Tipton Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The facilities include 21 dialysis stations including one within an isolation room. Facilities also include a patient consulting room. The unit is located within a standalone building in Tipton and is located approximately five miles from the referring hospital; Russells Hall Hospital.

The service provides dialysis services to patients with chronic kidney disease (CKD). Patients are referred by Russells Hall Hospital. This hospital forms part of the Dudley Group NHS Foundation Trust and is located in Dudley.

The trust refers patients who are stable on haemo-dialysis to this service.

Using our comprehensive inspection methodology we carried out the announced inspection on 2 May 2017, along with an unannounced inspection on 12 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:

• Completion of root cause analyses following reported incidents was effective and highlighted areas for the unit to develop.
• Learning following incidents at the unit and at other Fresenius units was shared with staff.
• Staffing was in line with national guidance for satellite dialysis units, although a receptionist vacancy had negatively impacted upon staff workload. We saw that a receptionist had been very recently recruited and was undertaking induction training.
• Policies and procedures were in line with national guidance, staff were made aware of updates as required.
• The unit worked with the NHS trust to ensure regular monitoring and assessments of patients.
• There was flexibility in patient appointments; this allowed patients to change their treatment time or day if needed.
• We saw that new members of staff undertook a comprehensive induction and training package to ensure they were competent to work safely with patients.
• We saw patients were treated with care and compassion. Patients generally reported a welcoming environment in which they were listened to.
• Staff worked well with patients who had additional needs such as learning difficulties, or cognitive impairment.
• The management of the unit presented as open and supportive, with a visible clinic manager who regularly undertook clinical duties to support the team.

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

• Staff were using a specific technique called ‘dry needling’ in a way that could cause significant harm to a patient.
• Medicines were not always managed safely in line with professional guidance and the services’ policies.
• We saw that patients who did not speak English may struggle to communicate with staff during treatment sessions; also there was limited literature in languages other than English.
• Compliance with infection prevention and control practice amongst staff was variable.
• The building was not completely fit for purpose; for example there were inadequate handwashing facilities for staff.
• Two privacy screens were available for patients which meant that some patients may be unable to receive treatment in a private manner.
• There was only one set of weighing scales, which meant if these were faulty, treatment could be delayed or affected.
• There was no sepsis policy and staff did not routinely screen for this.
• Patient records were not always securely stored.
• We saw patients and carers opening secure doors to allow entry to other patients and visitors. This may compromise security.
• Staff were not trained to level two safeguarding of vulnerable adults.
• The local risk register for the unit did not incorporate all risks identified during our inspection.

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.

We also issued the provider with a requirement notice) that affected dialysis services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

The dialysis unit was open for six days a week and provided treatment to 130 people each week. Most people attended for their dialysis three days a week. We spoke with 24 people who used the service, three of their relatives, three members of staff and the acting manager. The registered manager had left the week before. The acting manager started their new role on the day of our inspection. We also spoke with the Head Nurse who from January 2014 was to oversee the unit. They told us that from October 2014 the provider would no longer provide this service at this location but another company had been given the contract to do this.

Staff had most of the information they needed to know how to support people to meet their individual needs. We observed and people spoken with told us that staff knew how to support people in the way they preferred and to meet their individual needs. One person told us, “Staff are very good; I have no complaints about the treatment I get here.”

Staff liaised with other providers of people’s care to ensure that people’s needs were met and they received the treatment they needed.

We saw that people were generally treated in an environment that was clean and safe to ensure their wellbeing. Several people spoken with told us that recently the unit had been deep cleaned and it was now a lot better. One person said, “If you had come a few weeks ago the floor would not have been this clean.”

There were sufficient staff who had the appropriate skills and knowledge to ensure that the needs of people who used the service were met.

Most people and their relatives were asked for their views about the service provided and these were listened to.

Our inspection was unannounced, which meant that no one knew that we would be visiting. We spoke with 11 people using the service, one relative, four members of staff and the regional director. The manager was on holiday.

People told us the service was provided in three sessions on six days a week. There was a morning, afternoon and evening session and people told us they usually came on the same day and time, which suited them. Most people needed to be on the dialysis machine for up to four hours and this was prescribed by their doctor.

People told us they had the information they needed about their treatment and that any changes were explained to them so they were involved in any decisions.

We saw that staff respected people's dignity and supported them to ensure their health and well being. One person said, “I am well looked after here.” Another person said, “I am happy with my care.”

Systems were in place to ensure that people using the service were safeguarded from harm.

Staff received the training they needed so they knew how to support the people using the service. Staff told us they were well supported in their role.

The people using the service, their relatives and staff were asked for their views about the service and these were listened to. Audits were completed and action taken where needed to make improvements.

We spoke with a couple of patients throughout our visit and observed the care and support they received whilst at the unit.

We observed people to be put at ease, to be reassured and unrushed. One person we spoke with told us how the staff had helped her to come to terms with her diagnosis and treatment regime.

One person said: "All of the staff are fantastic".

People told us that they sometimes had to wait to go onto their machine if the person before was running late. This was because the machines needed to be disinfected. We observed that the staff were busy but people told us the staff were efficient and the whole atmosphere was calm.

People felt they were kept well informed during their time at the Unit.