We met with six people who were using the service; one relative and three staff. Service users told us that they "could not fault anything", that they felt "well looked after" and "in safe hands".

The building and the equipment were well maintained and the environment was clean. One person receiving treatment described the cleanliness of the unit as "excellent".

People, where possible, were able to make some choices about their care and service users views were sought and action was taken in response to the comments made. People receiving treatment had confidence in the people who were responsible for their care.

We found concerns in relation to safeguarding and consent and actions have been set in relation to these. These related to compliance with policy and training.

People told us that this was a good service, with excellent staff and a friendly atmosphere. They said they were treated respectfully and cheerfully, and that the nursing staff were sensitive in how they explained what they were doing. We were told that the unit was always clean and that that staff applied good hygienic practices. They said they were given sufficient information to understand their care and treatment and that they were confident that their health needs were well looked after.

Basingstoke Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The unit is commissioned by a local, host NHS trust to provide renal dialysis to NHS patients. The service is registered for 24 dialysis stations. The unit has four bays. Three bays have six stations and one bay has not been used since the contract was agreed, but is set up for four stations. The clinic has two single-bedded side rooms that can be used as isolation rooms if patients have an infection risk.

The service provides haemodialysis from Monday to Saturday each week with morning and afternoon session each day.

We inspected this dialysis unit using our comprehensive inspection methodology. We carried out the announced part of the inspection on 21 April 2017, along with an unannounced visit to the unit on 25 April 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 when they are provided as a single speciality service. 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:

• Staff were caring, compassionate and patients said they often went the extra mile. They were committed to providing patient-centred care.

• The unit offered heamodiafiltration as standard, which some evidence indicate delivers improved patient outcomes.

• Staff received a comprehensive induction and had good access to corporate training courses. Nurses were supported to complete external renal nurse training.

• Staff participated in annual appraisals and all start reported in the last staff survey that they understood their roles and responsibilities.

• Staff coordinated care safely and effectively with the NHS trust consultants and dietitian.

• Staff maintained comprehensive patient records.

However, we also found the following issues that the service provider needs to improve:

• Staff did not have a good understanding of risk management and challenging practices to improve care and safety.

• There were risks associated with staff not formally identifying patients for treatment and checking patient prescriptions when giving medicines. These risks had not been identified with associated mitigating actions.

• Some staff had not completed mandated training.

• There was a lack of clarity in when to apply clean or aseptic techniques when dialysing patients with AV Fistulas, and staff did not consistently follow the Fresenius corporate policy.

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. We also issued the provider with two requirement notice(s) that affected this dialysis service. Details are at the end of the report.

Edward Baker

Deputy Chief Inspector of Hospitals