As part of our inspection visit we talked with six patients during their dialysis treatment.

Prior to their first visit, everyone we spoke with felt they had received sufficient information about the unit and their treatment.

Comments included, “I am kept fully in the picture “and “I feel very involved.”

People using the service were very happy with the care and treatment they received. Several patients told us that they always ‘felt at home and comfortable’ when they visited. One person said, “just like a five star hotel here!” and another said, “I’m over the moon with the place!” A fourth person described the overall service as “very, very good.”

We asked people what they thought about the staff. Everyone had confidence that the staff were trained and competent to support them with their treatment. Comments included “the staff are faultless, very caring.”” everyone’s polite and friendly” and “staff are lovely and they are so concerned, they always ask how I am doing.”

Another person said, “the nurses are wonderful. All staff are very caring and will answer my questions.”

We also looked at recent surveys completed by people who attended the unit and the results were all complimentary about the service.

Purley Dialysis Unit is an independent healthcare location operated by the provider, Fresenius Medical Care Renal Services Limited. Purley Dialysis Unit is commissioned by a local NHS trust to provide a dialysis service for NHS patients over the age of 18 years with renal disease, who are considered low risk and do not require dialysis in the hospital. The clinic has a contract with the trust for 24 stations, four isolation rooms and a consulting room for the consultant outpatient clinics.

We inspected this service using our new comprehensive inspection methodology. We carried out the announced part of the inspection on 9 May 2017, along with an unannounced visit to the clinic on 19 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?

Before visiting the unit, we reviewed a range of information held about the service and asked other organisations and stakeholders to share what they knew.

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 infection prevention and control systems and processes, which reduced the risk of cross infection.

• The clinic was visibly clean and there were arrangements in place for infection prevention and control. There was no reported incidence of infection. The environment met hygiene standards for dialysis clinics.

• Patient medical and nursing records and other personal information were stored securely.

• There was an effective process in place for the provision and administering of medicines. Staff stored and administered medicines appropriately. The service had an effective process in place for medication audit.

• There were robust policies and procedures in place that guided staff in their practice and ensured patients safety. Policies were based on national guidance and were accessible to staff.

• Staff assessed and monitored patients’ pain and nutrition regularly and referred appropriately to the hospital specialist for support when necessary.

• Patients and staff had access to timely and relevant information that facilitated patients’ care and treatment.

• Staff received annual appraisals and competency assessments.

• The service managed staffing effectively and there were enough staff with the appropriate skills, experience and training to keep patients safe and to meet their care needs.

• The clinic participated in and used the outcomes from local and external audits to develop and implement patient care and treatment pathways. The unit participated in the renal peer review audit through their local NHS trust.

• The service had a consent process in place and we observed that documentation was accurate and signed.

• Staff worked effectively and collaboratively with the commissioning NHS trust and other professionals to monitor patients regularly and support their treatment.

• Staff understood the impact of dialysis treatment and worked to make the patient experience as pleasant as possible and meet individual patient needs.

• Patients were treated with respect, dignity and compassion by staff.

• Patients were provided comprehensive information and had access to support networks including social services, Kidney Patients Association and to the patients’ representative.

• The unit provided a person-centred, caring and compassionate approach in caring for patients through the named nurse system.

• Patients were able to visit the clinic before commencing dialysis treatment in order to familiarise themselves with the facilities, staff and routine.

• The service was planned and delivered to meet the needs of patients in the community.

• The unit provided a flexible appointment system that ensured patients’ preferred treatment sessions were met and could be adjusted to meet their work commitments or social needs.

• The unit had the resources to provide care and treatment for patients with mobility, hearing or visual impairment to ensure safe and effective treatment.

• There was a clear leadership structure in the Fresenius Medical Care organisation which was applied to the Fresenius Dialysis Clinic, with accessible managers.

• The unit had effective systems in place to monitor patients risk and the newly developed risk register reflected local and organisational risks.

• The unit and organisation sought and engaged effectively with patients and staff.

However,

• The grading of harm from incidents and the classification of clinical and non-clinical incidents was not clearly described on incidents forms by staff and did not reflect the reported events. For example patient falls in the clinic were reported under ‘non-clinical’ incidents. We did not see detailed investigations or sharing of lessons with staff to support prevention of falls in the clinic.

• The clinic did not have an early warning score system in place to support staff in recognising a deteriorating patient.

• The unit’s target for completion of staff mandatory training was 100%. At the time of our inspection, compliance with mandatory training was 68% and below the unit’s 100% target.

• Staff were not adequately trained on safeguarding. Staff had received level 1 safeguarding training and the training matrix showed 50% compliance. Following inspection, the provider told us 85% of staff had now completed their safeguarding training in July 2017.

• The clinic did not audit travelling and waiting times for the dialysis patients as a way to ensure quality of the services provided were achieved pre and post treatment.

• We were not assured that staff could recognise patients living with dementia, or would know how to support them.

Professor Edward Baker

Deputy Chief Inspector of Hospitals