We carried out an announced comprehensive inspection on 10 March 2016 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

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.

Chiltern Hills Heart Clinic (CHHC) is located in an independent hospital in Buckinghamshire. The clinic consists of one consulting room and an adjoining room containing a treadmill. Arrangements are in place with another provider to maintain the clinic premises including cleaning and repair and also provide additional services such as booking patients and diagnostic tests when needed. The clinic provides a private cardiology service of consultations and investigations including echocardiograms (ultrasound scan of the heart), electrocardiogram (ECG), blood pressure and heart monitoring.

The service is provided by one consultant cardiologist and a cardiac physiologist, who undertakes echocardiograms. They are supported by a medical secretary and a practice administrator. The clinic office is open 8.30am to 4.30pm weekdays. The consultant and cardiac physiologist attend at different times during the week. Patient appointments with the consultant are available Monday and Saturday mornings and Thursday and Friday afternoons. Appointments with the cardiac physiologist are available on Tuesday mornings and Wednesday evenings.

The service is provided mainly for adult patients, although a small number of young people and children are seen. In 2015 CHHC provided 1224 consultations, of which 334 were new consultations and 900 were follow up consultations. Fourteen patients under the age of 18 years were seen and no patient under the age of 10 years.

The consultant 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.

During the inspection we obtained feedback from 50 patients through interviews and comments cards. All the feedback was very positive.

Our key findings were:

• Risk assessments were undertaken and control measures were in place to protect staff and patients. However, with regards to infection control, there was a lack of arrangements to ensure policies and procedures reflected all the current guidance.
• Staff were trained in safeguarding children and adults at risk. Children were seen in clinic when a children’s nurse was on duty. Following the inspection the provider reviewed the service provision to children and made the decision to cease the service to children by end August 2016.
• Arrangements were in place to respond to a medical emergency including availability of equipment and trained staff.
• Referrals to the service were reviewed and care provided after assessment. Care was delivered in partnership with NHS services to meet patients’ needs.
• Audits were undertaken to ensure care was delivered effectively.
• Staff received regular mandatory training and participated in appraisals to maintain their skills relevant to their roles.
• Feedback from patients was very positive about their experience of the care they received.
• The service was open Monday to Saturday at varying times to suit patients’ preferences. Appointments were normally available within two weeks of referral.
• A wide range of patient information including videos was accessible on the clinic website.
• Appropriate governance arrangements included service audits, patient satisfaction survey and an annual service review, to identify areas for improvement.
• Staff described an open, transparent culture where they felt their contribution was valued.

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

• Ensure staff adhere to ‘bare below the elbows’ practice to reduce the risk of cross infection.
• Ensure staff who care for children have the recommended level of safeguarding training.

We saw how the provider has taken reasonable steps to ensure that the people who are using the service are fully informed of all the information relating to their treatment prior to their appointment. All documentation was in place and up to date and risk assessments were thorough and specific to the service.

The staff at the service are fully trained in the protection of vulnerable adults and were well informed on how to spot and report abuse. The staff are well supported by regular training and support by the registered manager. The provider has a system in place to ensure that the quality of provision is regularly sought including the feedback from people who had used the service.