We previously inspected Bath (known as Nomad Travel Clinic) on 1 February 2018. The full comprehensive report for this inspection can be found by selecting the ‘all services’ link and then ‘Bath’ on our website at www.cqc.org.uk.

At the February 2018 inspection we found the service was not meeting certain areas of the relevant regulations in that it was not providing Well-led services. We did however, find that the provider delivered Safe, Caring, Effective and Responsive services in accordance with the relevant regulations.

We carried out an announced focused inspection at Nomad Travel Clinic on 18 December 2018. This inspection covered the Well-led key questions to confirm the provider had carried out their plan to meet legal requirements in relation to the breaches of regulations identified in our February 2018 inspection. This report covers our review of the Requirement Notices and findings in relation to those requirements. The inspection was carried out by a Care Quality Commission (CQC) lead inspector.

At this inspection we found:

• Governance procedures had been strengthened to ensure oversight by the management team of cold chain maintenance and data protection of personal identifiable information.
• The non-clinical member of staff had received appropriate chaperone training.
• Management were responsive to non-clinical members of staff and initiatives had been put into place to support staff development.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 1 February 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well led services in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This location is registered with CQC, under the location name Bath, in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner, including the prescribing of medicines for the purposes of travel health. The provider is TMB Trading Limited and is operated as a NOMAD Travel clinic in Bath. It is a private clinic providing travel health advice, travel and non-travel vaccines, blood tests for antibody screening and travel medicines such as anti-malarial medicines to children and adults. In addition the clinic holds a licence to administer yellow fever vaccines.

The clinic is registered with the Care Quality Commission under the Health and Social Care Act 2008 to provide the following regulated activities: Diagnostic and screening procedures; Transport services, triage and medical advice provided remotely and Treatment of disease, disorder or injury. The lead nurse is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• The clinic had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the provider learned from them and improved their processes.
• The provider routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines and up to date travel health information.
• Each patient received individualised travel health information including additional health risks related to their destinations and a written immunisation plan specific to them.
• Staff treated patients with compassion, kindness, dignity and respect. Care Quality Commission comment cards completed by patients prior to our inspection were all positive about the standard of care received. They told us the nurses were caring, efficient, professional and knowledgeable.
• There was a leadership structure with clear responsibilities, roles and systems of accountability to support good governance and management. However management oversight could be improved in some areas. For example, for the preservation of the cold chain and adherence to requirements relating to personal data protection.
• Most staff felt supported by the leadership team and worked very well together as a team. However there were instances where management had not considered the needs of staff in order to facilitate their day to day work.
• The provider was aware of the requirements of the duty of candour.
• Clinic staff were encouraged to plan and develop the service to meet local needs such as responding to local disease outbreaks and visiting schools to provide travel health talks.

We identified regulations that were not being met and the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There were areas where the provider could make improvements and should:

• Review and embed systems and processes regarding management oversight in relation to obligations in data protection.
• Review processes whereby staff feedback and requests are listened and responded to.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice