We found that people’s views and experiences were taken into account in the way that the service was provided. People we spoke with told us of the changes that the service had made following their requests.

We looked at treatment records for three people and spoke to three people who had used the service. We also observed people being cared for, spoke with the manager and two staff members.

All people we spoke with told us the service was really good. One person told us “it’s absolutely brilliant”. Another told us “it’s better than being in hospital”. A third person told us “it’s personalised”.

We found that the service had systems in place to ensure that staff were aware of how to recognise a safeguarding concern. Staff we spoke with were able to tell us what they would do if they were concerned about someone. People we spoke with told us they feel safe using the service.

We found that current recruitment practices meant that people could be assured that all relevant checks had been completed for all people who worked in the service.

We found that the provider had effective systems in place to monitor the quality of the service and found that people’s views were taken into account and acted upon.

The service had a clear complaints procedure in place to be able to respond and learn from these. People we spoke with told us they knew who to talk to if they had a complaint.

Renal Services (UK) Limited Havant is operated by Renal Services (UK) Limited . It provides dialysis services and is commissioned by a local acute trust, as part of their renal service.

We undertook a follow up unannounced inspection on 24 April 2018. The previous inspection in June 2017 identified some serious areas of concern, against which a warning notice was issued to the provider to improve. There were also  some requirement notices and must and should actions. This inspection was focused on the areas which were identified as needing improvements.

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.

We do not currently have a legal duty to rate dialysis where these services are provided as an independent healthcare single speciality service.

The provider had made significant progress in addressing the issues identified at the last inspection in June 2017, these are detailed throughout report. We were not assured of the overall effectiveness of the audit program , but consider the requirements of the warning notice to have been met.

We found the following areas of good practice:

• Staff understood the principles of duty candour, an organisation wide policy had been introduced and incident reporting forms included prompts to remind staff to consider their duties under principle of Duty of Candour.

• Staff completed their mandatory training and had completed the required level of safeguarding training for both adults and children training.

• The unit was visibly clean and free from dust and clutter and there were robust processes for ensuing equipment was cleaned between patients although staff were unsure of the extra precaution to take when a patient had a known infection. Staff were observed to use personal protective equipment to protect themselves and others from the risk of cross contamination.

• Area where access needed to be managed or restricted were secured using key pads. However, staff did not always ensure access to the treatment area was controlled with doors being left unsecured. This meant patients continued to walk in and out of the unit when not accompanied by staff without challenge.

• There were safe system in place for the use by staff of patient group directions (PGDs) and patient specific directions (PSDs) designed to support the safe administration of medicines.

• Records were securely stored. Individual patient risk assessments were being completed and used to inform plans of care.

• There was a standard operating procedure and a new policy for the recognition and management of sepsis. Staff could describe how to recognise the signs of sepsis and the actions they would take.

• All new competency frameworks and policy documents were based on Renal Association Guidelines, the National Institute for Health and Care Excellence (NICE) and any guidelines from the commissioning NHS trust.

• Pain assessments were included in the patient’s record and where there were known long term condition impacting on an individual’s pain additional information was also available.

• Staff received an annual appraisal and the form used included a checklist to confirm the staff had received the annual updates as identified by the provider.

• Patient consent was to be revisited on an annual basis, to ensure the patients continued to consent to their ongoing treatment.

• For all patients’ staff had formally considered and recorded how the patients would be evacuated in an emergency such as fire.

• Patients were assisted in finding suitable holiday dialysis elsewhere and out of area patients could also be provided holiday dialysis by the service. There was a strict criteria for these patients to ensure the unit could safely meet their needs.

• Organisation wide complaints were regularly discussed at the quarterly Integrated Governance Committee and at the monthly clinic managers and sisters meeting. However, we did not see any reference to them or any shared learning from them in any of the unit meeting notes, therefore it was not clear how learning was shared with unit staff.

• Staff were positive about the leadership team and felt supported by them.

• A local risk register was being maintained and reflected known risks.

• An audit plan was in place and audits were being completed as part of the providers system for monitoring the quality of the service and to provide assurance risks were being managed.

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

• Some patients continued to have concerns and issues with their transport and while the provider was not responsible for this, there was no support network for these patients such as a patient transport group.

• Patients were offered three sessions per week, however on occasions, to maintain patient choice for dialysis times, the unit was potentially compromised by too many patients with high infection risks during an afternoon session.

• The provider had not produced and published a Workforce Race Equality Standard (WRES) report. Although they told us they were now collecting additional information about staff characteristics which enable them to produce a report.

• While audits were being used as part of the assurance process their actual effectiveness’ in driving best practice and improvements was not always evident as we observed some poor practices that were not reflective of the audit findings.

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 a requirement notice that affected this service. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals on behalf of the chief inspector of hospitals