During our visit to Sparkhill Dialysis Unit we spoke with seven people who were receiving dialysis treatment. We also spoke with six members of staff and reviewed documents that were made available to us.

The people we spoke with were generally satisfied with the care and treatment they received and had confidence in the staff delivering their care. People told us, “The staff try and help you in anyway they can and try and make you comfortable.” Another person told us, The staff are cheerful and professional. They put you at ease, if they can’t talk straight away they will come back.”

Staffing levels were adequate to meet the needs of people and were representative of the diverse range of people who used the service. This enabled people who did not speak very much English to communicate their needs.

We found the premises were clean and practices in place supported infection prevention and control. Feedback available on the quality of the services since the unit opened one year ago was positive.

Sparkhill Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The service has 24 dialysis stations including four isolation rooms. There are three consulting rooms and one meeting room. Dialysis units offer services, which replicate the functions of the kidneys for patients with advanced chronic kidney disease. Dialysis provides artificial replacement for lost kidney function.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 30 May 2017, along with an unannounced visit to the unit on 12 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.

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 issues that the service provider needs to improve:

• The process of incident reporting, investigation, escalation and learning from incidents was not consistent with a lack of understanding of the process.
• The unit did not meet the duty of candour requirements.
• We found medicines management processes including patient identification were not in line with safe medicine standards and national guidance.
• There was not a formal process to detect deteriorating patients and those with signs of sepsis to safely and appropriately manage them in line with best practice guidance and national standards.
• We found variable staff competency to correctly perform aseptic non-touch technique. There was insufficient action taken to reduce the risk of infection and monitor compliance with infection prevention and control procedures.
• We found staff training records to be incomplete and clinical outcome data such falls and infection rates to be conflicting.
• We found that staff did not understand and correctly follow safeguarding procedures and comply with the Mental Capacity Act and Deprivation of Liberty Safeguards.
• The risk register did not identify all the unit risks and therefore not appropriately managed or action taken.
• The overall leadership and governance of the unit required strengthening to improve.

However, we also found the following areas of good practice:

• Staffing levels were maintained in line with national guidance to ensure patient safety.
• Nursing staff had direct access to a consultant who was responsible for patient care. In emergencies, patients were referred directly to the local NHS trust and the emergency services called to complete the transfer.
• Overall, the unit achieved effective outcomes for their patients.
• All patients at the unit received high flux dialysis. High flux dialysis is the most effective type of haemodialysis; it is better quality dialysis with shorter dialysis times.
• Flexible staff worked over their hours when needed for the interests of patients.
• Staff were overall caring and friendly who knew their patients well and looked after them with compassion and understanding.

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 four requirement notices with details are at the end of the report.

Post-inspection, the provider provided an action plan in response to our findings to demonstrate action to address our concerns.

The action plan referred to improvements for the following:

• Mental capacity assessment
• Detection of the deteriorating patient
• Sepsis management
• Falls assessments
• Central venous access device assessments and escalation 
• Infection prevention and control practices
• Monitoring of patients at high risk of infection (including those with central venous access devices).

Full information about our regulatory response to the concerns we have described in this report will be added to a final version of this report we will publish in due course.

Heidi Smoult

Deputy Chief Inspector of Hospitals