During our visit to Woodgate Dialysis Unit we spent time with people who were receiving treatment on the day. We also spoke with four members of staff, three senior managers and one visiting health professional.

People were generally satisfied with the care they received and had confidence in the staff delivering their care. People told us “I’m reasonably pleased, reasonably satisfied. If I have something to say I’ll say it;” "I think the unit is well run;” and “I have confidence in the nurses, they know what they are doing.”

The People that we spoke with told us that staff were polite and respectful. They told us that staff would explain what they were doing. People attended the unit on a regular basis and generally knew what to expect at each visit. Information was made available to people about their treatment although what people could expect from the unit was not always made clear.

People using the service had confidence in it. They told us that it was a “very good” unit and the nurses “are very good, very caring”. One person commented that “we are like one big family”. People were happy with the treatment they received and they felt safe coming to the unit.

People told us that they thought the staff were “very good”, although they thought the unit sometimes seemed to be short of staff. They told us that the unit was “always clean” and that “staff wash their hands” and change their apron and gloves when they move on to look after a new person.

People told us that “if there is a problem, I will tell them”. Two of the people who came to the unit were on the registered provider’s Expert Patient Board, one of whom was the chair. He told us that people could come to him with any concerns, although they did not as they did not have any concerns.

Woodgate Dialysis Unit is operated by Fresenius Medical Care UK. The clinic opened in 2009. It is contracted by NHS England to provide renal dialysis to patients from University Hospital Birmingham NHS Foundation Trust (UHB). The contract period is for 10 years from 2009 – 2019.The service has 24 dialysis stations, which included four isolation rooms.

Dialysis is used to provide artificial replacement for patients with advanced chronic kidney disease who have lost kidney function.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 May 2017 and an unannounced visit to the unit on 26 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 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 good practice:

• Staff conducted daily water testing and there were no water failures.

• Senior staff shared learning from incidents that had occurred at the clinic and at other Fresenius units with staff.

• The majority of staff treated patients with compassion and dignity and patients reported a friendly environment at the unit.

• Staff monitored patient’s pain levels well and ensured patients were as comfortable as possible.

• The clinic had a good relationship with the parent NHS trust who provided all dialysis patients at the clinic with specialist support for their condition.

• New staff were well supported when they started at the unit and were supernumerary to support their learning.

• Clinic staff could access records at the local NHS trust, which nursing staff told us reduced the time it took them to chase blood results and other test results. This also meant it was easier for consultants to give advice to nursing staff regarding patient’s treatment as they had access to up-to-date information.

• The majority of staff interacted with patients in a friendly and personal way and welcomed patients when they arrived for their treatment.

• We saw clinic staff worked well together and they felt supported by senior staff.

• Staff at the unit told us the quality of patient care was their priority.

• The area head nurse visited the unit regularly and supported new staff particularly well.

• Senior staff held regular team meetings.

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

• Staff did not always administer medication in line with Nursing and Midwifery Council (NMC) guidelines.

• The centre did not have a sepsis policy or toolkit and staff had not conducted specific sepsis training.

• There was not a robust process in place for oversight of training compliance to ensure staff were up-to-date with their training and competent to carry out their role.

• Staff did not fully understand mental capacity and Deprivation of liberty safeguards (DoLS). We were not confident the unit had effective systems to ensure staff adhered to the Mental Capacity Act and DoLS legal requirements.

• We observed four out of five staff used poor aseptic non-touch technique processes when connecting and disconnecting patients to the dialysis machine.

• During the announced inspection, we observed two occasions where staff did not effectively communicate with patients during treatment. We were also told by two other patients that staff did not keep them up-to-date about their treatment or reassure them.

• One patient told us they experienced a waiting time of approximately four hours to start their dialysis with no updates given by staff.

• During our announced inspection, we noted that one of the three toilets was not available due to maintenance. This was having a negative impact on patients.

• Staff did not ensure patients with new fistulas commenced dialysis in a timely way. We would expect a risk based rationale for treatment of new fistula patients.

• The clinic manager was new in post and did not yet fully understand the risks to the service.

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 one requirement notice. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals