We visited this location at a time when we were able to talk to people who used the

service (patients) on a regular basis. People were satisfied with the service and appreciated it was available to help them carry on with their lives. They told us staff were 'very good', 'efficient' and 'respectful' when carrying out the necessary procedures. One person said, "They're very good; they look after you whilst you are here". Another patient said, "Nice staff, you can have a laugh with them".

Patients spoken with were satisfied with the level of privacy afforded to them. The treatment area was open with screens available for use around individual stations. However people told us they did not want their screen used throughout their treatment as they liked to see people and talk to those they had got to know due to attending the same sessions over a period of time.

People told us staff explained the treatment, and what was happening, especially if non routine procedures were required. Information leaflets were available and patients recalled being asked for their views on the service. One patient said, "They explain everything to me - as far as I can understand". Another said, "Things are explained as needed".

We were also told people were given some choices in the day and time of the sessions, and there was an evening session for those at work. However people recognised the essential nature of their treatment and agreed to fit in when there were sessions available. One person said, "There is some choice of morning or afternoon sessions within reason, but you want to start as soon as possible".

Diaverum UK Limited (Accrington) is operated by Diaverum UK Limited and commissioned by Lancashire Teaching Hospitals NHS Foundation Trust. It is based in a building belonging to East Lancashire Hospitals NHS Trust. 

The service is a nurse led unit, comprising of a manager, deputy manager, four senior nurses, two nurses, four dialysis assistants and three health care assistants. The service has 12 haemodialysis stations of which two are in a side room. Other facilities include a patient waiting area, a patient weighing area, clean utility, dirty utility, staff changing and rest room, offices, patient toilet, engineers repair room and water treatment plant.

The service provides haemodialysis treatment to adults aged 18 years and over, who have non-complex needs. Currently the service provides treatment to 24 patients between the ages of 18 and 65 and to 34 patients aged over 65 years.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 and 18 May 2017 along with an unannounced visit to the unit on 31 May 2017To 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 was a culture of incident reporting amongst staff with lessons learning shared.

• Medicines were stored and dispensed correctly.

• Staff were appropriately trained to recognise and report safeguarding concerns and we saw this process work during our inspection.

• The areas we inspected were visibly clean and tidy and records showed hand hygiene and water cleanliness were regularly maintained.

• Staff completed mandatory training which was managed by a regional practice educator.

• Pain relief, food and refreshments were available if required

• Patients spoke highly of the staff that cared for them and were happy with the treatment they provided.

• Staff we saw displayed a compassionate friendly approach to patients.

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

• Incidents were not categorised in terms of level of harm sustained. This meant that staff may be less aware of the impact of an incident.

• Root Cause Analysis templates did not contain headings to ensure important information such as a chronology was included in line with guidance by the National Patient Safety Agency.

• Patient records were not always fully completed in relation to risk assessments and clinical observations.

• Prescriptions were recorded on multiple charts rather than one and GP letters were not stored in patient record, which increased the risk that information may be missed.

• The unit did not have any records to provide assurances that daily general domestic cleaning had been completed.

• During a maintenance issue staff had difficulty obtaining a response from engineers despite calling a designated emergency number.

• Staff did not have a robust plan in place to ensure multiple patient transfers could be undertaken urgently if required.

• Main access front doors were not always secure despite the manager confirming that they should be.

• Sepsis training was not provided which posed a risk that staff may not always identify signs of sepsis.

• Not all cultural needs were met with only chaplains and celebrations undertaken based on Christian faiths.

• Staff used relatives to help translate conversations with patients, which was not robust and posed a risk that information could be misinterpreted.

• Governance of policies, procedures and pathways was difficult to understand with expired and inconsistent review dates and processes.

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 a requirement notice that affected the dialysis service. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals North