North Devon Satellite Dialysis Unit

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well. However, when learning was identified it was not always embedded in practice. The service did not always manage infection control well or manage medicines according to provider policy.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients told us the service went over and above to ensure there were no delays to their treatment, even when a recent incident with the building meant patients needed to be treated at other locations. Some patients told us they had some difficulties accessing their electronic patient care system but staff worked with the wider Fresenius teams to provide alternative ways to get information and fix the problem. Patients told us they understood the choices available to them and were provided information and explanations from staff whenever they needed it.

We observed learning was not always embedded in practice. For example, learning from a serious incident had identified actions that were meant to have been taken but we observed and identified they had not been completed. However, staff were supported by newsletters, emails, meetings to ensure learning was heard and known.

We found the provider guidance documents did not always reflect the learning from serious incidents such as the checking of blood connections. However, learning systems and processes were present both locally and at brand level. Investigations and incidents were captured in standardised documentations and the information shared with staff through newsletters and meetings to support learning being taken forward. The provider shared the learning from incidents at all Fresenius locations. Evidence of actions taken to address areas for learning was recorded in minutes of governance meetings and action plans.

Patients were given an information pack about their treatment. They were encouraged to visit the unit before starting treatment and all new patients were given an information letter. All patients received a transfer letter with all pertinent information when moving between services. The unit provided patients with details of ‘My companion’ application they could download for information. There was a suggestion/complaints box on the unit for patients to post in. There was a patient forum which met quarterly to discuss and share experiences. Fresenius had a patient experience team and patient experience champions on each unit.

At the last inspection, there was no proper policy and specific staff training for the early identification of sepsis in line with national guidance (NHS England, 2015). Although we requested a copy of the Sepsis policy, it was not forthcoming. The provider sent staff training certificates, 8 in total, all completed after the inspection date. We saw that patients had an individual dedicated booklet which contained an assessment pathway including risk factors for sepsis. Due to the ongoing nature of treatment, these booklets were designed to last several months. Staff knew how to escalate concerns for a patient who may be deteriorating due to sepsis.

The service had regular meetings with the local NHS trust which commissioned its services. The meeting minutes were comprehensive and considerate of performance and capacity, service improvements, learning and forward planning. The provider had systems to ensure the service was well maintained.

The service had regular engagement and commissioning meetings with system partners including the local NHS Trust. The unit treated patients referred from the local NHS trust. Patient details were integrated into the patient administration system. The electronic recording system flagged patient risk and critical information to staff. All staff were reminded to check this through the safety huddle and the information is also noted on the board behind the patient’s bed/chair.

People told us they felt safe with the staff that supported them and were confident to raise any concerns they might have.

Staff had training on how to recognise and report abuse. The service offered level 2 & 3 safeguarding training to staff and level 4 to senior leaders. Staff understood their safeguarding responsibilities and were aware of internal and external reporting processes. Service leaders notified the relevant authorities where required.

There were current policies and processes to reduce the risk of people being exposed to harm or abuse. The service had a safeguarding policy which incorporated the Mental Capacity Act, 2005 and Best Interests. This said, the policy was not representative of all current practice. For example, there was no reference to Deprivation of Liberty Safeguards (DoLS), instead the policy detailed Liberty Protection Safeguards (LPS), which at the time of assessment was not the legal framework used in practice. We fed this back through the brand level engagement as this policy was a provider level policy and would be applicable to all Fresenius sites. The service completed regular audits of consent in line with their minimum policy requirements of a minimum of every 3 months. We reviewed August and October audits which showed 100% compliance with consent recording in patient documentation.

People told us they were involved in making decisions about their care and support. However, we identified issues, such as handwashing practice, that did not meet the standards required and potentially put patients at risk.

Staff were aware of and knew where to find information about people's risks. Staff told us that changes were communicated to them through a number of different channels, for example internal messages and staff meetings. Patient records contained assessments to identify, mitigate and manage risks to reduce the risk of harm. For example, risks around mobility, equipment, and the environment were recorded. However, we identified issues, such as handwashing practice, that did not meet the standards required and potentially put patients at risk.

The service had pathways and processes to support with the risk assessment, identification and treatment of deteriorating patients. There were care pathways for staff to follow, including flow charts, if patient's experienced medical/ technical complications during treatment. Staff shared key information to keep patients safe when handing over their care to others. Shift changes and handovers included all necessary key information to keep patients safe. However, we identified issues, such as handwashing practice, that did not meet the providers standards or policy and potentially put patients at risk.

Staff responded quickly when called.

Leaders told us about the systems for maintaining equipment. They told us about daily safety checking of specialist equipment. We checked the completion records for this and found there were no gaps.

The design of the environment followed national guidance. The service had suitable facilities to meet the needs of patients' families. The service had enough suitable equipment to help them safely care for patients. Staff disposed of clinical waste safely.

The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them.

People told us they were supported by a friendly staff team who knew them well. Patients we spoke with told us they felt the staff had the skills to support them safely.

Staff felt well supported by the service leadership and felt confident to raise any concerns. They felt they were able to meet people’s needs. Staff confirmed they received support through supervision and appraisal.

The service had enough nursing and support staff to keep patients safe.

The mandatory training was comprehensive and met the needs of patients and staff. Managers monitored mandatory training and alerted staff when they needed to update their training. Managers limited their use of bank and agency staff and requested staff familiar with the service. Managers made sure all bank and agency staff had a full induction and understood the service. The manager could adjust staffing levels daily according to the needs of patients.

People told us they were supported by a friendly staff team who knew them well. Patients we spoke with told us they felt the staff had the skills to support them safely. However, we observed staff handwashing practices which did not meet the standards required and potentially put patients at risk.

The service completed monthly IPC and hand hygiene audits. There was a detailed action plan kept and the actions were documented once followed up. Compliance was not 100%. However the service showed clear actions and learning which was recorded well. However, we observed poor handwashing practice that did not meet the standards required and potentially put patients at risk.

Staff did not always know which items of equipment had been cleaned, this is clean stickers were not consistently used and hand washing was not consistently completed by staff. We found out of date curtains in clinical areas and observed staff moving between patients without changing personal protective equipment. We also observed handwashing practice that did not meet the standards required and potentially put patients at risk.

Clinical areas were visibly clean and well-maintained. The service generally performed well for cleanliness. We found cleaning records were not always up-to-date and would not demonstrate all areas were cleaned regularly, for example, the cleaning of bed spaces after the patient left the unit.

Staff followed systems and processes to prescribe and administer medicines safely. Staff reviewed each patient’s medicines regularly and provided advice to patients and carers about their medicines.

Staff did not always manage medicines well but prescribing documents were kept safely. Staff followed national practice to check patients had the correct medicines when they were admitted or they moved between services.

Staff completed medicines records accurately and kept them up-to-date. We observed the medicines keys left unattended on the unit.

Policies and processes followed best practice guidance. However, they were not always updated following learning from serious incidents. We found the medicine keys were left unattended which was not in keeping with the providers policy.