Chandlers Ford Dialysis Unit is operated by Fresenius Medical Care; it is commissioned by the local NHS Trust, as part of their renal service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 26 April 2017 along with an unannounced visit to the unit on 9 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 were effective processes in place to keep patients safe, including a well-embedded process for reporting incidents and learning from them. The unit’s patient data was inputted to the renal registry through the commissioning NHS trust.

• Staff showed effective, robust infection control, with high compliance in cleaning, hand hygiene, and strict segregation of high risk patients. There was an effective monthly audit programme to ensure standards were maintained.
• There was an effective process for obtaining and recording patient consent for renal dialysis. There was good access to renal dietician support and staff referred patients appropriately. Patients felt they were involved in decision making about their renal care.
• There was a good standard of compliance in mandatory training. All staff had an annual review of their practice competencies, assessing both knowledge and skills. Temporary staff within the unit had a work place induction. There were many routes for training and education that staff could access.
• The unit used a ‘named nurse’ system; we witnessed a good rapport between staff and patients who knew each other well. Staff treated patients with kindness and with consideration for their individual and cultural needs. All patients who spoke with us were happy with their care and this was reflected in the positive patient satisfaction survey results.
• Staff and patients felt that the local leadership was visible and approachable and felt well supported. Staff recognised and understood the Fresenius Medical Care core values.
• Policies and procedures in use within the unit, were based on national guidance and all clinical policies had been regularly updated. There was well prepared business continuity and disaster planning.
• We saw 100% of staff had participated in the staff satisfaction survey undertaken in 2016. The FMC human resources department had been actively involved in improving the retention of staff.
• There was a monthly review of the unit’s clinical dashboard by the area team to assess progress. They monitored the unit’s key performance indicators were monthly with actions identified for any shortfalls. The unit was involved in a pilot of a new local risk register.

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

• There were no dialysis beds or pressure-relieving cushions to promote the comfort of dialysis patients. There were no privacy curtains fitted enabling patients to maintain their privacy and dignity.
• There was a risk to the accuracy and completeness of patient records due to the duplication of records, the frequent transposing from written to electronic systems and the inability of staff to fully access the patients NHS records.
• There were no re-assessment of patient safety risks and a lack of person centred care plans found within the written records.
• There were no formal patient identification checks prior to administration of medicine and dialysis.
• Staff did not recognise or understand the Duty of Candour requirements.
• The unit flooring was damaged, so cleaning was ineffective.
• The waste compound was accessible by the public through the metal railings; and the bins were unlocked.

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 notice(s). Details are at the end of the report.

Professor Edward Baker

Chief Inspector of Hospitals

We spoke with seven people who used the service and six staff.

People we spoke with were all positive about the care and treatment they had received. One person told us: "It’s a good place, they treat me extremely well". Another person told us: "I am really happy with the unit and if I had not needed dialysis I would never have met these lovely people". A third person said: "There is no place I would rather have dialysis than here".

We found that people were consulted about their treatment and were informed when changes were needed to promote their health and wellbeing. People told us that staff treated them with respect and our observations on the day of our visit confirmed this.

People told us that staff were helpful and gave them the information they needed about their treatment. One person said: "The staff are brilliant, I cannot fault them". Another person said: "They are a very good and competent staff team".

The service had appropriate systems in place to enable people to raise concerns. People reported that they were confident that their concerns would be investigated and addressed.

Systems were in place to monitor the quality of the service provided and people were asked for their views about the service they received.