Boston Dialysis Unit is a 'satellite' unit for University Hospitals Leicester (UHL). Satellite units care for dialysis patients who are not so ill. It provides dialysis at the unit three times a day, six days a week.

When we visited we spoke with ten patients attending the centre, the manager, three members of nursing staff and a member of the ancillary staff.

People told us they were well cared for. One person said, "They’re very good the nurses.” We found people received safe and responsive care.

People were protected from the risk of infection because appropriate guidance had been followed and people were cared for in a clean and hygienic environment.

People thought there were not enough staff on duty. We found the unit was staffed in line with British Renal Workforce Planning Recommendations (2002) Guidance for satellite dialysis units. However, work is required on a regular basis to determine staffing levels in relation to dependency needs.

People who used the service knew how to complain if they needed to. There was an effective complaints system available. Comments and complaints were responded to appropriately.

The provider had sent us an action plan telling us what they were going to do to make sure they were compliant with the two standards we had set compliance actions against when we visited in July 2012.

Patients told us they still felt there were not enough staff on each shift. Two patients told us they sometimes had to wait up to twenty-five minutes to come off their dialysis machine when their treatment finished. We found data for March 2013 which showed one patient had needed to wait for twelve minutes.

The organisation had difficulty in recruiting qualified staff to the unit but new staff had been employed.

The number of additional hours staff were working had decreased since our last visit and the manager was having time to undertake managerial duties within their normal working week.

A call bell system had been installed to enable patients to call for assistance if they felt unwell although not all patients had access to it on the day we visited.

People felt they were treated with dignity and had their privacy respected. They also felt involved in their care and treatment. One person told us, “I read my care plan every time I come. I like to know what’s going on.”

People felt well cared for while they were receiving treatment. One person told us, “The care is very good. They work hard here. They could do with some more help.”

However, another person told us, “No-one checks on me. If I had a button to push it would make me feel more confident.”

People felt safe in the unit and staff knew what to do if they suspected anyone was being abused.

People felt there was a need for more nurses to look after them properly. One person said, “There are not enough staff to check on all of us regularly. It doesn’t give you a lot of confidence.”

People felt staff were well trained although they said they had difficulty in understanding what some of the staff were saying to them. One person said, “I don’t know what they (the staff) are saying a lot of the time. I ask them to repeat it but even then I don’t know what they’re saying. I don’t ask again as it looks bad.”

People told us they were asked about the service on a regular basis. They also told us they knew how to complain if they needed to.

On the day we visited, eleven people were having treatment. We spoke with two people, both who told us that the care they received at the centre was very good. One person told us that they had “a bit of banter with the nurses. It helps to pass the time.”

They said that the staff had always been very good and considerate. Both people told us that they had always felt respected and had been treated well.

One person had been attending the centre for five years, having been previously treated in another centre. They said that the Boston Dialysis Centre was always clean, the staff were cheerful and they had never had any problems with their care or treatment.

The other person we spoke with told us “I started coming here two weeks after it opened in 2003. I have never had to complain about anything, I’ve always been treated well by the staff and I’ve always received the best care possible.”

Both people told us that the procedures they needed had been explained to them and they understood what was happening. Both people attended the centre for 4.5 hours, three times a week.

Boston Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The site is situated on a business park and was opened for this service in 2005 and a refurbishment took place in 2015. The facility has 12 dialysis stations and provides haemodialysis services six days a week. Facilities include a consulting room, isolation room, nurses office and patient kitchen.

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. At the time of inspection these services were commissioned by a local NHS trust.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 April 2017 along with an unannounced visit to the unit on 2 May 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?

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:

• The unit was visibly clean with evidence of thorough infection control practices.

• Equipment was serviced and fit for purpose.

• Staff knew how to report incidents and treatment variances.

• Staff demonstrated a good understanding of their responsibilities around safeguarding.

• All staff were up to date with mandatory training.

• Medicines were administered in line with national guidelines.

• Staff carried out structured patient risk assessments throughout dialysis treatment.

• Staff followed evidence based treatment and best practice guidance

• All staff had received a recent appraisal.

• The service monitored closely patient outcomes and reported these to the commissioning trust.

• The commissioning trust submitted Boston Dialysis Unit figures to the Renal Registry.

• Staff received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards as part of their induction training.

• All patients received regular multidisciplinary reviews.

• Information sharing between the NHS trust and Boston Dialysis Unit was seamless.

• Staff demonstrated compassion to both patients and family members.

• Patients were treated with privacy and dignity.

• Where possible patient’s wishes were considered on dialysis appointment.

• Transport services were provided by Fresenius drivers located at the unit.

• Patients were involved in decisions around their care.

• The service received low levels of complaints. Those that were received were resolved appropriately and in a timely way.

• There was a company vision, strategy and values, which most staff were aware of and shared.

• Locally staff were well supported by the clinic manager.

• The service performed regular staff and patient surveys and responded to feedback.

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

• Some risks were not reported or monitored appropriately due to the two tier incident reporting system.

• Action plans developed in conjunction with a staff survey were not completed in a timely fashion.

• Although no errors had occurred in relation to patient identification there was no formal process to follow.

• Currently no guidelines were in place for staff to follow when monitoring and identifying patients at risk of developing sepsis.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Central Region