We spoke to people who use the service when we visited. They told us the service was “Very good” and “Fine, no problems”. They all said they felt involved in their care and treatment and received plenty of good verbal information regarding their condition and treatment options. They were able to make choices about how often they received dialysis. They also told us they had seen written information in and around the unit and had been given a patient’s guide when they first started with their treatment. Those we spoke with told us they were treated with dignity and respect at all times.

Other comments received included;

“It’s excellent, they can’t do enough for you”, “Staff are very good and friendly”, “I am happy here, I would give them nine out of ten”.

We looked at the results of the 2011 satisfaction survey undertaken annually, this told us the majority of patients surveyed had been told about how dialysis works and what to eat and drink for their condition.

Broadgreen Dialysis unit is operated by Fresenius Medical Care Renal Services Ltd. The unit has 22 dialysis stations. The service provides dialysis services for people over the age of 18, and does not provide treatment for children.

Patients were referred to the unit via the Royal Liverpool and Broadgreen University Hospital Trust.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 June 2017, along with an unannounced visit to the unit on 26 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.

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.

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 an independent single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following issues that the service provider needs to improve:

• We observed some of the privacy screens were being stored on the main ward and would be difficult to access due to being stored behind a dialysis chair and equipment.
• There were no call bells available for patients to use if they required assistance or emergency. This did not comply with the health building note (HBN) 07-02 main renal unit.
• One of the nursing stations was located facing away from the main ward. This meant that staff using the station would not be able to view patients whilst receiving care. The computer screen also faced a dialysis chair, which could pose a data confidentiality issue.
• Several of the dialysis machines had been reported to have media data port faults. This meant that staff were required to input data into the dialysis machine manually. This increased the risk of data being inputted incorrectly and had not been risk assessed.
• We found that emergency equipment was not consistently checked daily as we found six omissions throughout the month of May 2017.
• We found that fridge temperatures were not consistently recorded to ensure they were all within normal ranges. We found six omissions throughout the month of May 2017.
• We observed 13 prescription charts and found from May to June 2017 there were seven occasions where signatures were missing to indicate whether medication had been given.
• We looked at 13 patient records and found there were omissions in recordings
• The service does not have a policy or provide training for nursing staff with regards to identification or process for sepsis management
• Not all staff competency files were fully completed and up to date.
• From the 10 patients we spoke with, seven told us that their clinic appointment did not start on time.
• Not all risks associated with the unit had been risk assessed. For example, there was no risk assessment completed for there not being any call bells for the patients to summon help in an emergency.
• We did not see any evidence that patient concerns raised from the 2016 patient survey had been suitably addressed.

However, we found the following areas of good practice:

• Mandatory training was made available to all staff to enable them to provide safe care and treatment to patients.
• We observed cleaning logs were kept for the weekly disinfecting of the dialysis machines.
• All areas of the unit were tidy and well maintained; they were free from clutter and provided a safe environment for patients, visitors and staff to move around freely.
• The service had developed a Nephrocare standard for good dialysis care based upon standards of best practice.
• All patients we asked reported the staff were caring and respectful.
• Every patient had an individualised treatment prescription to ensure effective dialysis treatment.
• Parking facilities were available for patients, and we saw there were free dedicated spaces outside the unit and transport was arranged for those who needed it.
• Patients were supported to have holidays away from the unit.
• There was no waiting list for treatment. This meant that there were no patients waiting to start treatment.

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 a requirement notice. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals