Archived: Purley Dialysis Unit

Updated 25 July 2017

Purley Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The service is a private unit and opened in 2010 to provide haemodialysis to NHS patients primarily from the local area of Purley in South London. This was in response to the agreement with the local NHS trust to provide dialysis to their patients within their local area.

The service has a 10 year contract ending in February 2020 with the local NHS trust to provide dialysis treatment for their NHS patients. The contract was a partially managed service with equipment and staff supplied by the provider. The building and some facilities, such as lifts, were managed by the building landlord.

The service had a registered manager in post since 2013.

The service is registered with CQC for the regulated activity of diagnosis and treatment of disease.

There were no special reviews or investigations of the clinic ongoing by the CQC at any time during the 12 months before this inspection. The service has been inspected once using our old inspection methodology. The most recent inspection took place in April 2012 which found that the service was meeting all standards of quality and safety it was inspected against.

Updated 25 July 2017

Purley Dialysis Unit is an independent healthcare location operated by the provider, Fresenius Medical Care Renal Services Limited. Purley Dialysis Unit is commissioned by a local NHS trust to provide a dialysis service for NHS patients over the age of 18 years with renal disease, who are considered low risk and do not require dialysis in the hospital. The clinic has a contract with the trust for 24 stations, four isolation rooms and a consulting room for the consultant outpatient clinics.

We inspected this service using our new comprehensive inspection methodology. We carried out the announced part of the inspection on 9 May 2017, along with an unannounced visit to the clinic on 19 May 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?

Before visiting the unit, we reviewed a range of information held about the service and asked other organisations and stakeholders to share what they knew.

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. 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:

• The service had infection prevention and control systems and processes, which reduced the risk of cross infection.

• The clinic was visibly clean and there were arrangements in place for infection prevention and control. There was no reported incidence of infection. The environment met hygiene standards for dialysis clinics.

• Patient medical and nursing records and other personal information were stored securely.

• There was an effective process in place for the provision and administering of medicines. Staff stored and administered medicines appropriately. The service had an effective process in place for medication audit.

• There were robust policies and procedures in place that guided staff in their practice and ensured patients safety. Policies were based on national guidance and were accessible to staff.

• Staff assessed and monitored patients’ pain and nutrition regularly and referred appropriately to the hospital specialist for support when necessary.

• Patients and staff had access to timely and relevant information that facilitated patients’ care and treatment.

• Staff received annual appraisals and competency assessments.

• The service managed staffing effectively and there were enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.

• The clinic participated in and used the outcomes from local and external audits to develop and implement patient care and treatment pathways. The unit participated in the renal peer review audit through their local NHS trust.

• The service had a consent process in place and we observed that documentation was accurate and signed.

• Staff worked effectively and collaboratively with the commissioning NHS trust and other professionals to monitor patients regularly and support their treatment.

• Staff understood the impact of dialysis treatment and worked to make the patient experience as pleasant as possible and meet individual patient needs.

• Patients were treated with respect, dignity and compassion by staff.

• Patients were provided comprehensive information and had access to support networks including social services, Kidney Patients Association and to the patients’ representative.

• The unit provided a person-centred, caring and compassionate approach in caring for patients through the named nurse system.

• Patients were able to visit the clinic before commencing dialysis treatment in order to familiarise themselves with the facilities, staff and routine.

• The service was planned and delivered to meet the needs of patients in the community.

• The unit provided a flexible appointment system that ensured patients’ preferred treatment sessions were met and could be adjusted to meet their work commitments or social needs.

• The unit had the resources to provide care and treatment for patients with mobility, hearing or visual impairment to ensure safe and effective treatment.

• There was a clear leadership structure in the Fresenius Medical Care organisation which was applied to the Fresenius Dialysis Clinic, with accessible managers.

• The unit had effective systems in place to monitor patients risk and the newly developed risk register reflected local and organisational risks.

• The unit and organisation sought and engaged effectively with patients and staff.

However,

• The grading of harm from incidents and the classification of clinical and non-clinical incidents was not clearly described on incidents forms by staff and did not reflect the reported events. For example patient falls in the clinic were reported under ‘non-clinical’ incidents. We did not see detailed investigations or sharing of lessons with staff to support prevention of falls in the clinic.

• The clinic did not have an early warning score system in place to support staff in recognising a deteriorating patient.

• The unit’s target for completion of staff mandatory training was 100%. At the time of our inspection, compliance with mandatory training was 68% and below the unit’s 100% target.

• Staff were not adequately trained on safeguarding. Staff had received level 1 safeguarding training and the training matrix showed 50% compliance. Following inspection, the provider told us 85% of staff had now completed their safeguarding training in July 2017.

• The clinic did not audit travelling and waiting times for the dialysis patients as a way to ensure quality of the services provided were achieved pre and post treatment.

• We were not assured that staff could recognise patients living with dementia, or would know how to support them.

Professor Edward Baker

Deputy Chief Inspector of Hospitals

Updated 25 July 2017

We regulate this service but we do not currently have a legal duty to rate it. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary .