During our visit we observed treatment and care and spoke to eight people. We observed that staff responded respectfully and quickly to the needs of individuals. People told us that the care and the treatment they received were excellent. They said the staff were knowledgeable and gave them information that was clear and helpful. They told us that they were involved in all of the decision making processes concerning their consent to treatment and care and this encouraged their independence.

We looked at people's treatment and care records and found that these included detailed assessments and care plans. We saw that the staff referred to these frequently and in consequence people received safe and appropriate care.

People who used the service were protected against abuse because the staff had received training and were confident about the actions they should take if abuse was suspected.

Staff told us that they were well trained to undertake the care and treatment of people in a skilled and competent manner. We saw from staff records that staff had undertaken further training and they had received regular supervision and annual appraisals. In so doing the provider had ensured that the staff were able to provide appropriate and safe treatment and care.

Renal Services (UK) Limited - Milford-on-Sea is operated by Renal Services (UK) Limited. It is based within the premises of Milford-on-Sea War Memorial Hospital, commissioned by Portsmouth Hospitals NHS Trust. The unit provides dialysis services only. The service has seven dialysis chairs. Facilities include a reception/waiting area with chair weighing scales, the treatment area with six dialysis chairs and one side room with one dialysis chair. Leading from the treatment room is the mixed-sex patient toilet suitable for disabled access, the clean utility room and the dirty utility room. The water treatment plant is located close to the unit, within the hospital premises and the unit has a stores lockup in the car park.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 14 June 2017, along with an unannounced visit to the unit on 26 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.

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:

• All patients said staff were kind, considerate and professional. They helped reassure patients who were anxious and encouraged patients to be as independent as they wished to be with their dialysis treatment.

• This was a nurse-led unit and all staff followed procedures recommended by the Renal Association and checked the efficiency of each patient’s dialysis treatment. They also checked the quality of the water to minimise the risk of infections.

• They collaborated and communicated effectively with the renal team at the host NHS trust to support patients with their treatment programme. There was a focus on local governance, with audits and meetings to maintain standards and quality.

• Staff completed their mandatory and competency training and followed best practice with infection control procedures. They worked well as a team and knew how to report incidents including those relating to safeguarding vulnerable people.

• Staff reported a strong culture of patient-focused care, and clear leadership.

• The unit provided a valuable satellite dialysis centre, which improved access to treatment for patients living locally. There was adequate parking and regular patient transport services. Staff monitored delays with patient transport and the arrangements generally worked well. The provider had admission criteria which only patients who were stable on dialysis could be referred for treatment.

• Having a coastal setting, the unit was used for holiday dialysis and there were safe systems to help patients book for treatment from outside the area.

• Systems were in place to service and replace equipment, including the dialysis machines, chairs and water treatment plant.

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

• The risk register for the organisation did not capture the risks specific to the unit, for example the condition of the water treatment plant room, which was small and in need of refurbishment, so it could be easily maintained and kept clean. Also, the risks associated with security of the unit, following an incident and the potential impact of the staffing numbers on safety.

• The policy and procedures for incident management were not clear, detailed and comprehensive, to provide consistent guidance for staff.

• An external service of the dialysis chairs had reported the batteries on two of the chairs had failed, and action had not been taken to replace these.

• Although there was a unit level emergency plan, there were no personal emergency evacuation plans, to guide staff in how best to support individual patients.

• Policies and practices had been reviewed and revised but the medicines management and infection control policies omitted important guidance for staff.

• The corporate audit programme was not targeted to identify and address areas for improvement.

• There had been no staff survey in the past year.

• Staff did not consistently follow the medicines management policy for identifying patients before administering medicines.

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 to help the service improve. We also issued the provider with one requirement notice that affected Renal Services (UK) Milford-on-Sea unit. Details are at the end of the report.

Professor Edward Baker

Deputy Chief Inspector of Hospitals