Crawley Kidney Treatment Centre is operated by Diaverum UK Ltd. The centre provides haemodialysis for stable patients with end stage renal disease and failure. Dialysis units offer services which replicate the functions of the kidneys for patients with advanced chronic kidney disease.

The centre opened in 2001 and has been in its present location since January 2015. The facility is a standalone unit within an industrial park operating 24 dialysis stations (comprised of 20 stations in the general area and four side rooms which can be used for isolation purposes).

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 centre on 16 June 2017.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

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.

Services we do not rate

We regulate dialysis services 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:

• There were effective systems in place to keep patients safe. This included appropriate management and reporting of incidents, effective cleaning schedules and maintenance programmes. All staff were aware of their roles and responsibilities in ensuring patient safety.

• Effective processes were in place for the provision of medicines. These were stored and administered in line with guidance and staff completed competencies according to Diaverum UK policy to administer medicines correctly.

• Patients’ medical and nursing records were secure. Staff had access to all relevant records ensuring patients’ care was as planned and not delayed.

• Staff worked collaboratively with the referring NHS trusts to monitor and assess patients regularly. Patients received a verbal explanation. Patients and their GP’s were provided with written updates on their condition and treatment plans. These were provided to them a minimum of monthly.

• Staffing levels were maintained in line with national guidance to ensure patient safety. Nursing staff had direct access to a consultant nephrologist 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.

• Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident. Patients were able to continue their treatment at alternative centres.

• All policies and procedures were based on national guidance and compliance was monitored through an effective audit programme.

• Patients’ pain and nutrition were assessed regularly and patients were referred to appropriate specialists for additional support as necessary.

• There was a comprehensive training and induction programme in place to ensure staff competency.

• There were processes in place to ensure effective multidisciplinary team working, with specialist support provided by the referring NHS trusts.

• There were effective processes in place for gaining patient consent for treatment.

• Patients were treated with respect and compassion. Staff took care to maintain patient dignity and confidentiality when delivering care and treatment.

• The service met the needs of the local population and the needs of individuals attending for dialysis.

• The centre encouraged patients to self care through the ‘shared care’ programme.

• Staff were familiar with and worked towards the organisational vision of providing the best possible care for renal patients.

• There were effective processes in place to monitor risks associated with the service and individual patients. Quality assurance meetings occurred regularly and included the referring NHS trusts and specialists.

• There was evidence of strong national and local leadership, with accessible and responsive managers.

• All staff and patients were positive about the service.

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

• No staff had received specific training to recognise sepsis in patients despite the patients being a high risk group. This was not in line with national guidance.

• Best practice guidelines advise two registered nurses check at the point of administration of intravenous medicines. We saw the sodium chloride (0.9%) prepared by staff was not checked by a second nurse.

• The provider did not have plans in place to implement the Workforce Race Equality Standard (WRES) requirement.

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 that affected Crawley Kidney Treatment Centre. Details are at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals