Forest Dialysis Unit

During an assessment of Dialysis services

Date of assessment 5 November and 18 November 2024.

We carried out this assessment following information of concern around staffing levels, culture and fire safety. We inspected 10 quality statements across the safe, effective, caring and well-led key questions. We have not inspected this service before and ratings for all new providers are set to good following initial registration checks and assessments, and therefore the ratings for the areas that we have not assessed during this assessment remain as good. There was a good safety culture where events were investigated, and learning was embedded to promote good practice. Staff provided safe care and treatment, and the environment had improved and was now safe and well maintained. However, staffing levels were not always adequate to keep the department and people safe. Staff were trained and had the right skills to meet people's needs. However, many staff felt they did not have time to undertake role specific inductions or training. Staff had opportunities to learn and gain experience but not all staff were aware of how to access all training available to them. Staff delivered good care and treatment following evidence-based practice and people had good outcomes. However, medical reviews were not always happening consistently. Staff wellbeing was not always at the forefront and staff had a perceived sense of risk centred around staffing numbers. Some staff did not feel supported or valued. The department was well-led by leaders who embodied the cultures and values of their service. There was good governance and risk management, and a mostly positive culture. The department was prepared for emergencies and major incidents and worked as part of a multi-agency response.

We found 1 breach of regulation 12 in relation to safe and effective staffing and equipment and premises which impacted on care and treatment.

We have asked the provider for an action plan in response to the concerns found at this assessment.

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During an assessment of the hospital overall

Forest Dialysis Unit is operated by Diaverum Facilities Management Limited. The service provides haemodialysis and dialysis for patients in renal failure to NHS patients over the age of 18 under a contract with Gloucestershire Hospitals NHS Foundation Trust. The unit is located in a purpose-built building in a rural area on the outskirts of Cinderford, Gloucestershire. It has 12 dialysis stations, 4 of which are in private side rooms.

Patients typically live in the Forest of Dean although the unit also provides treatment to patients in the area on holiday under an NHS England scheme. Patients receive care in dialysis chairs and the unit is open 6 days per week from 7am to 6.30pm.

The provider registered this location in December 2023. A registered manager had their application under consideration at the time of our assessment and the service is registered to carry out the following regulated activities:

• Diagnostic and screening procedures

• Treatment of disease, disorder or injury

We undertook this assessment in response to some concerns raised with CQC.

We last inspected the service under a previous provider.

We assessed a total of 10 quality statements from the safe, effective, caring and well led key questions and found areas of concern around staff competency checks, medical reviews, and emergency equipment checks. Ratings for all new providers are set to Good following initial registration checks and assessments, and therefore the ratings for the areas that we have not assessed during this assessment remain as good.

We found 1 breach of regulation 12 in relation to safe and effective staffing and equipment and premises which impacted on care and treatment. Staff working at the unit had not had an appraisal or any clinical supervision since the unit was taken over in December 2023. Staff did not have protected or meaningful time to complete mandatory training. Only 67% of staff had undertaken mental capacity training. Regular quality assurance meetings involving the lead consultant responsible for patient care were not always happening. Regular quality assurance checks of resuscitation equipment were not always happening.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.

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