We carried out an announced comprehensive inspection at CP Medical Clinic on 11 December 2018 to follow up the concerns identified at our previous inspection in June 2018. You can find the reports of our previous inspections by selecting the ‘all reports’ link on our website.

This inspection was an announced focused inspection carried out on 4 February 2019 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified at our previous inspection on 11 December 2018.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This report covers our findings in relation to those requirements and improvements made since our last inspection.

CP Medical Clinic provides private medical services at 61-63 Sloane Avenue in the Royal Borough of Kensington and Chelsea and treats adults and children. The provider, Dr David O’Connell is registered with CQC under the Health and Social Care Act 2008 to provide the regulated activity of Treatment of disease, disorder and injury at this location.

At this inspection we found action had been taken on most of the issues identified at the previous inspections.

Our findings were:

Are services safe?

We found that this service was providing safe 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.

Our key findings were:

• The service had succeeded in making improvements to most aspects of policy and protocol, but there were areas for improvement identified. The provider was not consistently following policies and procedures used by staff at the host clinic.
• The service had reviewed risks associated with the service’s premises and ensured formal safety risk assessments were carried out at regular intervals to reduce risks to patients and staff.
• Management of fire risk kept people safe. The service had maintained a record of fire drills as outlined in the fire risk assessment.
• The provider monitored people on high-risk medicines. Records we looked at showed patients’ health was monitored in relation to the use of medicines and followed up on appropriately.
• The provider had started to implement a system to ensure the safe management of prescribing of controlled drugs.
• Records were not always written and managed in a way to keep people safe. Patient notes were not easily accessible in an emergency and it was not possible for the provider to share information with other services when there was an urgent need.
• CCTV cameras in the two consulting rooms had been removed. The provider did not have signs up warning people about CCTV recording in the host clinic. Staff put up signs during our inspection.
• There was no employee record for one member of staff who was employed by the provider in the carrying on of regulated activities and no record of a DBS check. During our inspection, the provider was able to obtain evidence of DBS disclosure application for the employee.
• Governance arrangements had improved to ensure effective oversight of risk. There was a controlled drugs policy in place and leaders had completed priority actions from the fire safety risk assessment.

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 ease of access to patient notes kept by the provider.
• Continue to develop quality improvement systems that monitor the positive impact on quality of care and patient outcomes.
• Review the systems for checking expiry dates on medicines stored by the provider.
• Review the process for sourcing patient feedback to improve and develop the service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection on 11 December 2018 to ask the service the following key questions: are services safe, effective, caring, responsive and well-led?

We previously carried out an announced comprehensive inspection at CP Medical Clinic on 5 June 2018. As a result of our findings during that visit the provider was served a requirement notice for breach of Regulation 18(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing) and two warning notices for breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance. The service submitted an action plan to tell us what they would do to make improvements and meet the legal requirements.

The full comprehensive inspection report from that visit was published on 20 July 2018 and can be read by selecting the ‘all reports’ link CP Medical Clinic on our website at www.cqc.org.uk.

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.

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.

CP Medical Clinic provides private medical services at 61-63 Sloane Avenue in the Royal Borough of Kensington and Chelsea and treats adults and children.

Our key findings were:

• There were systems to keep patients safeguarded from abuse.
• The service had a number of policies and procedures, most of which had been reviewed and updated. However, some policies did not reflect day to day practice in the service.
• Management of fire risk was not safe.
• People on high-risk medicines were not regularly reviewed.
• There were no systems to ensure the safe management of prescribing of controlled drugs.
• Records were not always written and managed in a way to keep people safe. Patients’ notes were not securely stored and access to them was not controlled.
• Patient notes were not easily accessible in an emergency and it was not possible for the provider to share information with other services when there was an urgent need.
• There was CCTV in the two consulting rooms. The provider did not have signs up warning people about CCTV recording in the hosting clinic.
• There was no employee record for one member of staff who was employed by the provider in the carrying on of regulated activities and no record of a DBS check.
• The service had clear systems for the management of vaccines.
• The premises were clean; there was evidence of infection control audits.
• Procedures for managing medical emergencies including access to emergency equipment were safe.
• There was minimal evidence of quality improvement activity.
• Staff treated patients with dignity and respect.
• The appointment system reflected patients’ needs. Patients could book appointments when they needed them.
• The service had processes for managing complaints.
• Governance arrangements were not in place to ensure effective oversight of risk.

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.

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 need to risk assess treatments offered and establish a process to identify medicines that were not suitable for prescribing if the patient did not give their consent to share information with their GP, or they were not registered with a GP.
• Review the need to put signs up warning people about CCTV recording in the hosting clinic.
• Review the need for communication aids and a hearing loop.
• Review the need to provide appropriate support and signposting for patients with a caring responsibility.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 5 June 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.

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.

CP Medical Clinic provides private medical services at 61-63 Sloane Avenue in the Royal Borough of Kensington and Chelsea and treats adults and children.

Eleven patients completed CQC comment cards telling us about their experience of using the service, all of which were very positive about the service and indicated that patients were treated with kindness and respect.

Our key findings were:

• There were limited systems in place to keep patients safeguarded from abuse.
• The service did not have clear systems for the management of vaccines.
• The premises were clean; however, no infection control audits or infection control training had been completed.
• There was minimal evidence that risks were assessed and well-managed; a number of health and safety and premises risk assessments had not been undertaken and equipment had not been calibrated.
• There was minimal evidence of suitable arrangements for assessing and managing fire risk.
• Procedures for managing medical emergencies including access to emergency equipment were not safe.
• There were limited arrangements to identify, learn and improve where things had gone wrong. There was no clear system for reporting incidents and adverse events.
• The service did not have a process to manage patient safety alerts. There was no record kept of the action taken in response to patient safety alerts.
• There was minimal evidence of quality improvement activity.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• There was evidence in place to support that the clinicians at the service carried out assessments and treatment in line with relevant and current evidence based guidance and standards.
• There was minimal evidence of systems to improve quality of care and treatment for patients.
• The service’s recruitment policy had not been followed as some staff had not received a DBS check.
• The appointment system reflected patients’ needs. Patients could book appointments when they needed them.
• The service had some processes for managing written and verbal complaints.
• There was a culture of integrity, openness and transparency and the provider was keen to address concerns found during the inspection.
• The service had a number of policies and procedures, most of which had not been reviewed and updated to reflect day to day practice in the service.
• Governance arrangements were not in place to ensure effective oversight of risk.
• The practice asked staff and patients for feedback about the services they provided.

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 the arrangements for verifying a patient’s and responsible adult’s identity.
• Review procedures and policies for communicating with patients’ GPs and following up urgent referrals.
• Review systems for monitoring the quality of medical records.
• Review the system for monitoring verbal complaints, concerns and comments.
• Formalise the processes for gaining consent to share information with patients’ GPs.
• Review the governance arrangements for ensuring effective communication with medical staff.
• Review the recruitment policy and procedure to help them do staff checks and employ suitable staff.
• Review the system for providing appraisals.