DaVita (UK) Ltd - Boston Also known as Renal Services (UK) Ltd

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 Good. At this assessment the rating has remained Good.

This meant people were safe and protected from 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 listened to concerns about safety and investigated and reported safety events. Staff knew how to raise a safety incident and felt confident to do so. However, not all staff were able to describe how lessons were learnt or improvements embedded following incidents.

The service used an electronic system to report incidents. Most incidents reported were related to travel delays or to patients not arriving for their treatment. In March 2026 there were 12 reports of patients who failed to arrive for their treatment. This relates predominantly to 2 patients. Having spoken to these patients they are now compliant with most of their treatment sessions. There had been 1 serious incident reported in the previous year. This involved a disconnection. The appropriate action was taken at the time. The incident was investigated and feedback was provided to staff. This feedback was provided at the safety huddle and through a learning bulletin which was sent to all units. In the year 24/25 there had been several reports of issues with water supply coming into the building. There was also a serious incident where a patient suffered a cardiac arrest due to high potassium levels pre dialysis. Staff responded well to this incident.

Staff understood the duty of candour. They knew they were to be open and transparent and give patients and families a full explanation when things went wrong. Staff had safety huddles twice a day. We reviewed the safety huddle documentation. This consisted of a checklist to ensure tasks were completed prior to the beginning of the session. There was a further “discussion record” where information was shared amongst staff. We were told and saw that this was only utilised when there was something to report. There was a record of the shared learning from an aseptic non touch technique conference someone had attended on 17 May 2026 and the feedback from an internal mock CQC inspection 2 weeks prior to our inspection. Learning arising from incidents were shared in this discussion record. When we asked staff about learning from incidents all staff stated that the ones they remembered were many years ago.

The service worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Patients were referred to the unit under the care of the regional renal centre. The leaders of the service met monthly with the regional centre to discuss service provision and quarterly to discuss the key performance indicators. Staff described good access to offsite doctors for advice, support and to prescribe medications. The leadership team also met with the ambulance service who provided transportation for patients every fortnight. Delays in transportation was one of the biggest challenges for the unit. This meeting enabled both services to discuss recent issues and to review what could be done better. Leaders also worked with other providers of care such as care homes, social services and the integrated care board to meet the safety needs of individual patients.

Staff made sure there was continuity of care, including when people moved between different services. There was a standard transfer letter which had recently been reviewed following an incident. The new letter was about to be launched at the time of our inspection. For one patient who had dementia a communication book had been put in place so that information between the 2 providers of care could be shared without reliance on family members or friends.

Patient records at the unit were paper based. There was limited access to the electronic records at the regional centre. When ward rounds were undertaken by doctors’, the doctor made notes about actions to be taken for individual patients. Copies of letters sent to healthcare professionals were copied to the unit.

Staff received training in recognising vulnerable adults and children and how to safeguard them. Compliance with training at level 3 for both adults and children’s safeguarding was 100%. There was a policy in place for staff to follow should this be required. However, when we spoke with 3 staff, they did not recognise the term safeguarding. On further questioning staff indicated that they would take the correct action if they thought someone was vulnerable. However, staff reported that this happened rarely, and some could not remember the last time they had to refer someone to the local authority. There was a number on the wall in the office to contact the local safeguarding team.

Staff were aware of the needs of individual patients and ensured that they were able to meet these. The service treated patients with dementia, and staff were confident in discussing the individual needs of each patient. Staff struggled to give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act without further prompting. Once prompted staff could discuss the arrangements they made for disabled patients.

The service worked with people to understand and manage risks by thinking holistically. The staff had access to policies and procedures to support them to assess the risk of harm and deterioration of a patient’s condition. Staff completed risk assessments for pressure ulcers, falls, use of bed rails, MRSA and a personal evacuation plan. Care plans contained actions to be taken to reduce the likelihood of the patient experiencing harm. Care plans were individualised and recorded patient’s wishes.

Staff used a recognised tool to identify deteriorating patients. The National Early Warning Score (NEWS 2) was used and medical staff made aware if patients deteriorated. In urgent situations a patient would be transferred to the regional renal unit. Staff monitored patients’ arterial access for infection. When patients have dialysis, staff connected a patient's bloodstream to an external machine using an access point. There were three main access points and most patients had either an arteriovenous fistula (AVF) or an arteriovenous graft (AVG). Common complications of access points in general included infection or blocking of the access point. To manage this risk, staff completed an arteriovenous fistula (AVF) and graft record, which included 3 monthly reviews of the flow through the access point, a photograph of the site every 3 months and a monthly documented check of the site. Staff were aware of other complications due to the patient’s condition. For example, staff carried out foot assessments to avoid extra complications.

Staff provided information to patients and their families about what to expect and what to look out for when having dialysis so that patients could manage their condition. Patients reported feeling able to raise any concerns about their health.

The service detected and controlled potential risks in the care environment. The service was a relatively new build and had annual fire and health and safety checks. There was restricted access to the clinical area using a buzzer system. A large waiting room contained chairs for patients to wait for transport on after their dialysis session. There were two individual toilets in this area. The clinical area provided space for 15 beds. Two of these were in side rooms to prevent the spread of known infections. There were curtains around the dialysis stations. These were replaced frequently to minimise the risk of infection.

The service made sure equipment, facilities and technology supported the delivery of safe care. Each bed space had a dialysis machine for it. There were 3 spare machines should a machine breakdown before or during treatment. A technician visited the unit to undertake repairs to machines. Staff made up individualised dialysis packs containing all items needed for each patient. These were individually made up each session. They contained a small box with the patient’s name on it that contained items that were reused, such as a reel of tape, this prevented cross infection between patients.

Staff knew how to report equipment that required maintenance or fixing. There was a policy to support them in doing this. Faulty equipment was easily identifiable to all staff, for example a red cross had been placed on one of the dialysis machines which was awaiting repair. Similarly, staff put locks on cupboard doors and fridges so that it was clear where repairs were required.

The water treatment plant was secure behind a locked door. Staff carried out daily checks when the unit was operational in line with national guidance. A dialysis water treatment plant (often called a Reverse Osmosis or RO plant) is a specialised multi-stage water purification system. This removes chemical and microbiological contaminates from the water used in dialysis. Due to the amount of water dialysis patients are exposed to the water used must meet extremely high purity standards. This prevents the patient becoming unwell. During the previous year the service had multiple occasions when a burst pipe in the area had led to them having to make other plans for patients. This included transferring patients to other centres for their treatment or conducting this at other centres outside of normal treatment hours. Staff worked well with sister sites to ensure that patients did not miss a session. Staff had access to support and advice should anything happen, this included out of hours.

Staff had enough equipment to provide care. This was stored appropriately in the storeroom. However, the working temperature in the storeroom was very cold. The manager told us there were plans to improve the comfort of workers whilst in this area. Substances hazardous to health were appropriately stored in locked cupboards. Waste was separated, stored and disposed of appropriately.

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. The staffing rota demonstrated that there were sufficient staff for each to care for 3 patients. On the day of our inspection a member of staff was unavailable to work at short notice, and a nurse undertook an additional shift to replace this member of staff. We were told that when staff needed time off others generally covered that member of staff. They did not use agency nurses often, as they had some bank staff. When they used agency staff, managers trained and inducted them for working in this area.

Each shift had 5 members of staff on duty and involved in patient care. The manager had 11 hours supernumerary practice to undertake their management responsibilities. The service operated a shift system to cover the days they undertook three sessions. This was on Monday, Wednesday, and Friday. On Tuesday, Thursday, and Saturday, there were 2 sessions.

Staff received training and development to meet the needs of the service. New staff had a supernumerary period before being allocated patients to care for. The staff we spoke with were experienced in dialysis care and had been caring for these patients for years. Leaders informed us that most of the staff came either from other units in the company or from NHS renal units. Therefore, they were knowledgeable about the care given to patients using the service. Staff undertook mandatory training and specialised training, including a 5-day course at the regional renal centre. Mandatory training compliance was good with most staff having completed 97% or more of their mandatory training.

Staff were able to identify their individual training needs at their annual appraisals. The appraisal rate at the unit was 100%. Staff felt well supported to develop their skills and experiences in the field of renal dialysis. The organisation ensured that staff were able to access training to meet their needs

The service assessed and managed the risk of infection. All areas of the unit were visibly clean and tidy. Where space had been used for storage. Staff stored equipment and consumable products in line with best practice. The prevention and control of infection policy was in line with national guidance and in date. This gave clear instructions to staff on how to prevent the spread of infection. Staff cleaned dialysis equipment before and after its use and labelled the equipment as being clean.

All staff followed the Aseptic Non-touch Technique (ANTT) when connecting and disconnecting patients. We observed 3 patients being disconnected and 3 patients being connected to the equipment and this was done using ANTT. 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 and wore the appropriate personal protective equipment (PPE).

Staff detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. Managers undertook hand hygiene, infection prevention and control and cleaning audits to ensure that infections were minimised. Data for March 2026, presented to the regional centre, demonstrated that compliance with hand hygiene was at 92%, hygiene and infection prevention and control was 98% and cleaning at 96%. This data was shared with the regional centre to provide assurance of a safe service.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff followed best practice in medicines management (that is, transport, storage, dispensing, administration, medicines reconciliation, recording, disposal, use of covert medication) and did it in line with national guidance. There was a medicines management policy which reflected national guidance to support staff.

Staff stored most medicines securely. One cupboard door and a fridge were awaiting repair of the locking mechanism. The manager had taken action to reduce the risk of medicines loss by moving only normal saline into this cupboard. The door to the medicines store was locked and staff gained access using a keypad. Other cupboards were secure and medicine was stored in line with national guidance. Managers obtained medicines from the regional centre under a contract. The service ordered this weekly and the contracted service delivered it. Less regularly used medicines were sourced from a nearby unit in the event of urgent need.

Staff administered medicines and recorded this in line with national guidance including the guidance from professional bodies such as the Nurse and Midwifery Council (NMC). Staff had training in anaphylaxis which enabled them to recognise when someone was having a drug reaction. The NHS renal physician who was based at the local NHS trust prescribed dialysis medicines. This included the prescribing of any patient specific medicines if they needed. The NHS trust renal physician reviewed patients’ dialysis prescriptions to ensure they met each patient’s individual renal needs.

The service also had trained vaccinators who offered influenza vaccinations to patients who were eligible and wanted this. These vaccinations were kept in line with national guidance in a special vaccines fridge where the temperature was monitored and recorded daily. These were administered under a patient group directive which allowed special vaccinators to administer these when required.

Where patients were on regular medicines outside of dialysis, the timing of taking these had been discussed with the patient. One patient explained to us that they had medicine for their blood pressure. On trying to take this prior to dialysis they found that their blood pressure dropped, making them feel faint. They had agreed with nursing staff to take this medicine during their treatment to prevent this.