Bath Kidney Care Centre

Updated 13 February 2023

Bath Kidney Care Centre is operated by Fresenius Medical Care Renal Service Limited. The centre provides dialysis treatment for patients living in Bath and the surrounding area. Dialysis treatment replicates the function of the kidneys for patients with advanced chronic kidney disease.

The unit has 16 dialysis stations, including two isolation rooms, and currently provides two dialysis sessions each day from Monday to Friday. The centre is accommodated in a building which was re-designed to accommodate a dialysis service.

The service is commissioned by NHS England. The service works closely with an NHS trust (referred to as the ‘parent NHS trust’) who refer patients for dialysis and retain clinical oversight and responsibility for patient treatment.

The centre is registered to provide the regulated activity of treatment of disease, disorder and injury for older and young adults over the age of 18.

The centre has a registered manager who has been in post since the centre opened.

The centre was registered with the Care Quality Commission in September 2019 and opened on 30 September 2019. This was the first time we inspected the centre.

Updated 13 February 2023

This was the first time we rated the service. We rated it as requires improvement because:

• Staff did not always follow principles for infection prevention and control. Not all staff wore the recommended personal protective equipment and waste was not managed safely.
• Staff administered oxygen which was not prescribed. This was not in line with national guidance.
• Recruitment checks were not always carried out in line with legislation.
• Systems and processes to ensure governance oversight and risk management was not always effective. There was no local risk register and the registered manager did not have ownership or input to local risks or how these were escalated.
• Daily checks of equipment were not always carried out.
• The service did not use a national tool to help staff to identify patients who deteriorated and to promote effective communication when concerns about patients were raised.
• Substances hazardous to health were not always stored securely.
• Arrangements to ensure patients’ dignity was maintained were not always effective.
• Patient safety huddles did not always include all relevant information about patients.
• Statutory notifications were not always submitted in line with legislation
• Not all staff were up to date with their mandatory training. There were no staff with a higher level of safeguarding training to provide support if required.
• Cleaning schedules did not clearly include arrangements for cleaning of the storeroom floor.
• Incident investigations were not carried out in a way that promoted learning or areas for service improvement.
• Not all staff were aware of who the freedom-to-speak-up guardian was.

However:

• There were enough staff to care for patients and provide dialysis treatment.
• Staff assessed risks to patients and acted on them and mostly managed medicines well.
• Staff recorded patient care and treatment clearly.
• Patients had access to a dietitian for advice and guidance regarding fluid and nutrition in line with national guidance.
• Managers monitored the effectiveness of dialysis treatment and made sure all staff were competent.
• Staff worked well together and with key staff from the NHS parent trust to provide effective patient care and treatment.
• Staff treated patients with compassion and kindness. Staff understood the impact dialysis had on patients and provided support for patients and their carers.
• The service planned care to meet the needs of local people and took account of patients’ individual needs.
• Leaders had the skills and knowledge to run the service using reliable information systems and supported staff to develop.
• Staff felt respected, supported and valued and were focused on the needs of patients.
• The service engaged with patients through regular patient surveys and formulated action plans where service improvement opportunities were identified.

We rated this service as requires improvement because safety and leadership required improvement, although effective, caring and responsive was rated as good.

Updated 13 February 2023

This was the first time we inspected the service. We rated it as requires improvement because:

• Staff did not always follow principles for infection prevention and control. Not all staff wore the recommended personal protective equipment and waste management was not managed safely.
• Staff administered oxygen which was not prescribed in line with national guidance.
• Recruitment checks were not always carried out in line with legislation.
• Systems and processes to ensure governance oversight and risk management were not always effective. There was not a local risk register and the registered manager did not have ownership or input to local risks or how these were escalated.
• Daily checks of equipment were not always carried out.
• The service did not use a national tool to help staff to identify patients who deteriorated and to promote effective communication when concerns about patients were raised.
• Substances hazardous to health were not always stored securely.
• Arrangements to ensure patients’ dignity was maintained were not always effective.
• Patient safety huddles did not always include all relevant information about patients.
• Statutory notifications were not always submitted in line with legislation
• Not all staff were up to date with their mandatory training. There were no staff with a higher level of safeguarding training to provide support if required.
• Cleaning schedules did not include arrangements for cleaning of the floor in the storeroom.
• Incident investigations were not carried out in a way that promoted learning or areas for service improvement.
• Not all staff were aware of who the freedom-to-speak-up guardian was.

However:

• There were enough staff to care for patients and provide dialysis treatment.
• Staff assessed risks to patients and acted on them and mostly managed medicines well.
• Staff recorded patient care and treatment clearly.
• Patients had access to dietitian for advice and guidance regarding fluid and nutrition in line with national guidance.
• Managers monitored the effectiveness of dialysis treatment and made sure all staff were competent.
• Staff worked well together and with key staff from the NHS parent trust to provide effective patient care and treatment.
• Staff treated patients with compassion and kindness. Staff understood the impact dialysis had on patients and provided support for patients and their carers.
• The service planned care to meet the needs of local people and took account of patients’ individual needs.
• Leaders had the skills and knowledge to run the service using reliable information systems and supported staff to develop.
• Staff felt respected, supported and valued and were focused on the needs of patients.
• The service engaged with patients through regular patient surveys and formulated action plans were service improvement opportunities were identified.