Great Bridge Kidney Treatment Centre is operated by Diaverum Facilities Management Limited. It was awarded the contract as part of a partnership agreement with University Hospitals Birmingham NHS Foundation Trust. It provides haemodialysis services for adult patients living with chronic kidney failure. The centre has 24 dialysis stations including four isolation rooms.

The nurse-led centre was supported by renal consultants employed by the NHS trust. The centre’s manager was responsible for the centre and dealt with all daily nursing and patient queries. The nursing director for Diaverum Facilities Management Limited had overall responsibility for nursing staff.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 31 May 2017, along with an unannounced visit to the centre on 13 June 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 treated patients with care and dignity.

• The centre was one of the best performing centres within Diaverum Facilities Management Limited during April 2016 and March 2017.

• The whole centre was visibly clean and tidy.

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

• The centre held monthly quality assurance meetings with the NHS trust 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 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.

• 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:

• Not all staff including the manager had completed their yearly clinical competency for aseptic non touch technique.

• Compliance with aseptic non touch technique and hand hygiene was variable.

• One nurse used a technique called dry needling incorrectly.

• Staff were not always performing the correct identity checks before commencing dialysis or administering medicines. One patient did not have a signed consent form for dialysis.

• Storage of sodium chloride and antiseptic solution was not adequate.

• There was out of date stock in the storeroom, and there were no supplies of intravenous administration sets on the announced inspection.

• Staff did not check the emergency equipment trolley each day it was in use and were not aware the emergency medicines had expired on the day of the announced inspection.

• Staff were not recognising the risks we saw during our inspection or escalating them appropriately.

• The centre did not offer staff safeguarding childrens training, despite allowing children onto the unit.

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 two requirement notices. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals