15 October 2019
During a routine inspection
Diaverum Dialysis Clinic - Lings Bar Nottingham is operated by Diaverum UK Limited. The service facilities include 12 dialysis stations and an additional three siderooms for use for patients needing to be treated in isolation.
We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection of the service on 15 October 2019.
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 rate
We have not previously rated this service and cannot therefore compare ratings with the last inspection. We rated it as Good overall.
We found good practice in relation to dialysis services:
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The clinic was well staffed and consistently met the required nurse to patient staffing ratios.
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Staff had completed mandatory training and competencies and were suitably skilled for their roles.
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There were processes in place for safe medicines management.
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Patients were complimentary about the care they received at the clinic.
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There was a consistent approach to record keeping and records were stored securely.
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Staff were observed to closely follow infection prevention control procedures when performing invasive procedures. Dialysis machines were routinely cleaned between patients. There were robust systems in place to manage patients with blood borne diseases.
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There were clear governance systems in place for sharing relevant information between staff at all levels.
However, there were areas where the service needs to make improvements:
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We did not observe staff asking patients about their well-being prior to the start of dialysis sessions. This meant that there was a risk that staff were not fully aware of potential risks to patient’s health and well-being prior to them commencing treatment.
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There was an infection control risk due to patients sharing a blood pressure machine and cuff, and a thermometer for taking observations prior to treatment sessions. The equipment was not cleaned between each patient use.
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We found that some equipment was out of date for testing. Although most of this out of date equipment belonged to the acute trust, it was used by Diaverum staff on occasion. There was some out of use / condemned equipment in the clinic which was not labelled ‘do not use’, therefore there was a risk that it was not clear to all staff that the equipment was not safe for patient use.
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Complaints information was not clearly displayed or widely available to patients- there were no complaints leaflets or posters available within the clinic.
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Some patients had long waits between arriving on transport at the clinic and starting their dialysis session. There could also be long waits for transport for patients to return home. This meant that patients often had to spend long periods out of the house in order to receive dialysis treatment.
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, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice. Details are at the end of the report.
Heidi Smoult
Deputy Chief Inspector of Hospitals (Midlands Region)