Archived: Sutton Dialysis Unit

Sutton Dialysis is operated by Fresenius Medical Care Renal Services Limited. The service is situated on a main high street with surrounding shops and offices.

The service has 24 dialysis stations. Facilities include eight isolation rooms located on the ground floor of the unit; three consulting rooms, a meeting room, and the main dialysis area are located on the first floor of the unit.

Dialysis units offer services, which replicate the functions of the kidneys for patients with advanced chronic kidney disease. Dialysis is used to provide artificial replacement for lost kidney function.

The service provides dialysis services for patients referred by St Helier Hospital, part of the Epsom and St Helier University Hospitals NHS Trust. 100% of patients receiving dialysis at the unit are funded by the NHS.

The Care Quality Commission had received one death notification and one serious injury notification from the unit in the previous 12 months.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 16 May 2017, along with an unannounced visit to the centre on 26 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? 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. 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:

• There was appropriate management and reporting of incidents and maintenance programmes. All staff were aware of their roles and responsibilities in ensuring patient safety. Effective processes were in place for the provision of medicines. These were stored and administered in line with guidance and staff completed competencies annually to ensure they continued to administer medicines correctly.

• Staff stored patients’ medical and nursing records securely. All staff had access to all relevant records ensuring that patients’ care was as planned and not delayed.

• Staff worked collaboratively with the local NHS trust to monitor and assess patients regularly.

• Staffing levels were maintained in line with national guidance to ensure patient safety. Nursing staff had direct access to a consultant who was responsible for patient care. In emergencies, patients were referred directly to the local NHS trust and the emergency services called to complete the transfer.

• Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident. Patients were able to continue their treatment at alternative centres or the NHS trust hospital.

• All policies and procedures were based on national guidance and compliance was monitored through an effective audit programme.

• Patients’ pain and nutrition was assessed regularly and patients were referred to appropriate specialists for additional support as necessary.

• There was a comprehensive training and induction programme in place to ensure staff competency. Training compliance was 100%.

• There were processes in place to ensure effective multidisciplinary team working, with specialist support provided by the local NHS trust.

• Patients were treated with respect and compassion.

• Staff were familiar with and worked towards the organisational vision and values.

• Quality assurance meetings occurred regularly and included the local NHS trust.

• There was evidence of effective national and local leadership, with accessible and responsive managers.

• All staff and most patients were positive about the service.

However,

• Staff did not adhere to correct infection control procedures at all times, including the use of personal protective equipment and when removing sterile equipment from packaging.

• There were no clear procedures in place for staff to respond to a patient with sepsis symptoms.

• Staff were not fully conversant with the Duty of Candour and how the duty is applied in practice.

• Staff did not have safeguarding children’s training in accordance with national guidance.

• Independent translation services where not always used when obtaining patients consent to care and treatment.

• The main risks identified to the service by local staff were different from the risks identified on the centre’s risk register.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Professor Edward Baker

Chief Inspector of Hospitals

London South Region