Lakeland Dialysis Limited

​Lakeland Dialysis Unit is operated by Lakeland Dialysis Limited.

It is a private holiday dialysis unit situated within a business park, on the outskirts of Cockermouth.

The service was established in 2004 and is a small independent nurse led unit, providing holiday dialysis to patients holidaying in the area.

The service provides haemodialysis from Monday to Saturday depending on the number of patient bookings, with morning and afternoon sessions offered.

We carried out a comprehensive inspection of the unit on 5 July 2017. This included an unannounced visit to the unit on 17 July 2017. We inspected a third time on 11 April 2018. The inspection took place as part of our comprehensive inspection programme. The service was in breach of regulations. We issued a warning notice to the provider about specific breaches within the unit. This identified concerns and areas for improvement at Lakeland dialysis unit including that the service needed to ensure:

• The appropriate recording of clinical incidents, including the severity and/or grade of the incident within the unit.
• The identification and completion of mandatory training for staff working within the unit.
• Safeguarding policies and training were in place to ensure staff were aware of safeguarding procedures. This included safeguarding children.
• The mitigation of risk to patients through the regular review of practice against clinical guidelines, policies and best practice.
• The processes of monitoring and reviewing staff competencies and ensure staff were competent to carry out their roles.
• The assessment, monitoring and improvement of services through regular clinical audit.
• The maintenance of staff records which included all necessary documentation such as essential employment checks.

We carried out an unannounced visit to the unit on 11 April 2018 to check on progress that had been made against our warning notice. This inspection focused on the specific issues we had raised following the comprehensive inspection earlier in the year.

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.

In this inspection, we found the following areas of good practice:

• We saw the unit manger had developed incident reporting policies and procedures. Guidance for staff was comprehensive and included the grading of the severity of the incident and when duty of candour should be applied.
• Mandatory training processes had been improved to include a new training policy and mandatory training list, which clearly showed when staff training was due.
• Safeguarding processes including children’s safeguarding were strengthened to include comprehensive training and guidance for staff and updated local authority contact and escalation arrangements.
• Policies and procedures to support patient care were regularly reviewed to ensure guidance was in line with current NICE guidance and best national practice.
• We saw improvements in the training culture in the unit, with mandatory staff training showing 100% compliance.
• Staff received competency reviews to ensure clinical practice was compliant with national guidance and best practice.
• The unit manager demonstrated clear leadership and had taken positive steps towards improvement.
• Governance processes had been strengthened to ensure risks were identified and mitigated and audit activity supported improved patient care.
• The development of staff records, which were comprehensive. These were well organised and included all required employment checks.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)