We undertook an unannounced focused inspection of the supported self-care unit (SCU) in the Mary Rankin Dialysis Unit at St Pancras Hospital Kidney Care Centre which is operated by the Royal Free London NHS Foundation Trust.

The inspection was conducted because the Care Quality Commission (CQC) had received anonymous information that patients were being left without proper supervision by qualified nursing staff.

During our inspection we found that patients had been left for short periods of time, up to an hour during staff breaks leaving only one nurse or health care assistant on the ward. There was no evidence that patients had been harmed prior to our inspection but there was an unnecessary risk at these times.

On the day of our inspection the trust took immediate remedial action to ensure that at all times there were two clinical staff including a nurse looking after patients.

We have not rated any part of this inspection because of its specific focus which did not include all areas of our ratings assessment model.

The summary of the key findings of our inspection were:

• There were systems in place for recording and escalating incidents both internally and externally.
• Staff were compliant with mandatory training and there was a reliable system to monitor this.
• Staff were aware of their roles and responsibilities in the escalation of safeguarding concerns.
• All equipment was maintained according to the manufacturer’s guidance.
• There were systems in place to safely manage the ordering, storage and administration of medicines.
• Nursing staffing levels were maintained in line with national guidance to ensure patient safety. The unit had taken action to address staff cover during staff scheduled breaks.
• Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident.
• All policies and procedures were based on national guidance, standards and legislation.
• Patients’ pain and nutrition were assessed regularly and patients referred to appropriate specialists for additional support as necessary.
• The service monitored key performance indicators. This demonstrated the service performed similarly to other dialysis centres.
• All staff completed a competency pack on commencement of post. Staff had the skills, knowledge and experience to ensure safe patient care.
• There were processes in place to ensure effective multidisciplinary team working, with specialist support.
• There were effective processes in place for gaining patient consent for treatment.
• Patients were treated with respect and compassion.
• Nursing staff gave patients adequate time to ask questions and provided written information regarding patients’ conditions, treatment plans and support networks.
• Nursing staff provided patients with information and contact details of support networks, which included the Kidney Patients’ Association and Citizens Advice Bureau.
• There was evidence that senior leaders were accessible and responsive.
• A ‘speaking up’ investigation in December 2016 had led to the local manager receiving increased support to manage unit. The unit had also introduced a lead nurse for home therapy.
• The ‘speaking up’ investigation update in April 2017 identified that work was in progress on a unit strategy and vision.
• The unit had effective systems in place to monitor risk and quality.

There were also areas of practice where the trust should consider making improvements:

• The trust should ensure patients and staff use personal protective equipment in accordance with the unit’s infection, prevention and control procedures.
• The trust should ensure the labels on sharps bins are fully completed to ensure the traceability of each container and stored securely.
• The trust should ensure cleaning solutions are stored and labelled in accordance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
• The trust should ensure fire evacuation procedures displayed on the wall provide instructions to staff on actions staff should take in regards to patients that were attached to dialysis machines.
• The trust should ensure that recording of patient competence is complete and the patients’ progress and level of competence is clearly documented.
• The trust should ensure managers are able to appropriately supervise and support staff at all times.

Professor Edward Baker

Chief Inspector of Hospitals