We carried out an announced focused inspection on 23 May 2018 to ask the service the following key questions; Are services safe, effective and well-led?

We carried out an announced comprehensive inspection at Messina Clinic Limited on 7 February 2018. As a result of our findings during that visit the provider was issued a warning notice for Regulation 12 Safe care and treatment and Regulation 17 Good governance.

The full comprehensive inspection report from that visit was published on 18 April 2018 and can be read by selecting the ‘all reports’ link Messina Clinic Limited on our website at www.cqc.org.uk.

The service submitted an action plan to tell us what they would do to make improvements and meet the legal requirements. We carried out an announced focused follow-up inspection on 23 May 2018 to check that the provider had followed their plan, and to confirm that they had met the legal requirements. The provider expressed a willingness to improve and had addressed core issues which could improve the quality, safety, and effectiveness of the service.

This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. At this inspection, we found that the practice had made improvements to provide safe, effective and well-led services.

Our findings were:

• Concerns raised at the last inspection had been addressed for example, all staff had received training in basic life support training.
• There were arrangements in place to keep patients safe. The service demonstrated that it was providing safe services in relation to medical emergencies, safeguarding, infection control, and role appropriate training.
• All policies had been reviewed in April 2018 and there was a plan to regularly review the policies in the future.
• The service had devised a written Business Continuity Plan and had reviewed and updated service guidance and procedures since the last inspection.
• The service had conducted a risk assessment and obtained emergency medicines and equipment.
• The service had adequate arrangements to respond to emergencies and major incidents such as power failure.
• There was a policy in place to share information with patients’ registered NHS GPs.
• The service had a cleaning schedule and had undertaken an infection control audit.

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

• Review quality improvement arrangements for patients.
• Review keeping records of relevant third party risk assessments and action plans.
• Continue to review systems for emergency medicine risk assessment.
• Continue to review systems for staff appraisals.

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 well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

We carried out an announced comprehensive inspection on 7 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 not 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.

Background

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.

The Messina Clinic Limited is an independent provider of medical services and was founded in 2008 to provide the Brazilian community with medical services from its location at 14-16 Dowgate Hill London EC4R 2SU in the London Borough of City and Hackney. The doctor provides private general practice, and cosmetic treatments which are available to any fee paying patient. The service saw children aged 12 and over, however most patients were adults.

The service is open Monday to Friday from 9am to 6pm and Saturday 9am to 1pm. The service does not offer out of hours services.

The service is located on the lower ground floor which had an accessible via a lift. The property is leased by the provider there is a lift available and the premises consist of a patient reception area, and two consulting rooms. There are two toilets on the lower ground floor and four toilets including an accessible toilet in the building’s main reception area.

The service is operated by three doctors (not on the GP register) including one director, supported by a service manager and two reception staff. Two of the doctors are responsible for the private service and one doctor is responsible for cosmetics treatments which are not registerable..

The lead doctor 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. The service is registered with the Care Quality Commission (CQC) to provide the regulated activity of treatment of disease, disorder or injury The service also provided cosmetic treatments which is not part of our remit.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection. We received seven comment cards which were all extremely positive about the standard of care received, across the services offered. Comments included that staff, were kind, caring, polite, friendly, helpful and patients said they were treated with dignity and respect. Comments about the service included that the clinic was clean and hygienic. We spoke with three patients during the inspection who said they were very satisfied with the care they received and told us that appointments ran on time that they were not rushed, that they were involved in their care and treatment and that the provider provided an excellent level of service.

Our key findings were:

• There were limited arrangements in place to keep patients safe. The service was not able to demonstrate that it was providing safe services in relation to responding to medical emergencies, safeguarding, infection control, staff recruitment, training and policies.
• There was limited evidence of quality improvement. For example, the service had not undertaken any clinical audits.
• Information on how to complain was available. The service had not received any complaints in the last 12 months.
• There were limited governance arrangements in place. The policies and procedures were lacking in detail.
• There was some evidence that staff were aware of current evidence based guidance. Not all staff had been trained to provide them with skills and knowledge to deliver effective care and treatment.
• There were systems and processes in place for reporting and recording significant events and sharing lessons to make sure action could be taken to improve safety in the practice.
• The service did not have adequate arrangements to respond to emergencies and major incidents such as power failure.
• There was a clear leadership structure and staff felt supported by management.
• The service had systems in place to collect and analyse feedback from patients.

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 how patients with hearing impairments are supported.

• Review the process for sharing learning from complaints.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice