During our visit we spoke with five people and we observed treatment and care. We spoke with three of the four staff on duty and the manager. We inspected the premises and looked at four care records.

We were told by people they understood their treatment and care. People told us they knew how to use the call bells but rarely had to because staff were attentive to their needs. We observed staff responded respectfully and promptly to the needs of people.

We looked at treatment and care records and found these included detailed assessments and care plans. We saw when people were having treatment, their care records remained close to them and staff referred to them.

We observed that the premises were clean and people told us it was always this way. The provider had systems in place to review and minimise the potential for infections from staff, people and equipment.

We found the building was accessible for people who required wheel chairs and other walking aides. The waiting room and treatment area were suitable to meet people’s needs.

Staff told us they were well trained to undertake the care and treatment of people having dialysis treatment. Records showed that staff had undertaken further training and received regular supervision and annual appraisals.

Renal Services (UK) Limited - Wiltshire is operated by Renal Services (UK) Limited. The hospital/service has 11 dialysis stations and operates 22 sessions each day which equals 132 sessions each week for a caseload of 38 patients. The unit also provides services for dialysis patients who holiday in the region. The unit carried out a total of 6550 haemodialysis sessions in the 12 months prior to May 2017.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 23 May 2017 along with an unannounced visit to the unit on 30 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? 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:

• There was a clear incident reporting process Staff received feedback from incidents they reported. Organisation wide learning from incidents was recognised and implemented.
• Staff were fully compliant with mandatory training and safeguarding training and there was a reliable system to monitor this.
• There were systems and process in place to safely manage medicines.
• Staff demonstrated good practice with infection, prevention and control processes.
• The unit had clear processes in place to ensure regular servicing and maintenance of equipment.
• There were business continuity policies and procedures to follow in case of a power failure or issues with the water supply.
• A falls assessment had been implemented after an increase in patient falls across Renal Services (UK) Limited services.
• Evidence based practice and the Renal Association guidelines were used to develop service delivery.
• There was a comprehensive training programme to ensure trained nurses were competent to carry out their role at the haemodialysis unit.
• Pain was assessed and manged well.
• Patient’s hydration and nutritional needs were monitored and managed well.
• Staff worked well as a team to deliver effective care to patients.
• There was good multidisciplinary working and strong communication links with the nephrology consultants from Portsmouth Hospital NHS trust.
• Staff had access to information about patients which enabled effective care and treatment, including access to NHS patient record computer systems.
• Informed consent was sought and documented prior to commencement of treatment
• Patients were treated with dignity, compassion and respect.
• Privacy and dignity was respected in all aspects of care.
• Staff took the time to interact with patients and had a good rapport with them. Patients found staff to be kind, informative and helpful.
• The patients spoke very highly of the unit, the staff and the care they received.
• Staff communicated with patients so they understood the care they received and were encouraged to ask questions.
• Staff understood the impact of the treatment on patient’s emotional wellbeing and actively supported patients.
• Services were planned and delivered to meet individual patient needs and improve quality of life.
• Patients had access to entertainment during their haemodialysis session.
• Patients were supported to arrange haemodialysis at their holiday destination.
• Patients were supported to achieve home dialysis if it was appropriate for the patient.
• Patients were fully assessed prior to being accepted as patients of the unit.
• There was no waiting list for patients to attend the unit.
• There was a system to monitor and deal with complaints. There had been no complaints at the unit in the last year. There had been 18 compliments.
• Leaders had the skills and experience to lead and staff spoke highly of the senior management team telling us they were visible and approachable.
• There were processes in place for unit managers to meet with other unit managers to ensure they did not work in isolation and shared good practice ideas and information.
• There was an effective governance system to support the delivery of good quality care.
• There was an effective systematic programme of audit which was shared with the consultants and contracting team.
• The unit valued feedback from patients and carried out a yearly staff survey.
• There was a replacement programme for the dialysis machines, in line with the Renal Association guidelines.
• The organisation had a vision and a set of values. They were displayed in the unit and referred to in staff newsletters.

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

• The unit did not have a policy around the management of sepsis and the deteriorating patient policy did not make direct reference to the management of suspected sepsis in a patient. However staff had received training on how to recognise signs of sepsis.
• There were no formal identify checks carried out prior to patients being connected to haemodialysis machines for treatment.
• There was no detail about what action staff should take if the drugs fridge temperature was out of range.

Following this inspection, we told the provider that it should make improvements, to help the service improve.

Professor Ted Baker

Chief Inspector of Hospitals