Staff completed daily safety checklists and were assigned responsibility for specific checks, including call bells and emergency equipment, to ensure they were functioning correctly and ready for use. Staff carried out daily monitoring of the water treatment plant which maintained the high purity water standards required for dialysis treatment and reduced the risks of infection, chemical contamination, and other avoidable harm. Results for water quality showed 100% compliance in the past year.

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 levels were monitored to ensure there were enough staff to deliver safe care and treatment on a ratio of one member of staff to four patients. Staffing levels had met minimum requirements on 98.5% shifts over the past year. Where unplanned absence occurred, the service had contingency arrangements to maintain safe care, including the use of bank or agency staff and, where required, rescheduling of patient sessions. The provider told us there had been no delays to patient care because of staff absence. Recruitment took place to fill vacancies and maintain workforce capacity.

Staff described some challenges balancing direct patient care and administrative responsibilities such as updating patient records across both DaVita’s paper records and NHS electronic systems. They told us duplicating records impacted on their ability to spend time with patients. Feedback from patients was mixed; some patients felt staffing levels were sufficient to meet their needs, others reported that staff did not always have enough time to get to know them as individuals. However, all patients expressed confidence in staff’s ability to provide their care and treatment.

The service provided a training programme to support staff with developing skills and competencies for their roles. This included induction training, mandatory training and specialist training. Staff provided mixed feedback regarding the effectiveness of induction arrangements. A buddy system was available to support new staff which staff told us were responsibilities undertaken alongside their usual workload. However, staff felt there was not always enough time available to provide support.

Staff also described how competing demands on their time sometimes affected their ability to complete training within required timescales. This had presented some challenges with completion of mandatory training with compliance between 91-96% in the past year against a target of 95%. A stakeholder reported that the service experienced difficulties releasing staff to attend specialist training, especially if staff needed to travel to a different location. The provider was aware of this and was implementing measures to strengthen workforce development including protected learning time and recruitment of a dedicated practice educator. Appraisals were consistently completed with 100% compliance in the past year.

Staff consistently reported positive working relationships within the team. This was supported by a clear staffing structure on each shift and visible support from the registered manager. During the assessment, staff worked collaboratively, supported one another effectively and responded promptly to patient needs, call bells and machine alarms.

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.

Patients were protected from the risk of infection because the service had systems and processes to support effective infection prevention and control practices. Clinical areas and equipment were observed to be visibly clean. Hand hygiene facilities were available, and staff were observed washing their hands and cleaning equipment after use. All staff observed during dialysis connection and disconnection procedures were wearing the required personal protective equipment (PPE) including visors.

The service promoted safe working practices through regular monitoring of infection prevention and control standards. Audits assessed staff adherence to policy and, where shortfalls were identified, these were addressed directly with individuals to support improvement and maintain safe practice. Most staff were observed to adhere to the bare-below-the-elbows policy at the time of the inspection.

However, cleaning records for the store room and water treatment plant were inconsistent. Cleaning had not been recorded in line with the agreed schedule. The cleaning cupboard was observed to have buckets stacked together and a sink that appeared unclean. The registered manager acknowledged concerns regarding the quality and consistency of cleaning in all areas of the building. Concerns had been escalated to the cleaning contractor to improve standards.

There were systems for infection prevention and waste management throughout the service. Clinical waste was stored securely and disposed of in accordance with procedures. Sharps were managed safely, with labelled sharps containers in use and secure waste bins. These arrangements helped protect patients, staff, and visitors from avoidable risks and contributed to the delivery of safe care.

The service did not make sure that medicines were managed and administered in a safe way.

The service did not have effective systems and processes to ensure medicines were managed safely and in line with organisational policy and best practice. This was a breach of regulation at the last assessment of the service on 24 March 2021 and remained a concern at this assessment.

We observed medicines administration practices that did not align with the service’s Medicines Management Policy or professional guidance. We observed the registered nurse responsible for collecting medicines from storage was not always the same member of staff administering those medicines to patients. This was inconsistent with the organisation’s medicines policy and increased the risk of administration errors including the possibility of medicines being administered to the wrong patient.

We observed medicines being placed in patient folders at dialysis stations before patients had arrived and before treatment had commenced. Medicines were distributed across multiple treatment stations and were, at times, left unattended in the patient’s folder when neither patients nor staff were present. Although staff explained that medicines were distributed in advance to ensure prompt administration at the start of dialysis treatment, the practice was not consistent with the service’s policy.

The service’s medicines risk assessment did not adequately identify or assess all risks associated with current practice. The risk assessment did not consider risks associated with one member of staff collecting medicines and another administering them, nor did it assess the risks of medicines being left unattended or stored in patient records. Processes did not ensure effective action was taken in response to risks.

While the service carried out regular medicine audits, these did not provide sufficient oversight of compliance with all aspects of the medicines policy. Audit records from June 2025 to May 2026 indicated a high level of compliance, however, the audit tool did not include key elements of medicines administration as set out in the organisation’s own policy. Audits did not check whether the same member of staff collected and administered medicines or whether medicines were left unattended and stored as required. This meant audits did not provide assurance that medicines were managed in line with the organisation’s policy and safe practice.

Although medicines stock logs were available for some medicines stored in the clinic, these did not always reflect the amount available. Stock logs were not available for all medicines.