On the date of our visit to Yeovil renal unit people we spoke with said they were "involved with their care and could make choices about their treatment" with their care staff.

Care was delivered in a professional and friendly manner. People told us "Staff are very good and have always got time for you." Professionals who visited the unit said "staff are very organised and keep people up to date with things."

Staff were trained in aspects of infection control which enabled them to give safe care. We observed staff attending to the needs of people having treatment by carrying out their tasks with suitable personal protection.

People being treated thought there were enough staff to ensure they did not have to wait for long with assistance. One person said "the staff are always on the go, but they make time for you if you need it."

Records relating to staff rotas were clear, legible and archived for the appropriate amount of time.

We spoke with five of the patients receiving dialysis on the day of our inspection. The patients all understood the care and treatment they were receiving. They told us that the hospital consultants and the dialysis nurses on the unit had explained the treatment and support they would receive. They had also received information leaflets prior to admission explaining what they could expect. Patients said “The doctor told me all about my treatment and gave me leaflets” and “The nurses answer all my questions”.

All of the patients we spoke with had follow-up appointments with their hospital consultant on a three monthly basis. In between these appointments patients said they could raise any matters with the nurses on the dialysis unit. We were told “I was told from the start that if I had any problems just ask”.

Patients told us that the staff looked after them well and they were happy with the care provided. We were told “The staff are excellent”; “People come running if I need anything” and “They are cheerful and caring, it makes you feel so much better”. We observed that staff carried out their roles in a caring, competent and confident manner. We were told the staff “know what they are doing they are absolutely great”.

Patients thought the dialysis equipment was satisfactory and the dialysis chairs were “alright”. We were told “They serve the purpose and can be adjusted but if you have back ache you need extra cushioning” and “The chairs are adequate but not brilliant”. The main problem experienced by patients was the cool air blowing from the air conditioning system. We were told “Everything is fine apart from the heating” and “We move around and some areas are cooler than others”. We observed that patients were able to bring in their own pillows and blankets to make them more comfortable.

Patients were generally happy with the quality of service provided. One patient said “I haven’t got any complaints, but I am confident they would sort it out if I had”. Another patient told us “I wouldn’t change anything apart from the heating”.

Yeovil Renal Unit is operated by B. Braun Avitum UK Limited. The service has 13 dialysis stations for patients and offers two shifts of daily sessions between 6.30am and 6.30pm. The service also offers three evening shifts on Mondays, Wednesdays and Fridays (from 6.30pm to 11pm). The service is open six days a week and operates 180 sessions for a current caseload of 55 patients. The unit has capacity for 65 patients. Facilities include a main unit with12 dialysis stations, divided into three bays, and one isolation room with dialysis station. There was a manager and clerical office, consultant’s office, rear service corridor, and patient toilet.

The medical care is covered by three NHS hospitals (Dorchester, Southmead and Exeter). The patients from Southmead and Exeter have their blood results reviewed monthly at a continuous quality improvement meeting and patients from Dorchester are reviewed in the unit. The dietetic cover is provided by a dietician who visits the unit twice weekly as agreed through a service level agreement with Somerset Commissioning Group.

Dialysis units offer services, which replicate the functions of the kidneys for patients with advanced chronic kidney disease. Dialysis is used to provide artificial replacement for lost kidney function.

The service is a nurse led unit and is supported by the renal unit at Dorchester Hospital in Dorset.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 June 2017 and further unannounced inspection on 29 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?

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 when they are provided as a single specialty service. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of improvement that were required:

• Staff were not fully compliant with mandatory training in line with corporate policy.

• Nurses did not check patients’ identity prior to commencing haemodialysis treatment.

• There was no policy or guidance available to staff about the early recognition or management of sepsis. Staff had received no specific training for the early identification of sepsis and management (infection) in line with national guidance (NHS England, 2015).

• Patients’ records were not securely stored on the unit during dialysis.

• There was no awareness of and evidence of compliance with the Workforce Race Equality Standard (WRES) which became mandatory in April 2015.

• Patients felt that it was difficult to have a private conversation on the unit.

• There was not an effective process to monitor how local service risks were identified, mitigated and acted upon.

• Some chairs in the unit were visibly damaged and many patients found them to be uncomfortable.

• Due to a lack of permanent unit manager prior to the inspection, unit staff were not having regular meetings, and some staff had not had an annual appraisal in the preceding 12 months.

However, we found the following areas of good practice:

• Evidence based practice and the Renal Association guidelines were used to develop how care and treatment was delivered. All policies and procedures were based on national guidance and updated when required to reflect change to national guidance and then distributed to staff. Patient outcomes were monitored in line with best practice guidelines.

• There was a good incident reporting culture and the staff were aware of the procedure to follow when reporting an incident or an adverse patient incident. Staff followed company policy with regards to infection, prevention and control.

• The unit had clear processes to ensure regular servicing and maintenance of equipment, and there were policies and procedures to follow in case of a failure in the water supply or power failure. Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident.

• There was good multidisciplinary working and strong communication links with the lead consultant and the local NHS trust.

• There were effective processes for gaining informed consent, which was sought and documented prior to treatment.

• 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 their quality of life.

• There was a system to monitor and deal with complaints. There had been no formal complaints at the unit in the year prior to our inspection.

• Staff felt valued and supported in their roles and reported a positive working culture.

• There was a replacement programme for the dialysis machines, in line with the Renal Association guidelines.

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 three requirement notices. Details are at the end of the report.

Edward Baker

Chief Inspector of Hospitals

South Region