Clacton-on-Sea Dialysis Unit

Clacton-on-Sea Dialysis Unit is operated by Diaverum UK Limited. The service is commissioned by East Suffolk and North Essex NHS Foundation Trust. The service has eight dialysis stations which are mixed sex. Facilities include a clean utility, a dirty utility, water treatment works and stores.

The service provides haemodialysis to adults aged 18 years old and over who have non-complex needs. The service did not provide haemodialysis to patients under 18 but had undertaken safeguarding and knew how to identify children at risk of harm. Currently the service provides treatment to 32 patients in Clacton-on-Sea and surrounding areas.

We inspected this dialysis service using our comprehensive inspection methodology. We carried out the inspection on 18 February 2020. We provided a short-notice announcement (24 hours) of the inspection as we needed to be sure that key people would be available.

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. We rated it as Requires Improvement overall.

• The service did not always control infection risk well. We observed poor hand-washing and hygiene practices in relation to the service’s aseptic non touch technique. We observed unsafe sharps management practices. We saw that falls assessments were not fully accurate. Not all staff were familiar with the services policy for using a nationally recognised tool to monitor deteriorating patients. We did not see evidence that staff met to discuss incident feedback and look at improvements to patient care. We raised these concerns with leaders following our inspection and received updated policies and training records to address the concerns.
• The service did not have a registered manager and staff told us they felt they did not receive enough support in the absence of a clinic manager. The services governance structures were not fully effective and some of the concerns we identified on inspection including unsafe sharps management practices and poor infection prevention and control practices were unknown. We were not assured that the service’s risk register was detailed enough and actions identified were assigned to people who had left the organisation and did not adequately mitigate risk. The service performed poorly compared to other Provider sites on 11 out of 12 questions on the service’s staff survey.

However:

• Staff provided effective care and treatment, supported patients with dietetic advice on food and drink and assessed and monitored patients regularly throughout their dialysis treatment. The unit manager monitored the effectiveness of the service and made sure staff were competent in their roles. Multidisciplinary team staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait for treatment. Complaints were investigated and responded to effectively.

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 issued the provider with two requirement notices that affected dialysis services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals