Forest 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

We assessed 4 quality statements. There was a positive learning safety culture where events were investigated, and learning was embedded to promote good practice. Staff were open and honest when things went wrong or could be a risk. Staff provided safe care and treatment. The environment was now safe, well maintained and met people’s needs. However, staff felt staffing levels were not always adequate to keep the department and people safe. The provider used recognised staffing tools to plan numbers, but staff felt this did not always take account of patient acuity. Staff were trained and had the right skills to meet people's needs. However, some staff were unaware of competency frameworks or were not given the time to undertake role specific inductions. Staff had the opportunity to learn and gain experience but not all staff were aware of how to access all training available to them. 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. There were 67% of staff who had undertaken diaverum mental capacity training, although one staff member was on maternity leave at the time of inspection. However, staff also completed mental capacity act training as part of the host NHS trusts’ mandatory safeguarding 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.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were confident about raising concerns. These were taken seriously, people involved in investigations if they wanted to be, and reports of the event were shared with them. People or those who represented them were given an apology and an explanation of the event, and people were given a timely response.

Staff were confident to report incidents and supported when things went wrong. Staff knew what they should report and when. However, staff felt they were sometimes blamed and some reported being discouraged from reporting some incidents. The service’s formal reporting system was easy to use. Staff saw incidents as an opportunity to learn and improve but felt they did not always get feedback.

Staff had effective systems to raise concerns both formally and informally. Reports were analysed and urgent actions taken by leaders to manage or remove risks, but staff felt they did not always get feedback from incidents.

We did not look at Safe systems, pathways and transitions during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

People were appropriately supported when they felt unsafe or experienced abuse or neglect. People told us they felt staff always had their best interests at heart and trusted staff would escalate concerns they had about them or their care and treatment. People felt safe and supported to understand and manage their risks.

There was a strong understanding of safeguarding and staff knew how to take appropriate action. Where applicable, there was an understanding of the Deprivation of Liberty Safeguards (DoLS) and this was only used when it was in the best interest of the person. People were supported to understand their rights, including their human rights, rights under the Mental Capacity Act 2005 and their rights under the Equality Act 2010. However, not all staff had completed mental capacity training.

There were effective systems, processes and practices to make sure people were protected from abuse and neglect. There was a commitment to taking immediate action to keep people safe from abuse and neglect. This included working with partners in a collaborative way. Safeguarding systems, processes and practices meant that people’s human rights were upheld, and they were protected from discrimination.

We did not look at Involving people to manage risks during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

People said the department was clean and comfortable and not too crowded. There were separate dialysis stations with individual TVs and call bells. People were seen quickly and checked on regularly and could alert staff to any needs or issues.

Staff had access to all the equipment they needed and guidance or instructions for using it. Staff used their training in moving and handling and managing emergencies to support their safety. The department was made safe by staff regularly assessing environmental risks. Building maintenance was supported and provided through an external third-party company.

People were kept safe while waiting to be seen or receive treatment. The facilities were well maintained, and any equipment used with patients was in good working order and used safely. Staff wore personal protective equipment in line with regulations.

Hazardous and clinical waste was responsibly managed. The department’s fire safety and other emergency systems were tested and maintained. However, some equipment such as resuscitation equipment was not always checked in line with best practice and manufacturer guidance.

People told us they felt there were enough staff with the right skills and experience to look after people safely but it sometimes felt like the unit was short staffed. They said the staff were well trained and competent with the care and treatment they were providing. People were listened to and given good advice and information.

Leaders kept staffing numbers at a safe level with a suitable skill mix increasing numbers as much as possible and in line with current staffing guidance. They used bank staff when necessary, ensuring they were familiar with systems and processes. Staff kept up to date with mandatory training but reported they did not always have time for role-specific training or education. Staff did not have effective supervision and were yet to have any annual reviews of their work or discussions about future learning and development opportunities. Staff told us they often felt the shifts were understaffed due to the acuity and needs of patients.

Staff were noticeably busy and worked under pressure when people required closer supervision or if any issues with venous access arose. There was a good degree of support and mutual respect among staff working in the department.

Records showed there were enough staff to meet the recommendations of the British Renal Society. When bank staff were needed, they had training in renal care. Records showed the nursing and healthcare assistants mostly achieved the approved staffing numbers but were supplemented at times by bank staff. However, not all registered nurses had a formal renal qualification which meant not all staff had the necessary skills to care for all patients.

We did not look at Infection prevention and control during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

We did not look at Medicines optimisation during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.