We carried out an announced inspection at Nuffield Health Reading Fitness and Wellbeing Centre on 13 December 2017. We found that this service was not providing well-led care in accordance with the regulations. The full report on the December 2017 inspection can be found by selecting the ‘all reports’ link for Nuffield Health Reading Fitness and Wellbeing Centre on our website at www.cqc.org.uk.

The provider was asked to make improvements regarding staff training and knowledge of the Mental Capacity Act 2005 and verifying patient identity. In addition, we asked the provider to improve the system for monitoring actions from patient safety alerts.

This inspection was an announced focused inspection carried out on 6 December 2018 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 13 December 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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.

We carried out an announced focused follow-up inspection on 6 December 2018 to ask the service the following key question; Are services well-led?

Our findings were:

Are services well-led?

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

Nuffield Health Reading Fitness and Wellbeing Centre provide health assessments that include a range of screening processes. Following assessment and screening, patients undergo a consultation with a doctor to discuss the result findings, recommend lifestyle changes and decide on any treatment plans or referrals.

Our key findings were:

• The service had ensured all clinical staff (including doctors and physiologists) had received up to date training on the Mental Capacity Act 2005.
• The provider had reviewed the identity checking procedure and advised locations they did not need to make any changes to the previous process. The location was reviewing this.

We reviewed the actions undertaken as a result of patient safety alerts. A tracker had been commenced which detailed what the alert was and who had actioned it. The tracker was managed by the clinic manager.

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

• Consider the risks associated with not undertaking identity checks on clients.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nuffield Health Reading Fitness and Wellbeing Centre on 13 December 2017 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 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 service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Nuffield Health Reading Fitness and Wellbeing Centre provide health assessments that include a range of screening processes. Following the assessment and screening process patients undergo a consultation with a doctor to discuss the findings of the results and any recommended lifestyle changes or treatment planning.

We received eight completed CQC comment cards. All the completed cards indicated that patients were treated with kindness and respect. Staff were described as friendly, caring and professional. Some patients commented how use of the service had helped them with their individual care needs. In addition, comment cards described the environment as pleasant, clean and tidy.

Our key findings were:

• The service had clear systems to keep people safe and safeguarded from abuse. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. The doctor and physiologists were only trained to level one for child safeguarding.
• The clinic had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the location learned from them and improved their processes.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance, with the exception of mental capacity act guidance.
• The service had a programme of ongoing quality improvement activity.
• Feedback from patients about the care and treatment they received was positive.
• Patients were treated with dignity and respect and they were involved in decisions about their care and treatment.
• Patients were provided with information about their health and with advice and guidance to support them to live healthier lives.
• Systems were in place to protect personal information about patients. However, we noted there were no established processes to verify patient identity.
• An induction programme was in place for all staff and staff received specific induction training prior to treating patients.
• Staff were well supported with training and professional development opportunities. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The service encouraged and acted on feedback from both patients and staff. Patient survey information we reviewed showed that people who used the service had given positive feedback about their experience.
• The practice had a clear vision to provide a safe and high quality service. And there was a clear leadership and staff structure. Staff understood their roles and responsibilities.
• There were clinical governance systems and processes in place to ensure the quality of service provision. Staff had access to all standard operating procedures and policies.

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 system for monitoring actions from patient safety alerts .

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with two people who were using the service at the time of our inspection. They were complimentary about the service and staff. They told us staff treated them respectfully, and listened to their comments. They referred to staff as “friendly” and “confident”.

We spoke with three staff on duty at the time of our inspection; a physiologist, a doctor and the clinic manager. A doctor told us “We provide preventative care. We play a role in primary health care.” People who use the service completed a health and lifestyle questionnaire and on site assessments for health professionals to review. This ensured suitable care and advice was provided. Risks were identified and addressed appropriately.

Equipment was checked and calibrated to ensure it worked correctly. It was serviced in accordance with the manufacturers’ guidance and provider’s procedures. Staff were trained to use the equipment safely and kept records to document its safe use. Equipment to support people in a health emergency was available.

Complaints were dealt with appropriately and in accordance with the provider’s policy. People were aware of the process to raise concerns, and staff understood how to deal with complaints.

People told us they were pleased with the care provided by the physiologists and doctors at the Nuffield Health Reading Fitness and Wellbeing Centre. They said staff were professional and knowledgeable. One person told us that her experience "exceeded expectations." People were provided with information about what to expect from their health assessments. The people we spoke with told us they had no complaints about the service and said they would feel comfortable making a complaint if they had one.

We found that people using the service were provided with appropriate care to meet their needs. The importance of obtaining verbal or written consent was well understood by staff. Health assessments were provided by trained and competent staff. Staff had infection control training and risk assessments included controls to minimise the risk of infection. There were systems for monitoring the quality and safety of services provided to people which included collecting feedback from people who used the service. Where improvements to services were required, these were made.