Kings Norton Kidney Treatment Centre is operated by Diaverum Facilities Management Limited.

It provides haemodialysis services for adult patients living with chronic kidney failure including those with hepatitis B and HIV. The centre has 20 dialysis stations including four isolation rooms.

We inspected the centre using our comprehensive inspection methodology. We carried out an unannounced inspection of the centre on 17 October 2018.

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 rated this service as requires improvement overall.

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

• Staff relied on familiarity to identify patients instead of prescribed formal checks as outlined in local protocols. Patient records did not always contain a photograph of them to provide an additional form of visual identification to help keep patients safe, particularly when administering medication. Staff should follow local procedures and ensure all patient checks are carried out when administering medication to keep patients safe.

• Staff did not always observe infection prevention control and appropriate use of personal protective equipment to ensure risks of cross contamination were prevented. Staff did not always use aseptic technique practices and procedures, which meant applying the strictest rules to minimise the risk of infection.

• Staff did not always follow best practice to keep everyone safe from harm. For example, they did not always dispose of sharps safely, which increased the risk of needle stick injury and cross contamination. Staff did not always dispose of clinical waste appropriately.

• The service did not always have access to spare equipment, for example, scales to ensure patients received accurate measurements in advance of treatment.

• Fire regulations were not always observed. For example, a fire door was propped open, which did not meet fire safety regulations and presented a safety risk to those in the building.

• Loose leaf patient information was not always stored securely in folders. This increased the potential risk of medication errors and the potential for breach of confidentiality.

• Patients with English as a second language were not always provided with a translator to help them understand information that was being relayed about their treatment. All patients should have access to an interpreter when English is not their first language when providing consent to treatment.

• Managers did not always carry out investigations relating to incidents or make use of them for learning opportunities or to improve outcomes.

• Managers did not always provide timely statutory notifications to the Care Quality Commission following serious incidents.

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

• There were good systems and processes to ensure staff met mandatory training requirements and oversight of compliance was provided by an onsite practice development nurse.

• Staff were trained to understand the principles of safeguarding both patients and children.

• The premises were clean and tidy and people had access to resources to practice infection prevention control.

• Side rooms were available for patients identified as a high risk of infection.

• There were technical personnel on hand to ensure the environment and equipment were maintained and in working order.

• Patients who were planning holidays were managed to ensure they received appropriate treatment while away. They were safely managed upon return, with special consideration for those patients returning from high risk areas.

• Staff demonstrated a good understanding of the key principles of the Mental Capacity Act 2007.

• Patients told us staff were caring and compassionate and we saw this in practice.

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 that affected the service. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals

Kings Norton Kidney Treatment Centre is operated by Diaverum Facilities Management Limited. It was awarded the contract as part of a partnership agreement with a local NHS trust. It provides haemodialysis services for adult patients living with chronic kidney failure including those with hepatitis B infection. The centre has 20 dialysis stations including four isolation rooms.

The nurse-led centre is supported by renal consultants employed by the local trust who contract the service. The nursing director for Diaverum Facilities Management Limited has overall responsibility for nursing staff.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 25 April 2017, along with an unannounced visit to the centre on 3 May 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.

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:

• Nursing staff used appropriate infection prevention and control practices when treating patients.

• The whole centre was visibly very clean and tidy.

• IT systems between the centre and trust allowed healthcare professionals to communicate easily and coordinate care effectively.

• The centre had effective processes for reporting and management of incidents.

• The centre held monthly quality assurance meetings to discuss all issues relating to service delivery.

• All patients knew how to complain, the centre responded to complaints in line with its local policy.

• We saw all staff worked well together and supported one another during busier periods.

• The consultant nephrologist and dietitian from the NHS trust regularly held clinics at the centre to review patients’ medical and nutritional needs.

• Nursing staff treated patients with care and dignity.

• Patients we spoke with told us all nurses were kind, caring and hardworking.

• The centre had access to additional support from a clinical psychologist and renal social worker if patients needed additional support.

• Treatment was provided in line with national guidance.

• The centre was one of the best performing centres within Diaverum Facilities Management Limited during October and December 2016.

• Patients and staff told us the centre’s manager was accessible, supportive and responsive.

• The centre’s opening hours were appropriate to allow patients to attend for their regular treatment.

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

• Oxygen cylinders were not stored safely in line with regulations.

• Staff were not labelling clinical waste bags in line with regulations.

• Patients sat in the waiting area could overhear conversations held in consulting rooms.

• Some patient records were not always stored securely.

• The manager had not completed their yearly clinical competencies since 2016.

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 to help the service improve. We also issued the provider with three requirement notices. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals