Colchester Dialysis Unit is operated by Diaverum UK Limited, who took over the service in October 2016. The service has 23 chairs, three of which are separate from the main unit and located in the renal ward of the subcontracting acute NHS trust.

The service treats NHS-funded patients only under a service level agreement with the acute trust in which the service is located. It operates from Monday to Saturday, from 6.30am to 11.30pm.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 27 April 2017, along with an unannounced visit to the service on 11 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? 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. 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 service had appropriate policies for infection prevention and control. Staff were compliant with infection control policy and best practice; for example, with regular hand washing and training in aseptic non-touch technique.

• The service had a comprehensive equipment maintenance schedule to ensure appropriate and regular maintenance of all equipment in the unit. All equipment was within date for maintenance testing.

• Patient records were complete, clear and stored securely.

• Staffing was sufficient to safely meet patient needs and in line with national guidance. There was a local roster policy to ensure appropriate skill mix, staffing levels and to provide for sufficient time off for staff between shifts.

• Local policies and procedures took account of national best practice, guidance and policy. For example, the policy on accepting patients for holiday dialysis was based on the Department of Health Good Practice Guidelines for Renal Dialysis/Transplantation Units.

• Nursing staff completed a specialist renal course provided by the University of Sheffield prior to starting on the unit. New starters received a local induction on the unit and were required to have all competencies assessed and signed off as part of this.

• There were opportunities for additional staff training and development. For example, the unit was supporting a nurse to become a practice development nurse to support the training and development of other staff on the unit.

• There were two renal dieticians working part-time on the unit and nursing staff confirmed that there was good access to dietician input if required.

• Staff treated patients with dignity and respect and respected their confidentiality. Patient feedback about their care and treatment was consistently positive.

• Patients each had their own named nurse who would be their first point of contact to discuss any concerns.

• The service had links with peer support groups such as the Kidney Patient Association (KPA) to offer the patients, family members and carers access to support services.

• There was an appropriate and up-to-date complaints procedure and we saw two examples of complaints that had been responded to appropriately. Complaints were discussed at meetings, with any actions or learning shared. Staff were familiar with the complaints procedure.

• Staff were consistently positive about the culture and leadership at the service and felt engaged with their work.

• There was a provider-wide vision with which staff were familiar. At a local level, there were areas of innovation and improvement, such as opening a nurse-led satellite site in Clacton in; working towards repatriating patients from Ipswich and Chelmsford for home treatment and peritoneal dialysis (PD); and working on home care and shared care packages for patients.

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

• We were concerned that there was a risk of under-reporting of incidents because staff we spoke with were not clear on the incident reporting system or what would constitute an incident.

• There was no clear system to ensure sharing of learning from incidents with all staff to reduce the risk of similar incidents reoccurring.

• Safeguarding training was not sufficient to support staff in recognising and reporting potential safeguarding concerns. The safeguarding leads had received training to level two in safeguarding adults. This was not in line with national guidance, which specifies that designated safeguarding leads should be trained to level three in safeguarding adults.

• The daily checks on the resuscitation trolley had not consistently been completed, with 13 gaps in the daily checks from February to April 2017.

• We had concerns about medicines management. There was no clear process for patient identification and matching when administering medications, and the process solely relied on the patient verbally confirming their name and date of birth. However, by the unannounced inspection, the service had begun to implement an appropriate identification system.

• A consultant told us they sometimes had difficulties accessing laboratory results for patients and frequently had to re-request tests to ensure they were reliable. This was raised as a concern in minutes from clinical governance meetings.

• Staff and patients told us that patient transport services were a major concern in meeting the needs of patients and consistently getting patients to their appointments on time.

• There was no specific training to help staff meet the needs of patients with, for example, learning disabilities or dementia, although the unit did treat such patients.

• We were concerned that the risk register was not appropriate for the service as it was not being regularly updated and did not reflect the risks identified on inspection, for example the issues in relation to medicines management and delays with accessing laboratory results. There was only one item on the risk register which related to staffing levels on the unit. We did not see this as a risk on inspection as staffing levels were appropriate to safely meet patient need. Managers acknowledged the risk register needed to be updated.

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, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals