When we visited Scarborough Dialysis Unit we found that people were happy with the service they received. One person we spoke with told us “It’s been a very good experience. The atmosphere is calm and the staff are very good at keeping me up to date”.

We found that the premises were well maintained and were suitable for the delivery of the treatment. We looked at the recruitment procedures that were in place and found these to be appropriate although it was not possible to check all required documentation.

We had previously identified issues with staffing levels in the unit and had asked the provider to take action in this area. We found at this subsequent visit that additional staff had been recruited and there was now dedicated management time available.

We found the quality assurance processes used to be inclusive and extensive. Patients were given chances to feedback and this was listened to and acted upon. There were also corporate processes in place to ensure that the unit was delivering to a high standard. A robust complaints system was in place and this ensured that patients were responded to if any issues were raised. Records were found to be accurate, up to date and appropriately stored and disposed of.

The dialysis unit provided treatment for around 28 patients. We looked at documentation and spoke to staff and patients about consent to treatment. We saw there were signed consent forms in all the files we looked at and patients confirmed that they were always asked before any treatment was carried out.

Patients told us that the care and treatment received was of a high standard and that their needs were consistently met. Patient files that we looked at were complete and detailed and contained information pertinent to each individual. One patient told us “I am very happy with everything”. Another patient told us “Staff are brilliant at doing what works best for you”.

We looked at records regarding staff training in safeguarding and saw that all staff had received relevant training. Staff’s understanding of their responsibilities was good and patients reported that they felt safe within the unit.

We looked at levels of staffing and found that these were inadequate. Although staff were maintaining a high level of care this was not sustainable with the current staffing levels and this was having a moderate impact on both staff, patients and the organisation of treatment.

We also looked at the quality assurance carried out by the unit and found this to be detailed, robust and up to date.

We were unable to speak to people regarding their care during the inspection.

Scarborough NHS dialysis unit is operated by Fresenius Medical Care Renal Services Limited (FMC), an independent healthcare provider. It is commissioned by Hull and East Yorkshire NHS foundation trust on behalf of the North East and Yorkshire Renal Network. All patients are managed by consultants employed at York Teaching Hospitals NHS Foundation Trust.

The service is situated on the site of Scarborough NHS hospital. It is a 10-station unit comprised of nine stations in the general area and one side room, which can be used for isolation purposes.

The unit provides haemodialysis for stable adult patients with end stage renal disease/failure.

We inspected this service using our comprehensive inspection methodology and carried out the announced part of the inspection on 17 May 2017. We carried out an unannounced visit to the hospital 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? 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:

• Staff were clearly able to describe the incident reporting system and were able to provide examples of incidents and how to report them. Staff understood the classification of incidents as clinical, non-clinical and Treatment Variance Reports (TVR’s).
• We observed staff working with competence and confidence and the training available in the clinic supported all staff to perform their role well. One hundred percent of staff had received induction and appraisal and two staff were completing a renal qualification.
• We observed a caring and compassionate approach taken by the nursing staff during our inspection. We observed that consent processes were in place and documentation was completed fully
• Performance indicators for December 2016 showed comparable performance against other Fresenius units nationally.
• The unit was able to provide Haemodiafiltration (HDF) 100% of the time during the 12 months prior to inspection.
• Patients were supported with self-care opportunities and a patient education process was in place.
• Holiday dialysis for patients was arranged to provide continuity of treatment and support the wellbeing of patients.
• Morale at the unit was high and staff spoke positively about the support they received from the clinic manager.
• Staff and managers demonstrated a willingness to learn and a proactive attitude to improving services and patient care.

We found the following issues that the service provider needs to improve:

• We found the incident policy did not give guidance regarding categorisation of incidents by level of harm
• When we reviewed the incident investigations / reports for these incidents, we found that one of the investigations was not robust, in that it had not identified all contributory factors or root causes.
• The medicines management and children and adult safeguarding policies did not refer to most recent guidance and policies had no review dates.
• There was a lack of re-assessment of individual patient needs and individualised care plans.
• There was no clear system to ensure staff could consistently identify and manage deteriorating patients and patients at risk of developing sepsis.
• The provider did not formally monitor or audit, arrival and pick up times, for patients who used patient transport services, against NICE quality standards.
• The unit was not meeting the ‘Accessible Information Standard’ (2016) or the Workforce Race Equality Standard (WRES) (2015) at the time of our inspection.
• There was no audit or assessment of compliance against the medicines management policy to ensure safe practice.

Following this inspection, we told the provider that it must take some action 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 issued the provider with one requirement notice. Details are at the end of the report.

Ellen Armistead.

Deputy Chief Inspector of Hospitals (North region)