We carried out an announced comprehensive inspection on 26 April 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led. We found the service was meeting the regulations for being safe, effective, caring and responsive however they were not meeting the regulations for providing well-led care.

This inspection was a focused follow-up inspection carried out on 27 September 2018 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches of regulations that we identified at our previous inspection on 26 April 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were:

The provider had made the necessary improvements to rectify the breaches in regulations identified at our previous inspection;

• There was an effective system for reporting, investigating and learning from incidents and significant events.
• There was an effective system to ensure updates in current evidence based guidance were incorporated into clinical practice.
• The provider had implemented a business continuity plan for emergencies and major incidents.

In addition since our previous inspection;

• The provider had developed a five-year business plan to realise the vision to deliver high quality care.
• They had reviewed policy on carrying out identity checks on new patient registrations and ensuring parents accompanying the child patient had the authority to consent to care and treatment on their behalf.
• The provider had ensured information was available that signposted patients to out of hours services.
• They had provided training to reception staff in basic life support, safeguarding and chaperoning.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 26 April 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 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.

Citydoc Westend provides travel vaccinations, sexual health services and doctor consultations to the whole population.

The female clinician 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.

Fifteen people provided feedback about the service.

Our key findings were:

• The service had systems and processes to minimise most risks to patient safety.
• The service had adequate arrangements to respond to medical emergencies.
• There was a process for reporting and investigating significant events and incidents, however it was not effective.
• Staff received essential training, and adequate staff recruitment and monitoring information was retained. Although the receptionist had not received basic life support and safeguarding training at the appropriate level for their role.
• There was some evidence of quality improvement activity.

• Patient feedback indicated that staff were caring and courteous and treated them with dignity and respect.

• The service responded to patient complaints in line with their policy.
• The service had good facilities and was equipped to treat patients and meet their needs.
• There were systems in place to collect and analyse feedback from patients.
• The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.

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.

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 the training requirements of reception staff to ensure patient’s are safe in the waiting area.
• Review the arrangements for not requiring patients to provide identification when registering with the service.
• Review consent procedures in relation to adult attending with children and consent to inform a patient’s NHS doctor.
• Review the arrangements for informing patients of out of hours services.
• Develop a clear vision and set of values for the service including a strategy and supporting business plans to deliver them.