Aston Kidney Treatment Centre (the centre) is operated by Diaverum Facilities Management Limited. The service has 24 dialysis stations. Facilities include four isolation rooms, two consulting rooms, two meeting rooms and an office room.

Diaverum was awarded the contract as part of a partnership agreement with a local NHS trust to provide haemodialysis adults over 18 years living with chronic kidney failure.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 28 June 2017, along with an unannounced visit to the centre on 3 July 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.

We regulate dialysis services but we do not currently have a legal duty to rate them when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve:

• The process of incident reporting, investigation, and learning from incidents was poor with a lack of understanding of good governance processes.
• Staff did not have the required level of knowledge and understanding to meet the duty of candour requirements.
• We found several safety concerns with medicines management, which were not in line with safe medicine standards. This included issues with storage, prescription, administration and documentation of medicines.
• The centre could not evidence annual competency records including aseptic non-touch technique. Training records were not up-to-date.
• Overall, compliance with aseptic non-touch technique and hand hygiene was variable. We found that not all staff followed correct infection prevention and control policies.
• There were issues with access to the centre building including access to parking facilities.
• Staff at the centre were in the process of receiving mental capacity awareness training. The practice development nurse confirmed this training did not include deprivation of liberty safeguards.
• The manager did not recognise the risks we observed during the inspection or escalate them appropriately.
• Safeguarding knowledge and awareness was not sufficient to provide assurance that staff were aware of actions to take.
• The centre did not adequately support patients who did not speak fluent English. We were concerned patients would not be able to communicate if they felt unwell or give informed consent.
• Staff did not adequately maintain patient dignity.
• Most records we viewed did not contain suitable and adequate risk assessments to ensure the health and safety of patients receiving care or treatment.
• The centre was experiencing issues with some patients accessing dietitian support. This had not been identified as an issue by the centre,
• The centre was not labelling clinical waste bags in line with regulations.
• We saw staff breach information governance requirements and did not adequately protect patient information from non-authorised access.
• Effective processes were not in place for identifying, recording and managing risks. Concerns identified by the inspection team had not been identified on the risk register. We raised our concerns with the centre manager who did not respond appropriately to concerns raised at the announced visit.
• The overall leadership and governance of the centre needed strengthening.There was no evidence of a learning culture.The centre did not proactively seek patient safety and care quality improvements.

However, we also found the following areas of good practice:

• Staffing levels were maintained in line with national guidance to ensure patient safety. Nursing staff had direct access to a consultant who was responsible for patient care. In emergencies, patients were referred directly to the local NHS trust and the emergency services called to complete the transfer.
• Overall, the unit achieved effective outcomes for their patients.
• The centre delivered high flux dialysis to all patients and haemodiafiltration to 99% of patients. These are the most effective forms of treatment for kidney failure.
• Staff worked flexibly, working over their hours when needed for the interests of patients.
• Staff were caring and friendly. They knew their patients well and looked after them with compassion and understanding.
• Overall, feedback from patients was consistently positive about the nursing staff delivering day-to-day care. The service had received three complaints in the 12 months preceding our inspection.
• There was effective multidisciplinary working between centre staff and the referring NHS trust.

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.

Full information about our regulatory response to the concerns we have described in this report will be added to a final version of this report that we will publish in due course.

Heidi Smoult

Deputy Chief Inspector of Hospitals