Ernest Gardiner Treatment Centre is operated by Letchworth Garden City Heritage Foundation. The service has two designated treatment rooms as well as a communal therapy area. Facilities include physiotherapy equipment and couches where treatment can be provided and blood taken.

The centre provides minor treatments, for example, leg ulcers and therapy services as a community outpatient service only. We inspected the community adult nursing core service.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 3 January 2017: an unannounced visit to the centre was not required.

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 do not rate

We regulate independent community clinics but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The service maintained effective standards of cleanliness and hygiene within the centre. The service had sufficient equipment, which was well maintained.

• Patient records were generally written and managed well. Information about patients was accessible at all times when the clinic was open.

• Staff had an understanding of how to recognise and act on safeguarding vulnerable adult concerns. Staff understood consent and decision making requirements.

• There were always sufficient numbers of staff to ensure that patients received safe care and treatment at all times.

• Pain was assessed and strategies were discussed with patients to manage and minimise their pain.

• Pre-employment checks were undertaken for new members of staff. There were induction arrangements for new members of staff.

• All staff from each discipline were involved in assessing, planning and delivering patient care. Care and treatment provided was patient focused.

• Staff took time to interact with patients, were respectful and considerate. Patients understood the care and treatment they received.

• Services provided reflected the needs of the population served. A free transport service was provided to patients who required transport to the treatment centre. Patients were seen promptly. Feedback about the service acted upon.

• There was a positive culture and good leadership. Staff feedback was sought on a continuous basis through one to ones and team meetings.

• The service had a documented vision and staff aimed to provide all patients with quality care. There was a governance structure in place and meetings were held regularly.

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

• One incident had been reported as a safeguarding concern but had not been reported internally as an incident.

• The hepatitis B status of staff was not held on their personnel file.

• Some policies did not reflect the latest guidance and others had not been developed. For example, the service did not have a safeguarding children policy and the consent and capacity policy did not reflect the latest guidance.

• Attendance at mandatory training was low for some training courses, in particular health and safety as well as safeguarding children.

• Information about the service’s overall outcomes for patients’ care and treatment was not collected or monitored and audits did not always follow national guidelines. Patients' feedback was collected.

• Staff competency checks were not undertaken for specific skills or use of equipment.

• Risks faced by the service had not all been identified and recorded on the risk register.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Edward Baker

Deputy Chief Inspector of Hospitals (Central Region)