People told us that they were “Very happy” with the care and treatment they had received. One person said “Staff are absolutely wonderful”, and one said “It’s a small unit and really relaxed”. A patient told us there had been a recent period when the staff were working “Flat out” because of staff sickness but that it had not “made any difference” to the care they had received.

The patient health records were up to date and described the treatments that were being provided. People were aware of their treatment plan and told us they understood the information they were given. They were receiving well planed care which was provided in line with their assessed needs.

The unit was clean and tidy. Staff were aware of infection control principles because of appropriate training and monitoring of their practices. Staff were observed following these principles throughout the visit. The equipment being used was single use where possible and when this was not systems were in place to make sure that the risk of cross infection was reduced by effective cleaning and decontamination practices.

Staff were recruited and selected for the role they undertook and appropriate checks were carried out to make sure they were competent in delivering the care including ongoing review of their practice and appropriate training.

Records were up to date, stored in line with good principles and were disposed of according to the policies and procedures.

We visited this location on a weekday and were able to talk to two people who used the service on a regular basis. We were told the staff are ‘good’, ‘welcoming’ and ‘build up relationships’. Staff were said to ‘bend over backwards’ and ‘sort things out straight away’. People also told us staff ‘speak appropriately and professionally’, ‘treat me with respect’ and that they ‘had not had any complaints’ and they confirmed they knew how to discuss issues and who with.

Darlington Dialysis Clinic is operated by Diaverum UK Limited. The unit has 18 stations comprised of 16 stations in the main area and two side rooms (which can be used for isolation purposes). It is contracted by South Tees Hospitals NHS Foundation Trusts, to provide haemodialysis for stable NHS patients with end stage renal disease/failure. Patients are referred to the unit by local NHS trusts.

The service is situated as a ‘standalone’ dialysis unit on the site of Darlington Memorial hospital.

The service originally commenced in 1994, but was taken over by Diaverum in 2011.

The provider does not treat children at the unit.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 14 June 2017, along with an unannounced visit to the unit on 23 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.

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;

• Incident reporting and investigating processes were robust and staff were clear in relation to their roles and responsibilities.
• We found that the clinic was visibly clean, arrangements for infection prevention and control were in place and there was no incidence of infection.
• The unit was compliant with the NHS Estates guidance (Health Building Note 07-01) and equipment maintenance arrangements were robust.
• There was a good range of comprehensive policies in place to support staff; these were accessible and understood by staff we spoke with.
• We observed a caring and compassionate approach taken by the nursing staff during inspection.
• Nurse staffing levels were maintained in line with national guidance to ensure patient safety.
• We saw 100% compliance in relation to mandatory training completion.
• The clinic provided opportunity for patients to visit prior to starting dialysis treatment, as part of pre-assessment.
• Patients were supported with self-care opportunities and a comprehensive patient education process was in place. Holiday dialysis for patients was arranged to provide continuity of treatment and to support the wellbeing of patients.
• The unit took a proactive approach to risk management, the risk assessments we reviewed were appropriate to the environment and had been reviewed regularly.
• The unit manager was visible to both patients, staff, and maintained a supportive and positive culture on the unit.

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

• Nursing staff were not trained to safeguarding children level two in accordance with national guidance and the safeguard policy did not include children.
• Comprehensive patient assessments were not routinely updated and care plans were not developed for specific health conditions such as diabetes.
• The service did not fully follow patient identification procedures for checking medicines before administration, which increased the risk to patients of medicine errors, and audits were not completed to ensure maintenance against national standards.
• Policies were not reviewed regularly and we were not assured that they were reflective of best practice.
• The service did not have sufficient arrangements for appropriate information and interpreting services for patients who cannot communicate in English, in line with the Accessible Information Standard.
• The service had not implemented the Workforce Race Equality Standards 2015 (WRES).
• Arrival and pick up times for patients were not monitored in accordance with NICE quality standards.

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 issued the provider with three requirement notices, which are at the end of the report.

Ellen Armistead.

Deputy Chief Inspector of Hospitals (North region)