Diaverum Dialysis Clinic - Lings Bar

Updated 17 December 2019

Diaverum Dialysis Clinic – Lings Bar Nottingham is operated by Diaverum UK Limited. The service is an independent single specialty provider of dialysis in Gamston, Nottinghamshire. The unit primarily serves the community of south Nottingham. It also provides haemodialysis for those patients from outside the area who may be on holiday.

The service has a registered manager in post, who at the time of the inspection, had recently been appointed and had registered with the CQC in July 2019.

We inspected this service on 15 October 2019 using our comprehensive inspection methodology. The inspection was unannounced (staff did not know we were coming).

The facility is based within Lings Bar Hospital. The service has 12 treatment stations and is open Monday to Saturday from 6.15 am to 6.15pm. Facilities include three side rooms for patients requiring treatment in isolation.

There is a service level agreement with a local NHS trust to provide haemodialysis (HD) to adults over the age of 18.

Most patients use hospital arranged transport, to and from the facility with a small number using their own transport. There are designated parking spaces for those who wish to drive, including two disabled parking bays.

Diaverum works closely with the referring Trust. It is a nurse led clinic with weekly visits from the consultant nephrologist and trust dietitian. There are monthly multidisciplinary team (MDT) meetings held with the consultant and clinic manager/senior staff nurse.

Staff within the clinic can access an NHS email account to ensure patient confidentiality. Staff also have access to electronic records and IT systems to collate blood and virology results.

Arrangements for emergency patient care i.e. cardiac arrest, are via a 999 call to the paramedic ambulance service. All staff have basic life support training and all required equipment was on site. Registered Nurses have ILS training as required from Trust.

Updated 17 December 2019

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:

• The clinic was well staffed and consistently met the required nurse to patient staffing ratios.

• Staff had completed mandatory training and competencies and were suitably skilled for their roles.

• There were processes in place for safe medicines management.

• Patients were complimentary about the care they received at the clinic.

• There was a consistent approach to record keeping and records were stored securely.

• 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.

• 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:

• 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.

• 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.

• 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.

• Complaints information was not clearly displayed or widely available to patients- there were no complaints leaflets or posters available within the clinic.

• 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)

Updated 17 December 2019

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service generally controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. 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. Key services were available six days a week.

• 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. People could access the service when they needed it.

• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

There were often long waits before and after treatment due to transport issues. It was not always easy for people to give feedback and raise concerns about care received as there were no complaints leaflets or posters available in the clinic. Leaders did not always follow effective governance processes to ensure that patient risks were identified and managed.