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Inspection summaries and ratings from previous provider


Overall summary & rating

Updated 10 August 2017

Basingstoke Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The unit is commissioned by a local, host NHS trust to provide renal dialysis to NHS patients. The service is registered for 24 dialysis stations. The unit has four bays. Three bays have six stations and one bay has not been used since the contract was agreed, but is set up for four stations. The clinic has two single-bedded side rooms that can be used as isolation rooms if patients have an infection risk.

The service provides haemodialysis from Monday to Saturday each week with morning and afternoon session each day.

We inspected this dialysis unit using our comprehensive inspection methodology. We carried out the announced part of the inspection on 21 April 2017, along with an unannounced visit to the unit on 25 April 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.

Services we do not rate

We regulate dialysis services but we do not currently have a legal duty to rate them when they are provided as a single speciality service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • Staff were caring, compassionate and patients said they often went the extra mile. They were committed to providing patient-centred care.

  • The unit offered heamodiafiltration as standard, which some evidence indicate delivers improved patient outcomes.

  • Staff received a comprehensive induction and had good access to corporate training courses. Nurses were supported to complete external renal nurse training.

  • Staff participated in annual appraisals and all start reported in the last staff survey that they understood their roles and responsibilities.

  • Staff coordinated care safely and effectively with the NHS trust consultants and dietitian.

  • Staff maintained comprehensive patient records.

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

  • Staff did not have a good understanding of risk management and challenging practices to improve care and safety.

  • There were risks associated with staff not formally identifying patients for treatment and checking patient prescriptions when giving medicines. These risks had not been identified with associated mitigating actions.

  • Some staff had not completed mandated training.

  • There was a lack of clarity in when to apply clean or aseptic techniques when dialysing patients with AV Fistulas, and staff did not consistently follow the Fresenius corporate policy.

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. We also issued the provider with two requirement notice(s) that affected this dialysis service. Details are at the end of the report.

Edward Baker

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Updated 10 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • Staff understood the incident reporting process and reported incidents in line with the Fresenius policy. There were systems for sharing learning from incidents including from those that occurred outside the clinic.

  • Most staff had completed mandatory training and there was a system for monitoring and alerting staff when they were required to undertake update training.

  • There were enough staff to deliver the treatment and the unit rarely needed to use bank or agency staff

  • Staff consistently followed the provider’s policy for hand hygiene, and wore personal protective equipment.

  • Patients with, or at risk of having blood born viruses were dialysed in one of the units two isolation rooms, on dedicated a dialysis machine to minimise the risk of cross infections.

  • Staff disposed of clinical and non-clinical waste appropriately.

  • The clinic environment was tidy and well organised, with sufficient storage for materials and equipment.

  • Systems were in place for planned and responsive maintenance of equipment.

  • The dialysis machines included automatic alarms to alert staff if the machine malfunctioned or if the patient’s dialysis pathway went outside set parameters.

  • The resuscitation trolley was readily available equipped with items needed in an emergency.

  • Staff checked the water treatment plant and took the necessary actions if they found non-compliances with test results.

  • Staff checked medicines daily and all medicines were in date and stored at the correct temperature.

  • Staff followed agreed procedures to create records accessible within Fresenius and the commissioning NHS trust. Their records were comprehensive.

  • There were sufficient staff on duty to support the needs of patients.

  • The clinic had emergency preparedness plans for the clinic and emergency evacuation plans for each patient.

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

  • The provider had not notified the Care Quality Commission of deaths within its own clinical incident reporting policy timescale of 72 hours of the incident.

  • Not all staff had completed the mandatory training.

  • There was a lack of awareness of who the corporate safeguarding lead was.

  • The safeguarding policies did not make reference to female genital mutilation, to enable staff to recognise and protect vulnerable individuals from being groomed for terrorist activities.

  • Staff did not apply aseptic techniques in line with the Nephrocare Standard Good Dialysis Care policy, or dispose of sharps correctly.

  • The clinic manager, as registered manager, was not aware of how many cycles the dialysis machines had completed and their projected replacement dates.

  • When administering medicines, staff were not assured they were delivering the correct dose of the prescribed medicine to the correct patient, and recording this in line with Nursing and Midwifery Council code.

  • Staff recorded some notes, such as blood results, in different folders/files. The risks associated with the practice had not been assessed.

  • Staff had not risk assessed their practices of not formally identifying patients prior to dialysis.

  • The risk assessments for, for example, falls or pressure ulcers were not linked to detailed care plans to guide staff in how to support patients with an identified risk.

Effective

Updated 10 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • The clinic staff based practices on the corporate ‘good dialysis care’ policy and procedure, based on internationally recognised good practice guidance.

  • They used a recognised tool to assess vascular access for infection and damage.

  • Most patients had arteriovenous fistulas, with the proportion in line with Renal Association standards

  • The clinic offered haemodiafiltration as standard, but also provided haemodialysis when necessary.

  • The unit monitored patient outcomes and contributed data to the Renal Registry.

  • Patients accessed the trust’s dietitian at the clinic, and said they had good support.

  • Staff were competent in their roles and had access to mentors and role-specific training.

  • There was comprehensive induction training to assist staff in understanding their roles and responsibilities

  • Staff were supported to develop their skills. Three nurses had completed the renal nurse course and another was due to complete the course in 2017.

  • Staff were given lead roles to support colleagues in, for example, infection control, holiday dialysis, vascular access and nutrition.

  • All staff had undertaken annual training in basic life support.

  • Clinic staff worked collaboratively with the trust’s consultants and dietitian, and there effective systems for sharing information.

  • Patients gave to consent to treatment and staff kept documented written consent forms in patient files.

  • Staff had completed training in the Mental Capacity Act 2015.

  • The clinic monitored delays with patient transport.

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

  • The clinical risk policy and clinical governance strategy had not been reviewed within the last three years to ensure they reflected current good practices. The corporate ‘good dialysis care’ policy did not make reference to recent National Institute for Clinical and Health Excellence (NICE) guidance on Renal replacement therapy services for adults.

  • Staff did not have access to specific guidance on identifying and responding to sepsis.

Caring

Updated 10 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • Patients told us staff were caring, compassionate and treated them with respect and dignity. Our observations confirmed this, with for example, staff closing curtains to respect a patient’s dignity.

  • The previous patient survey result showed 98% of patients said they were treated with dignity and respect.

  • Patients said they could have private discussions with staff if they requested them, in one of the consulting rooms on site.

  • Staff explained the care and treatment they provided and involved patients in their care, by discussing results with them and asking their opinion.

  • Patients said they received emotional support, from staff and other patients when they attended for dialysis.

  • The clinic had established a named nurse approach to foster patient- centred relationships with regular reviews.

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

  • On a minority of occasions, staff did not welcome to patients onto the unit or take time to talk with them.

Responsive

Updated 10 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • The clinic offered a convenient location for dialysis treatment in north Hampshire.

  • There was free parking at the clinic, which patients appreciated.

  • The clinic was suitably designed for the delivery of dialysis services.

  • Staff met the individual needs of patients, by taking account of pre-admission assessments.

  • New patients could visits the clinic before they were admitted, to familiarise themselves with the environment and procedures. They also had a patient guide and welcome pack.

  • Staff helped patients to arrange holiday dialysis.

  • The clinic operated a ‘batched’ appointment system to reduce waiting times for patients.

  • Patients were given the Fresenius complaints policy and procedure, and this was displayed in the waiting room.

  • Staff displayed useful information for patients in the waiting room, including results of the patient survey and associated action plan.

Well-led

Updated 10 August 2017

We do not currently have a legal duty to rate dialysis services.

We found the following areas of good practice:

  • Staff said they were well supported by the clinic leadership team and by colleagues. They said they liked working at the clinic and the manager was approachable.

  • Clinic and trust staff worked collaboratively to support the needs of patients.

  • Staff understood their roles and responsibilities and made patient care their priority.

  • The manager attended monthly clinic manager meetings at the NHS hospital, where the trust’s haemodialysis lead shared updates. He also attended regional and national meetings quarterly.

  • There was a patient representative, whose role was to liaise between patients and the clinic manager.

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

  • The clinic’s governance arrangements did not include effective local risk management.

  • The clinical governance framework did not promote frequent scrutiny and challenge of clinic performances.
Checks on specific services

Dialysis Services

Updated 10 August 2017