​Lakeland Dialysis Unit is operated by Lakeland Dialysis Limited.

It is a private holiday dialysis unit situated within a business park, on the outskirts of Cockermouth.

The service was established in 2004 and is a small independent nurse led unit, providing holiday dialysis to patients holidaying in the area.

The service provides haemodialysis from Monday to Saturday depending on the number of patient bookings, with morning and afternoon sessions offered.

We carried out a comprehensive inspection of the unit on 5 July 2017. This included an unannounced visit to the unit on 17 July 2017. We inspected a third time on 11 April 2018. The inspection took place as part of our comprehensive inspection programme. The service was in breach of regulations. We issued a warning notice to the provider about specific breaches within the unit. This identified concerns and areas for improvement at Lakeland dialysis unit including that the service needed to ensure:

• The appropriate recording of clinical incidents, including the severity and/or grade of the incident within the unit.
• The identification and completion of mandatory training for staff working within the unit.
• Safeguarding policies and training were in place to ensure staff were aware of safeguarding procedures. This included safeguarding children.
• The mitigation of risk to patients through the regular review of practice against clinical guidelines, policies and best practice.
• The processes of monitoring and reviewing staff competencies and ensure staff were competent to carry out their roles.
• The assessment, monitoring and improvement of services through regular clinical audit.
• The maintenance of staff records which included all necessary documentation such as essential employment checks.

We carried out an unannounced visit to the unit on 11 April 2018 to check on progress that had been made against our warning notice. This inspection focused on the specific issues we had raised following the comprehensive inspection earlier in the year.

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 when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve, and take regulatory action as necessary.

In this inspection, we found the following areas of good practice:

• We saw the unit manger had developed incident reporting policies and procedures. Guidance for staff was comprehensive and included the grading of the severity of the incident and when duty of candour should be applied.
• Mandatory training processes had been improved to include a new training policy and mandatory training list, which clearly showed when staff training was due.
• Safeguarding processes including children’s safeguarding were strengthened to include comprehensive training and guidance for staff and updated local authority contact and escalation arrangements.
• Policies and procedures to support patient care were regularly reviewed to ensure guidance was in line with current NICE guidance and best national practice.
• We saw improvements in the training culture in the unit, with mandatory staff training showing 100% compliance.
• Staff received competency reviews to ensure clinical practice was compliant with national guidance and best practice.
• The unit manager demonstrated clear leadership and had taken positive steps towards improvement.
• Governance processes had been strengthened to ensure risks were identified and mitigated and audit activity supported improved patient care.
• The development of staff records, which were comprehensive. These were well organised and included all required employment checks.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

We spoke with three patients being treated at the unit and one relative during our visit as well as the two owners. We received positive feedback from patients and from the recent satisfaction survey.

From the patients, comments included:

“Staff seem very nice and there was plenty of flexibility with the times I could have the treatment.”

“There are no problems with cleanliness this place is spotless.”

“They (the staff) both seem very nice, no problems at all. It’s a very personal service here.”

“They (the staff) are the tops.”

“I would love to come here all the time. It’s better than the NHS.”

“I don’t worry about the treatment I know it’s going to be ok. It’s very clean and they know what they are doing.”

“It’s so nice and quiet.”

Satisfaction survey comments included:

“Excellent place, great staff and can’t do enough for you. Well worth a visit.”

“Thanks again for looking after me so well last week. I only wish I could have my dialysis with you all the time. I was very impressed with your facility and your kindness.”

“Very friendly couple I would recommend the unit for treatment.”

“The service was very good.”

“Very good knowledgeable staff and no problems.”

Lakeland Holiday Dialysis Unit is operated by Louise Edgar and is also the registered manager. The unit is situated within a business park, on the outskirts of the market town Cockermouth. The service consists of four dialysis stations in a main room on ground floor level, close to the main entrance. The building is leased from a private firm and is shared with several other businesses.

Lakeland Holiday Dialysis Unit has a contract with NHS England to provide holiday haemodialysis for patients who are deemed appropriate. All the patients remain under the care of the NHS consultants at their host NHS trust.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection on 5 July 2017 along with an unannounced visit to the unit on the 17 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?

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 issues that the service provider needs to improve:

• Mandatory training was not reviewed and we saw gaps in training records.

• Clinical incidents were not graded in severity and policy guidance did not include duty of candour.

• Staff clinical competencies were not reviewed following induction and staff received no formal clinical supervision.

• Patient outcomes were not formally monitored.

• Recruitment checks were not recorded fully and the provider did not have a policy to review disclosure and barring checks.

• Policies were brief and lacked sufficient detail to guide staff safely through clinical practice.

However, we also found the following areas of good practice:

• All patient feedback we received was positive.

• Nurse staffing levels were planned, implemented and reviewed to keep patients safe at all times.

• Patients could access care and treatment in a timely way and there was a clear referral criteria for new patients.

• We saw personalised care plans for patients with specific conditions.

• All staff received an annual appraisal.

Following this inspection, we issued the provider with a warning notice and told the provider that it must take some actions to comply with the regulations and that it should make other improvements. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals