We carried out an announced comprehensive inspection at Cardio Direct (UK) Ltd. as part of our inspection programme to rate independent health providers.

During our previous inspection on 13 December 2017, we asked the provider to make improvements regarding reviewing their procedures for infection prevention and control audits to ensure this was undertaken on a regular basis. Also, the provider should have obtained copies of fire safety and legionella assessments for the premises to satisfy themselves that these have been undertaken. At this inspection, we checked these areas as part of this comprehensive inspection and found this had been resolved.

The service provided screening and diagnostic services in the area of cardiac medicine for various client groups, including those under the age of 19 as part of their ongoing care through football academies. This service was registered with CQC under the Health and Social Care Act 2008 in respect of all of the services it provided. The provider had a 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 provider had embedded systems to support the safeguarding of patients from abuse but were unable to demonstrate that these were always fully effective in practice.
• Clinical systems to support services offered by the provider were well planned, effective and safe.
• There was a process in place for patient feedback, but patients had not engaged. The provider therefore was looking to review the process to ensure better engagement regularly. This was not formally documented.
• The provider was unable to demonstrate any patient feedback in relation to access to care and treatment but was a bespoke service. The provider demonstrated that they worked around patient’s needs. For example, we saw evidence where weekend appointments were provided due to patient need.
• The governance systems in place were comprehensive but demonstrated that they would benefit from strengthening in the areas of risk management.
  

The areas where the provider Must make improvements are:

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

The areas where the provider Should make improvements are:

• Continue to embed systems to support the collection and consideration of patient feedback.
• Review systems to ensure that personnel files provide assurances that all necessary information has been gathered at recruitment and on an ongoing basis.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection of Cardio Direct (UK) Ltd on 13 December 2017 to answer the following key questions:

Are services:

• Safe
• Effective
• Caring
• Responsive
• 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 a caring service 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 a well-led service 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 provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The provider, Cardio Direct (UK) Limited, is registered with the CQC as an organisation providing a cardiovascular diagnostic service to private patients from consulting rooms at 112 Harley Street, London W1G 7JQ. The provider is registered to provide the regulated activities of treatment of disease, disorder or injury and diagnostic and screening procedures.

At this inspection we found:

• The practice had clear systems to manage risk and provide safe care and treatment. However, they had not obtained copies of fire safety and legionella assessments for the premises to satisfy themselves that these had been undertaken. These were however obtained following the inspection.
• The premises were clean and tidy. The provider had undertaken a recent infection prevention and control (IPC) audit and the IPC procedure in place was appropriate for the service provided but did not include the undertaking of a regular IPC audit.
• The practice carried out staff checks on recruitment and on an ongoing basis, including checks of professional registration where relevant.
• The provider routinely reviewed the effectiveness and appropriateness of the service provided to ensure it was in line with current guidelines. The practice had a comprehensive programme of quality improvement activity in place. Test results were routinely reviewed by a consultant cardiologist.
• A patient information leaflet was sent to all patients which included details of the availability of a chaperone; the confidentiality agreement and the complaints procedure. Clear information regarding the cost of services was given on the website.
• The patient survey results showed that 98% of respondents were satisfied with the care they received.

• The facilities and premises were appropriate for the services delivered and a mobile service was available for sports screening of large groups, such as professional football clubs and for patients unable to travel to the premises, such as elderly or frail patients.
• The provider had the experience, capacity and skills to deliver a high-quality and sustainable service and to address any risks. There was a strong focus on continuous learning, improvement and development of services and staff. All staff had received a six-monthly appraisal which included a review of training needs.

There were areas where the provider should make improvements:

• The provider should review their procedures for infection prevention and control audit to ensure this is undertaken on a regular basis.
• The provider should obtain copies of fire safety and legionella assessments for the premises to satisfy themselves that these have been undertaken.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We were unable to speak to any people using the service on the day of our visit because there was nobody scheduled to come in for an appointment at the time we visited. We looked at feedback questionnaires that had been completed by people who had used the service and the most recent audit of these questionnaires. People who had used the service said that they felt the procedure had been explained in detail and that adequate time had been allowed for their consultation. One person wrote that the staff were "friendly, informative and professional".

People were assessed by either a nurse or doctor before undergoing any cardiovascular tests. People were provided with information and a contact number to call if they had any concerns after they had left the clinic. There were procedures in place to deal with a medical emergency.

Staff received appropriate professional development and attended relevant training courses and conferences. The comments from the feedback questionnaires were complimentary about staff, the majority of respondents agreed that "The staff were friendly and professional in the clinic". Staff had received safeguarding training and were able to describe what actions they would take should they have a concern. Staff carried out regular audits of test results to identify areas for improvement and staff development. There were regular staff meetings to discuss these comments and identify practice issues within the clinic and areas that could be improved.