We carried out an announced comprehensive inspection on 2 October 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 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.

CQC previously inspected the service on 9 January 2018. During this inspection we found that the service was providing caring and responsive care. However, the service was not providing safe, effective, or well-led care and breaches to regulation were identified. A warning notice was issued against regulation 12 (1) Safe care and treatment and regulation 17 (1) Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We inspected the service on 9 May 2018 to confirm that the service was compliant with warning notices issued. We found those relating to regulation 12 had been resolved and the warning notice met, however there was a continuing breach to regulation 17. We checked this area as part of this comprehensive inspection and found this had been resolved.

We received 24 completed comment cards and spoke with three clients who used the service during the inspection. Feedback from clients was consistently positive. We received comments that the staff were friendly, kind and put them at ease. They commented that the service received was caring, informative and efficient. Many clients described how they had used the service on several occasions.

Our key findings were:

• The service had systems to manage and monitor risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The service ensured that care and treatment was delivered according to evidence- based research or guidelines.
• Staff maintained the necessary skills and competence for their role and to support the needs of patients.
• Staff involved treated patients with compassion, kindness, dignity and respect.
• Feedback from clients who used the service was consistently positive.
• The practice was proactive in seeking patient feedback and identifying and solving concerns.
• The culture of the service encouraged candour, openness and honesty.

There were areas where the provider could make improvements and should:

• Review the processes to manage risks relating to the care of substances hazardous to health (COSHH). Continue to take action to mitigate the risk of legionella.
• Review the recording methods used to record safety checks for emergency equipment.
• Review the systems and processes in place to ensure that regular audits are evidenced, including clinical audits of care and outcomes for patients.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection on 9 January 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led? During this inspection we found that the service was providing caring and responsive care. However the service was not providing safe, or well-led care and breaches to regulation were identified.

This inspection was an announced focused inspection carried out on 8 May 2018 to confirm that the service was compliant with warning notices issued following the January 2018 inspection. A warning notice was issued against regulation 12 (1) (safe care and treatment) and regulation 17 (1) (good governance) and of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report covers our findings in relation to the requirements against regulation 12 (1) (safe care and treatment) and regulation 17 (1) (good governance).

Our findings were:

Are services safe?

We found that this service was not 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.

CQC inspected the service on 9 January 2018 and asked the provider to make improvements regarding breaches to regulation 12 and regulation 17 of the Health and Social Care Act. We checked these areas as part of this focused inspection on 8 May 2018 and found those relating to regulation 12 had been resolved and the warning notice met, however there was a continuing breach to regulation 17.

Jabs Travel Clinic provides independent travel advice and treatments. The service is provided by two nurse directors and one part-time nurse employed by the service. A medical director works remotely to provide medical support to the service. The service was a registered yellow fever centre.

One of the nurse directors 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.

Services are provided from;

Jabs Travel Clinic Limited, F10-F11 The Officers Mess, Coldstream Road, Caterham, Surrey, CR3 5QX

The service is open Tuesdays, Thursdays and Fridays from 8.30am until 6.30pm. On Mondays it is open between 8.30am and 1.30pm. On Saturdays it is open between 10.00am and 4.00pm. The service is closed on Wednesdays and Sundays. The services were provided to both adults and children under the age of 18.

Our key findings were:

• Patients were at risk of harm because systems and processes were not in place in a way that kept them safe. For example, risk assessments were not consistently in place and action had not always been taken to mitigate the risks. For example there was no Legionella risk assessment and a risk assessment for medical emergencies did not fully mitigate the risk.
• The provider had up to date policies in place that were relevant to the service provided.
• The provider had taken action to ensure that staff had the appropriate authority for the administration of medicines via the use of Patient Specific Directions (PSDs) used for the administration of certain vaccines.
• Electrical safety checks, maintenance and calibration had been undertaken for relevant appliances in use within the service.
• The provider had a system in place for the receipt and action on safety alerts.
• A cleaning schedule was in place detailing what should be cleaned and the method and frequency of cleaning.
• There was a system in place to report and record significant events within the service.

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.

We carried out an announced comprehensive inspection on 9 January 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 regulation.

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.

Jabs Travel Clinic provides independent travel advice and treatments. The service is provided by two nurse directors and two part-time nurses employed by the service. A medical director works remotely to provide medical support to the service. The service was a registered yellow fever centre.

One of the nurse directors 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.

Services are provided from;

Jabs Travel Clinic Limited, F10-F11 The Officers Mess, Coldstream Road, Caterham, Surrey, CR3 5QX

And, a satellite service was from;

The Manor Clinic, 165 High Street Sevenoaks TN13 1XT

We were told by the provider that they were planning on closing the Manor Clinic satellite service and the service website shows that this closed on 1 February 2018.

The service is open on a Tuesday, Thursday and Friday from 8.30am until 6.30pm. On a Monday it is open between 8.30am and 1.30pm. On a Saturday it is open between 10.00am and 4.00pm. The service is closed on a Wednesday and Sunday. The services were provided to both adults and children under the age of 18.

We did not visit the Manor Clinic satellite service as part of this inspection.

We received 19 completed comment cards and spoke with one person who used the service during inspection. Feedback from people who used the service was consistently positive. People commented on the professionalism of the staff, the quality of the information they were given and their experience of the consultation and treatment provided. Staff were described as kind, friendly and attentive.

Our key findings were:

• Patients were at risk of harm because systems and processes were not in place in a way that kept them safe. For example, risk assessments were not in place and action had not always been taken to mitigate the risks. For example there was no health and safety, fire or lone working risk assessment.
• The provider did not have a system in place to ensure policies were available and up to date for all areas of activity within the service. We found no health and safety, fire, recruitment or significant event policies in place. Other policies were out of date.
• There was no evidence of quality improvement initiatives including clinical audit.
• The provider could not provide assurance that staff had the appropriate authority for the administration of medicines via the use of patient specific directions (PSDs) used for the administration of certain vaccines.
• We found no evidence during inspection of electrical safety checks for any of the appliances in use within the service.
• We found no record of external maintenance or calibration of the vaccine fridge or the set of weighing scales in use.
• We found no system in place for receiving and acting on safety alerts.
• There was no clear schedule detailing what should be cleaned or the method or frequency of cleaning.
• There was no system in place to report and record significant events within the service.
• Recruitment processes were in place; however there was no recruitment policy and there were gaps in recruitment records including evidence of satisfactory references and photographic identification prior to recruitment.
• The provider had both online and face to face training opportunities in place for staff, however there were some gaps in training in relation to basic life support, fire safety, health and safety and information governance.
• There was no recorded strategy or business plan and the provider was unable to demonstrate capacity to provide well-led services.
• The provider ensured needs were assessed and care and treatment delivered in line with relevant and current evidence based guidance.
• We observed staff treating people who used the service with kindness and compassion.
• Feedback from people who used the service was positive about the care and treatment they received.
• The provider acted on feedback from people who used the service.
• Appointments were available to be booked online and people were able to access advice and support by walking into the clinic. There was flexibility of appointments and longer appointments were available for more complex travel needs.

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 their duties.
• Ensure specified information is available regarding each person employed.

You can see full details of the regulations not being met at the end of this report.