We completed an unannounced inspection visit on 06 August 2012, to East Cheshire NHS Renal Dialysis Unit. We spoke with five people who used the service, five staff members and the Consultant Nephrologist as well as the manager during the course of our inspection.

The people we spoke with told us they had no concerns about the staff respecting their privacy or dignity and one person told us: "You couldn't fault them" when referring to the staff and the care they provided.

The people we met had received dialysis at other units before their treatment at Fresenius Medical Care Renal Services Limited, East Cheshire NHS Renal Dialysis unit and one person told us: "I knew what to expect as I'd been on dialysis before I came here."

One person told us: "I've never had to wait for treatment once I am here I am pretty much straight onto my treatment."

Another person told us: “The staff are professional and kind, it's more of a family atmosphere here, we get to know each other very well."

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 5 May 2017, along with an unannounced visit to the unit on 15 May 2017.

East Cheshire Dialysis unit is operated by Fresenius Medical Care Renal Services Ltd.

The unit has 10 dialysis stations in the main ward and two side rooms.

The service provides dialysis services for people over the age of 18, and does not provide treatment for children.

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.

We found the following areas of good practice:

• There were processes in place to control and prevent the risk of infection. We saw that the environment appeared clean and audits of the environment took place to provide assurances. All areas of the unit appeared clean, tidy and well maintained; they were free from clutter and provided a safe environment for patients, visitors and staff to move around freely.
• We saw evidence that chemical contaminants in water used for the preparation of dialysis fluid was monitored. Chlorine levels in water were tested daily and other contaminates such as nitrates tested monthly.
• We observed equipment stock used for dialysis treatment was CE marked. For example, dialysis needles and accessory kits. This ensured that all dialysis equipment was approved and compliant with relevant safety standards. This was in accordance with the Renal Association guidelines.
• We saw there were appropriate processes in place to support those patients with blood borne viruses (BBV). There were two side rooms and there was routine blood testing for BBV.
• We observed that patient fistula’s (fistula is a connection, made by a vascular surgeon, of an artery to a vein), or central venous catheters (venous catheter is a tube inserted into a vein in the neck, chest, or leg near the groin, usually only for short-term haemodialysis) were assessed pre and post dialysis for infection, with any variances recorded via the electronic system.
• The Fresenius service had developed a Nephrocare standard for good dialysis care based upon standards of best practice. The standards addressed the processes to follow immediately before, at the beginning, during and at the end of haemodialysis treatment and provided a guide for all staff to follow to ensure safe care and treatment for patients receiving treatment at the unit.
• Information about the outcomes of patients’ care and treatment was collected and monitored by the service to ensure good quality care outcomes were achieved for each patient.
• All patients we asked reported the staff were caring and respectful.
• Every patient had an individualised treatment prescription to ensure effective dialysis treatment.
• There was no waiting list for treatment. This meant that there were no patients waiting to start treatment.
• We observed that managers were visible and approachable on the unit and provided support to staff as required.

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

• The service does not have a policy or provide training for nursing staff with regards to identification or process for sepsis management. This was not in line with the NICE guideline (NG51) for recognition, diagnosis, or early management of sepsis. (Sepsis is a life-threatening illness caused by the body’s response to an infection).
• Conversations and comment card responses were generally good, however, not all patients felt that communication and information from managers had been sufficient.
• The service did not have or maintain a Workforce Race Equality Standard (WRES) action plan or publish data with regards to monitoring staff equality.

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.

Ellen Armistead

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Deputy Chief Inspector of Hospitals North Region.