People who used the service told us they thought Bodmin Dialysis Unit was “like one big family” and “we get looked after really well”. We saw they had detailed care records that included consent to treatment. We were told their care was discussed with their consultant on a regular basis.

On the day of the inspection the unit was busy with an organised but relaxed atmosphere. We saw staff making sure people were comfortable and had access to drinks and snacks. As the people who used the service were at the unit three times a week it was clear everybody knew each other well and we heard ongoing general conversation between the staff and people who used the service whilst staff were continually monitoring the equipment in use.

We found that Fresenius Medical Care Renal Services Limited had robust systems in place for monitoring the quality of the service and supporting and training their staff. We saw staff had access to up to date policies and procedures and had regular staff meetings to ensure they were up to date with their practice.

Bodmin Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The treats NHS patients on behalf of the Royal Cornwall Hospital NHS Trust. The service has 14 dialysis stations (two in side rooms) for patients and operate two sessions daily. The service is open six days a week and can operate 168 individual sessions weekly. The unit has a current caseload of 47 patients. The service also accepts patients for dialysis who holiday in the region.

Dialysis units offer services, which replicate the functions of the kidneys for patients with advanced chronic kidney disease. Dialysis is used to provide artificial replacement for lost kidney function.

The service is a nurse led unit which provides outpatient satellite dialysis provision to patients.

We inspected the dialysis service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 June 2017, along with an unannounced visit to the hospital on 16 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 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:

• There was a clear incident reporting process Staff received feedback from incidents they reported. Organisation wide learning from incidents was recognised and implemented.

• Staff were fully compliant with mandatory training and safeguarding training and there was a reliable system to monitor this. There was a comprehensive training programme to ensure trained nurses were competent to carry out their role.

• There were systems and process in place to safely manage medicines and to ensure regular servicing and maintenance of equipment was in place. .

• Staff demonstrated good practice with infection, prevention and control processes.

• There were safe nursing staff levels to ensure safe and effective patient care.

• There were business continuity policies and procedures to follow in case of a power failure or issues with the water supply.

• Pain was assessed and managed well and patient’s hydration and nutritional needs were monitored and managed well.

• There was good multidisciplinary working and strong communication links with the nephrology consultants from the referring trust.

• Staff had access to information about patients which enabled effective care and treatment, including access to NHS patient record computer systems. Informed consent was sought and documented prior to commencement of treatment.

• Staff took the time to interact with patients and had a good rapport with them. Patients said staff were kind and helpful and generally spoke very highly of the unit.

• Staff understood the impact of the treatment on patient’s emotional wellbeing and actively supported patients.

• Patients had access to entertainment during their haemodialysis session.

• There was a system to monitor and deal with complaints. There had been three complaints at the unit in the 12 months prior to the inspection, none had been upheld.

• Leaders had the skills and experience to lead and staff spoke highly of the unit manager and senior management team telling us they were visible and approachable.

• There was an effective systematic governance system and programme of audit which was shared with the consultants and contracting team.

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

• Not all care plans had been regularly reviewed, in line with organisational policy, to ensure the welfare and safety of the patients who attended the unit.

• Staff were not aware of the visions and values of the organisation.

Edward Baker

Deputy Chief Inspector