We carried out an announced comprehensive follow-up inspection on 17 January 2019 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 providing well-led care in accordance with the relevant regulations.

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, in respect of issues we found at the previous inspection.

CQC inspected the service on 18 October 2018 and as a result asked the provider to make improvements regarding the following issues: there were no policies for safeguarding of vulnerable children and adults, or infection prevention and control; not all staff had received up to date safeguarding training and no guidance or training had been given to identify the signs of sepsis and to inform staff of appropriate action to take in cases where sepsis was suspected; There were no risk assessments in respect of general health and safety at the premises, staff workstations and emergency medicines; no adequate infection prevention and control protocols and no adequate infection prevention and control audit had been undertaken within the last 12 months; there was no written guidance on sharps injuries; patients were not informed of the availability of chaperones; there was no locum handbook, to provide locums with information about the service and its policies and procedures; there was limited evidence of quality improvement activities within the last 12 months, such as clinical audits; there was a lack of systems in place to monitor and improve the quality and safety of the services or to identify and mitigate risks to people’s health safety and welfare; administrative staff had not received appraisals for several years; the provider had not established a full range of written governance policies or consistently reviewed and updated its existing policies; there was no business continuity plan in place.

We issued requirement notices for breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We checked these areas as part of this comprehensive inspection and found the service had resolved most issues and was working on those remaining.

Broadgate Spine & Joint Clinic Limited provides private general practice appointments, including blood tests; dietary advice; psychiatric support; flu vaccinations; travel clinic, providing travel vaccinations; sexual health, such as pregnancy and sexually transmitted disease testing; and health screening including cervical and breast cancer screening. Services are provided only to adults, aged over 18 years.

We received feedback from 42 patients using the service. Patients were consistently positive about the service they received, telling us that: they found it easy to access care, all staff treated them with dignity and respect and they felt involved in all decisions about their care.

Our key findings were:

• The service had implemented appropriate policies for safeguarding of vulnerable adults and children, and all staff had received up-to-date safeguarding training appropriate to their role.
• Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. They knew how to identify and manage patients with severe infections, for example sepsis.
• Patients received coordinated and person-centred care. Staff referred to, and communicated effectively with, other services when appropriate, for example when referring patients to specialist services.
• The service had a hearing loop in the reception area to assist patients with a hearing impairment.
• Waiting times, delays and cancellations were minimal and managed appropriately.
• We saw no evidence of discrimination when making care and treatment decisions.
• Leaders at all levels were visible and approachable. They worked closely with staff and others to make sure they prioritised compassionate and inclusive leadership.
• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.

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

• Revise the practice business continuity plan to ensure it includes all relevant contact details.
• Display sharps injury guidance in the clinical rooms for the benefit of any staff who may suffer such an injury.
• Ensure all staff are supported by a programme of regular appraisals.
• Introduce regular staff meetings and record meetings for the benefit of learning and sharing of decisions and information to all staff.
• Carry out a suitable premises health and safety risk assessment detailing any issues and rectification needed with review and completion dates.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 18 September 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not 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 care in accordance with the relevant regulations.

The service was last inspected in February 2014, by the Care Quality Commission’s Hospitals Directorate, when it was found to be compliant with the relevant regulations. 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.

The service provides private general practice appointments, including blood tests; dietary advice; psychiatric support; flu vaccinations; travel clinic, providing travel vaccinations; sexual health, such as pregnancy and sexually transmitted disease testing; and health screening including cervical and breast cancer screening. Services are provided only to adults, aged over 18 years.

We received feedback from 52 patients using the service. The feedback was consistently positive regarding easy access to the service, their involvement in decisions about their care and confirming staff treated patients with dignity and respect.

Our key findings were:

• At the time of the inspection, the provider did not have in place policies relating to safeguarding and infection prevention and control.
• Not all staff had received up to date safeguarding training and no guidance or training had been given to identify the signs of sepsis and to inform them of appropriate action to take in cases where sepsis was suspected.
• The provider had not carried out risk assessments in respect of general health and safety at the premises, staff workstations and emergency medicines.
• An infection prevention and control (IPC) review, carried out shortly before our inspection had not identified various issues that needed to be addressed. For example, there being no IPC protocols in place, premises deep cleaning and cleaning of medical equipment was not recorded, and there was no written guidance on sharps injuries.
• There were not effective systems and processes in place to assess monitor and improve the quality and safety of the services provided or to or to identify and mitigate risks to people’s health, safety and welfare.
• Administrative staff had not had appraisals for several years.
• The provider had not established a full range of written governance policies, or consistently reviewed and updated where necessary its existing policies.
• The provider recognised that the were some areas of practice that required improvement. Consultants had been appointed before our inspection was announced to review clinical and business practices to bring about improvement.
• The provider assessed needs and delivered care in line with relevant and current evidence-based guidance and standards.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The provider organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

You can see full details of the regulations not being met at the end of this report.

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

• Review how patients are informed of the availability of chaperones.
• Review the process of providing locums with information about the service and its policies and procedures.
• Review arrangements for carrying out clinical audits to drive improvement.

• Review procedures for conducting and recording staff meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

At our previous scheduled inspection in May 2013, we found the provider was not operating effective recruitment procedures. The service was not consistently demonstrating that appropriate pre-employments checks were carried out for new employees. Following this inspection, the provider sent us an Action Plan which detailed improvements they made to their recruitment. We carried out this follow-up inspection to check whether the service was now compliant with the regulations relating to recruitment.

At this inspection we found that the service had safe and thorough systems for recruiting staff.

We spoke with five people using the service who all told us they were happy with their care and treatment. One person said, “I have been using this service for years and so do my family. They put the needs of the patient first.” Another person told us, “they have more time to spend with me and explain things very clearly. I think I have been given good advice and the doctor was very friendly.”

The treatment areas were clean, spacious and provided privacy. All of the staff had attended life support training and knew what to do in the event of a medical emergency.

The people we spoke with told us they felt safe with the staff. There were systems in place for safeguarding people. Staff were able to explain how they protected people.

Staff were provided with training and support, however, improvements were needed with staff recruitment in order to make sure all pre-employment checks were completed.

People using the service told us they knew how to make a complaint and felt confident that any complaint would be professionally managed.

During the visit we did not have the opportunity to speak to any patients directly. However observation of the practices of the clinic, discussion with staff and inspection of records indicated that staff protected people’s privacy and dignity and treated them with respect. Feedback from patient surveys indicated that patients felt that staff listened to them and offered them choices about their care and treatment as far as possible.

The premises are well maintained and kept clean and hygienic, and appropriate quality assurance systems are in place. However there is room for improvement in safeguarding adults training and procedures, recording of staff recruitment checks, training and supervision, and more regular portable appliances testing for the further protection of people using the service.