We spoke with seven patients who were in the process of dialysis. Each made positive comments about the quality of the service including comments such as 'I can't see how it could be improved', 'The staff are friendly and seem to know their job and how to handle the machines'. Patients received an information booklet about the unit and their treatment when they first attended the centre. They could express their views though a patient forum and also by way of an annual satisfaction survey.

Records showed that equipment in the unit had been regularly maintained. We observed individual staff members using the equipment. They demonstrated how it worked and showed us the alarm and information systems.

There were sufficient members of staff to maintain a good quality of care. Records showed that staff were recruited, assessed and trained to a high standard. Regular appraisal took place and continuing training was offered when appropriate.

Records showed the provider had quality assurance systems in place. This meant that patient care and safety was monitored and assessed to ensure people were being cared for appropriately and safely.

All of the patients we spoke with said they were satisfied with the care provided by the unit. Patients told us they were offered a choice of morning or afternoon treatment sessions. One person who had received treatment in other dialysis units said, “The treatment is exceptionally well done here”.

People told us they received good information about their care. We were told, “Staff explained everything about my treatment” and “I feel very well informed and have my own personal booklet”.

Patients said the staff looked after them very well. We were told, “The staff look out for me, I don’t think they could do anything better” and “The staff come straight away whenever I need them”.

Throughout the inspection we observed the interactions between staff and patients and these were seen to be appropriate, caring and respectful. One patient said, “If I am feeling a bit down the staff will come and chat with me”. We observed that patients were treated with dignity and respect. We were told, “I can’t fault the staff they are polite and respectful” and “Staff always have a nice smile and say hello to me”.

People told us they thought the staff were knowledgeable and skilled, “They are well trained and know what they are doing” and “If you want to know anything the staff can help”.

We were told that a patient forum met twice a year to consider matters raised by patients.

Frome Renal Unit is operated by B.Braun Avitum UK Limited. The service has 12 dialysis stations for patients and operates two shifts of sessions daily between 7.00am and 7.00pm. The service is open six days a week and operates 144 sessions for a caseload of 48 patients. Facilities include 11 dialysis stations, one isolation room and machine, one storeroom, one plant room and an office and 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.

The service is a nurse led unit and is supported by the renal unit at Southmead hospital which is run by North Bristol NHS trust.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 June 2017 and further unannounced inspection on 14 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.

The main service provided by this unit was dialysis. Where our findings on dialysis – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the dialysis core service.

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 a good incident reporting culture and staff were using data to improve services.

• The service demonstrated good practices for effective infection control and prevention.

• The environment complied with national guidance for satellite dialysis units and the unit was clean and tidy.

• Staff adhered to recommended practices for infection control such as the use of personal protective equipment and the use of aseptic non-touch techniques, when connecting patients to dialysis machines.

• All equipment was regularly serviced and maintained, and consumables were all in date and well managed.

• There were safe nursing staff levels to ensure safe and efficient patient treatment.

• There were good working relationships between the unit and the consultant nephrologist who was responsible for patients’ treatment.

• Staff completed contemporaneous documentation about care and treatment given to patients including evidence of discussion around risks.

• The unit had a clear procedure for identifying patients receiving blood and blood products.

• The service had effective contingency plans in the event of adverse conditions.

• Policies and procedures reflected current evidence-based guidance and practice.

• The unit had a comprehensive annual audit schedule with clear actions taken as a result.

• The service monitored key performance indicators and these demonstrated the service performed similarly to other dialysis centres in most categories.

• Dietitians saw patients regularly and patients felt they had a good amount of information to manage their diets.

• Dieticians used screening tools to identify patients at risk of malnutrition.

• Staff had the skills, knowledge and experience to ensure safe patient care.

• There was effective multidisciplinary working and a close working relationship with the supervising NHS trust involving specialist link nurses.

• There were effective processes to ensure consent was obtained at the beginning of and throughout patient treatment.

• Staff treated patients with respect and compassion.

• Patients were complimentary about the care and treatment they received at the unit.

• There were processes to assess patients’ emotional needs.

• The unit had a well-attended patient forum and invited outside speakers to attend.

• Staff took care to maintain patient dignity and when carrying out care and treatment.

• Staff showed a considerate and holistic approach to delivering information to patients.

• There was a good end of life pathway with involvement from the supervising NHS trust, which followed national guidance and best practice.

• The service met the needs of the local population and the needs of individuals attending for dialysis.

• The building met national guidance for satellite dialysis units.

• There was good provision for support to patients going on holiday and the unit welcomed patients from other parts of the country to receive dialysis while on holiday.

• There were processes to support patients who missed their dialysis.

• The unit had received no complaints in the last 12 months.

• Leaders had the knowledge, skills and experience to manage the service.

• Staff felt valued and there was a positive culture. We observed team working and respect for others.

• All patients and staff were positive about the service and the service used forums to engage with patients and their relatives.

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

• The service did not have a sepsis policy/standard operating procedure to follow if patients displayed signs of sepsis. The service did not use a recognised early warning tool to alert staff to deterioration in their condition during dialysis.

• Staff did not routinely receive feedback form incidents reported.

• Not all staff were up to date with mandatory training including safeguarding and aseptic non-touch technique.

• Not all patients felt involved in their care and treatment.

• Patients did not always feel their privacy was maintained when holding discussions about their care or treatment.

• Not all governance processes were effective to ensure a robust approach to managing quality and performance. There were no formal action plans from patient review meetings.

• There was not an effective process to monitor risks and understanding of efficient risk management processes were unclear.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.

Edward Baker

Deputy Chief Inspector of Hospitals

South West region