Crewe Renal Dialysis Unit

Updated 26 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service provides haemodialysis treatment to adults. The Crewe dialysis unit opened in 2013 and primarily serves the Crewe and Leighton area population, with occasional access to services for people who are referred for holiday dialysis.

The registered manager (clinic manager) was available on the day of CQC inspection and we met the regional business manager and the regional lead nurse. Fresenius Renal Health Care UK Ltd has a nominated individual for this location.

The clinic is registered for the following regulated activities - Treatment of disease disorder or injury.

Updated 26 September 2017

Crewe Dialysis Unit is operated by Fresenius Medical Care. The service has 18 stations for dialysis. There are on average 780 treatments sessions delivered a month. The service provides dialysis services for people over the age of 18, and does not provide treatment for children.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 7 June 2017 along with an unannounced visit to the clinic on 13 June 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.

We regulate dialysis 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:

• Staff had been trained in the safeguarding of adults and children and were aware of their responsibilities in this regard.
• The unit was visibly clean and tidy and we observed good infection prevention and control procedures to be followed.
• There were adequate staff to meet the needs of the patients.
• Care and treatment at the unit was evidence based and provided in line with the provider’s Nephrocare Standard Good Dialysis Care. The unit’s policies and procedures took into account professional guidelines, including the Renal Association Guidelines and research information.
• Data relating to the unit’s treatment performance was submitted to the commissioning trust for inclusion in the renal registry, and the unit was benchmarked against the provider’s other units across the country.
• A monthly clinic review was completed and actions were taken where the expected targets were not achieved.
• All staff were trained in intermediate life support.
• Staff received an annual appraisal of their work and set objectives for the year ahead.
• There was a thorough induction for new staff.
• There was a good system of multi-disciplinary working through weekly review meetings.
• The annual patient survey indicated that patients felt that staff were caring, treated them with dignity, and explained things in a way they could understand.
• Where issues had been raised by patients these had been addressed by the clinic manager.
• Patients were supported to deliver their own care within the unit, or progress to home dialysis.
• The individual needs of patients were taken into account for example changes to times and length of treatment for social events.
• Individual plans were in place to help patients coming from other units or transitioning from children’s’ services.
• Family members were supported to be present if a patient wished this to occur.
• Staff addressed any dissatisfaction from patients quickly to prevent it escalating into a formal complaint.
• The unit had effective systems to monitor and action areas of governance and risk.
• The clinic undertook some staff and patient engagement and acted on feedback they received.
• Staff felt their leaders were visible and listened to them.
• Staff felt able to raise any concerns or issues they had.

However, we also found the following issues that the service provider needs to improve:

• Incidents which required notification to the Care Quality Commission under the (Registration) Regulations 2009: Regulation 16 had not been reported.
• Not all staff were up to date with mandatory training.
• Medicine storage for one frequently used medicine was not secure and the administration of medicines by dialysis assistants did not meet the provider’s policy. This was brought to the attention of the manager during the inspection.
• A process for providing medicines to people other than patients at the unit had been established. The storage and provision of these medicines did not meet with safe medicine management guidance. This process was stopped during the inspection.
• Patient observation records were not consistently completed on both the paper and electronic systems.
• There was no escalation process should a patient’s condition deteriorate. There was no sepsis management pathway.
• The records for staff competency assessments had not been fully completed.
• The procedure for obtaining consent from patients with impaired mental capacity was not understood by staff. We found one example of where this had been done incorrectly. This was brought to the attention of the manager during the inspection.
• There was no access to psychological support through the clinic or the commissioning trust. This had to be accessed via the GP. Also there was no advocacy service representative at the clinic.
• There was no audit of the transport arrangements and no patient transport group in the clinic.
• There was no patient changing area or storage facility for outdoor clothing or bags.
• There was no procedure to audit the rate or reasons for patients not attending the clinic.
• The senior staff were unclear about any admission criteria for the clinic.
• Staff were not able to articulate the organisation vision and values.
• There was limited patient engagement and there was no patient group.

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 two requirement notices. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals North West