People who use the service told us that staff were “respectful” and “pleasant”. They were provided with information about the services on offer. Consultations took place in private rooms and translation services were available if needed.

When people first arrived at the clinic they were greeted by receptionists who confirmed appointments and escorted to a comfortable waiting area. Medical histories were taken before people were treated and information was provided to patients on aftercare. Staff had been trained in what to do in a medical emergency and there were emergency drugs and equipment available.

Staff had been trained in safeguarding vulnerable adults and child protection. The registered manager had set up e learning for staff to complete in safeguarding vulnerable adults and was monitoring staff awareness. There was a policy and procedure in place for how to report any concerns, including to the local authority.

The environment was clean and tidy in all areas. There were records in place that showed what infection control checks were completed by staff. All equipment was monitored and maintenance checks completed as required.

When staff started at the service they received an induction. Staff undertook mandatory training on an annual basis including what to do in a medical emergency. All staff had annual appraisals.

The service conducted audits to monitor the quality of the service it was providing.

We did not speak to people who use the services on this occasion however we saw evidence that people were satisfied with the service provided by 101 Diagnostics.

David Fraser Badenoch - Diagnostics is operated by David Fraser Badenoch and is a single, inepdent service. The service has one consultation room, one diagnostics room, one minor procedures room and one recovery room. The service discontinued the x-ray provision before our inspection took place and was in the process of deregistration. This did not affect any other aspect of the service. The x-ray equipment was marked as out of use and was due to be removed.

The service provides urologist consultations, eight types of ultrasound examination, intravenous urography, flexible cystoscopy, bladder installation, vasectomy, excision of minor skin lesions, minor orthopaedic procedures and phlebotomy on an outpatient basis. At the time of our inspection the service was registered to provide plain x-ray examination but had recently ceased this service. Several other providers use the service’s facilities. Each service has its own registration and we did not inspect these. We inspected all aspects of the diagnostics service; surgical services will be inspected separately.

The service provides care and treatment to patients who self-pay or whose insurance company pays for their care. The team also provided care for patients referred from clinical staff based in embassies.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 18 December 2018 followed by a telephone interview with the head of clinical service on 19 December 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We have not previously rated this service. We rated it as Good overall.

We found good practice:

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• The service team acted on audits and quality evaluations to continually identify opportunities for benchmarking and improvement.
• Safety and risk management processes were clearly embedded in practice and a strict referral system meant staff saw patients only when they had enough information to provide a safe level of care.
• Staff managed all areas relating to health and safety, such as medicines management and staffing, in line with established processes and protocols. The registered manager and the lead nurse ensured protocols were reviewed and updated in a timely fashion to reflect the latest national standards.
• Staff worked in a no-blame culture that encouraged open discussion of mistakes and reporting of incidents. This included use of the duty of candour, which staff used to ensure patients were kept informed when things went wrong. This approach included the incident, complaint and governance processes.
• The service did not have a waiting list and had no delayed or cancelled appointments for non-clinical reasons in the previous 12 months.
• Governance processes included all staff and helped the team to assess the quality of the service and to drive development and improvement.
• The registered manager had implemented an improvement plan for appraisals amongst non-clinical staff. In December 2018, 50% of this staff group had completed an appraisal, which was an improvement from 33% in October 2018. The manager planned to have completed all appraisals by February 2019.

We found areas of outstanding practice:

• The team maintained a proactive awareness of new and emerging treatments nationally and internationally. This resulted in the development of new and innovative procedures for patients.
• Administration staff had undertaken detailed analysis of the feedback behaviour of patients to understand what prevented more consistent completion of feedback. They had tested and introduced new feedback designs that had resulted in a significantly higher response rate, which staff used to improve the service.

However, we also found the following issues that the service provider needs to improve:

• The management of sharps was not in line with Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 and presented a safety risk. The service addressed this at the time of our inspection and should ensure the new standard is maintained.
• There was limited privacy and confidentiality in the recovery area. The service planned to address this by utilising more space following the discontinuation of the x-ray service.
• An established medical advisory board (MAB) was in place although attendance was sporadic, at only 59% of the expected attendances in the previous three meetings.
• The service did not have facilities for independent language interpretation for patients, which presented a risk when staff needed to discuss clinical issues or break bad news.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.