Hereford Kidney Treatment Centre is operated by Diaverum Facilities Management Limited. The service has 20 dialysis stations, including four isolation rooms. The service was commissioned by University Hospitals of Birmingham NHS Foundation Trust.

Dialysis clinics 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.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 June 2017, along with an unannounced visit to the service on 4 July 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:

• Staffing levels maintained patient safety during treatment.

• Patient records were well maintained, regularly updated and stored securely.

• Patient information was accessible to all staff at the point of care.

• Patient comorbidities and frailty were taken into account when planning patient treatments.

• In response to recruitment difficulties, the unit developed dialysis support worker roles, to offer staff development opportunities and to provide patients with timely care.

• Patients were regularly reviewed, involved with their care planning, and kept informed of treatment options.

• Staff were supportive of patients, treating them with respect and ensuring privacy during all interactions.

• Patients opinions were regularly sought and actions taken to improve the quality of the service in response to findings.

• There were effective systems in place to support and develop staff both locally and across the area. This included peer reviews and a deputy managers’ mentorship programme.

• The service had a positive relationship with the NHS trust, supplying support networks to promote effective patient care and treatment.

• The local GP attended the unit daily and supported the consultant nephrologist to manage dialysis patients.

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

• Over half of the dialysis machines had not been serviced in line with recommendations. This was in breach of Regulation 15 of the Health and Social Care Act 2008. We raised this as a concern on the day of the inspection and the service took actions to address this.

• The unit was visibly clean, however we found some equipment was not clean and ready for use. Cleaning schedules did not reflect the needs of the service. This was in breach of Regulation 15 of the Health and Social Care Act 2008.

• Store room temperatures were higher than the manufacturers’ recommended temperatures for the safe storage of sodium chloride solution and disinfectants. This was in breach of Regulation 12 of the Health and Social Care Act 2008. This was raised with the team locally and actions were taken to remove temperature sensitive items from the storeroom.

• There were inconsistencies in the checking of medicines, with two nursing staff not always checking medicine at the point of administration.

• Staff had not completed safeguarding children training.

• The service did not have a Workforce Race Equality Standard report.

• There was varied compliance with mandatory training and inconsistent annual reassessments of clinical skills.

• There was no formal risk register in place during our initial inspection. This was completed subsequent to our inspection and detailed areas of concern and actions to mitigate risks.

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 two requirement notices that affected the dialysis service provided. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region)