We carried out an announced comprehensive inspection on 14 February 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led? At the inspection we found the provider was not meeting the regulations for providing safe, effective and well-led care. The full comprehensive report on the February 2018 inspection can be found by selecting the ‘all reports’ link for Dr Daniel Consulting Rooms on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 22 January 2019 to confirm that the practice had taken action to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 February 2018. This report covers our findings in relation to those requirements.

At this inspection we found the provider had not made all the necessary improvements.

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 practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

CQC inspected the service on 14 February 2018 and asked the provider to make improvements regarding safe care and treatment, and good governance. We checked these areas as part of this comprehensive inspection and found some issues had been resolved whilst others remained outstanding.

Dr Daniel Consulting Rooms, also known as Foresight Medical Centre, is an independent GP practice located in the London Borough of Westminster.

Dr Alix Daniel 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.

Eleven people provided feedback about the service. All feedback we received was positive about the service.

Our key findings were:

• Some systems and processes were in place to keep patients safe. However, we identified shortfalls in relation to the management of infection control.
• Clinical audit activity had been initiated.
• Staff had received annual appraisals. However, the service was unable to provide documentary evidence to demonstrate that all staff had received formal training relevant to their role.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Information about services and how to complain was available.

• There was a lack of good governance around establishing key policies, staff training and seeking feedback from people using the service.

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 safeguarding and chaperone policies to ensure they have sufficient and up to date information.
• Review the system in place to ensure the accuracy of fridge temperatures and establish local protocols for maintaining the cold chain.
• Review the monitoring system to ensure that regular safety checks have been undertaken by the building’s management.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 14 February 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 practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Dr Daniel Consulting Rooms, also known as Foresight Medical Centre, is an independent GP practice located in the London Borough of Westminster.

The GP principal 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.

Nineteen people provided feedback about the service. All feedback we received was positive about the staff and service offered by the practice.

Our key findings were:

• There were systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice delivered care and treatment according to evidence-based guidelines. However, there was no recent clinical audit to demonstrate the practice reviewed the effectiveness and appropriateness of the care it provided.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients reported that they were able to access care when they needed it.
• The practice had not determined what mandatory and additional training staff needed to meet the needs of their patients.
• The practice had not established some policies, procedures and activities to ensure safety and support good governance. For example, in relation to safeguarding; infection prevention and control; health and safety; and significant events or incidents.

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 practice’s arrangements for chaperoning.
• Review the system in place to ensure the accuracy of fridge temperatures.
• Review patient access to interpreting services.

People who had used the service told us that they were given information about their care and treatment before they underwent procedures. They said that staff were "very professional", "welcoming" and "very attentive".

People who had used the service described it as "very good". Appropriate medical checks were undertaken before people received treatment. We also looked at feedback questionnaires that had been completed in the last twelve months. Letters of thanks that had been sent to Dr Alix Daniel informed how patients were happy with the service. Overall, people were happy with the care and treatment received.

People who use the service were given sufficient information and were involved in making decisions about their care. People who use the service reported Dr Alix Daniel had understood their problem and that they understood their proposed treatment. People had described Dr Alix Daniel “knowledgeable and reassuring". A medical history was taken for each person and there were procedures in place to deal with emergencies.

There was a safeguarding policy in place for protecting vulnerable adults, staff were able to describe what action they would take.

Staff received adequate training and supervision. There was a procedure in place for them to undergo annual appraisals.

The service conducted audits to monitor the quality of the service it was providing. Regular patient feedback questionnaires were completed.

We saw evidence through a patient satisfaction survey report that people were satisfied with the service, but were unable to speak to any person on this occasion.