In November 2017 we undertook an announced comprehensive inspection at Oxford ADHD Centre. We found the service was providing effective, caring, responsive and well-led services but there were improvements required in providing safe services. Following the inspection we issued a requirement notice.

We carried out an announced focussed follow up inspection on 21 March 2018 to check whether the required improvements had been made. We found necessary changes had been made to ensure the service was providing safe services.

The report from the November 2017 inspection can be found by selecting the ‘all reports’ link for Oxford ADHD Centre on our website at www.cqc.org.uk.

Our key findings were:

• Risks associated with the provision of services were well managed.
• The potential risks posed by medical emergencies had been assessed and action taken to ensure staff were prepared for a medical emergency.
• Prescribing was undertaken safely, including the process for initialising patients on medicines.

We carried out an announced comprehensive inspection on 7 November 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 not always 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.

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.

This was the first inspection undertaken at this service.

Oxford ADHD Centre is an independent clinic in Oxford for children and adults withAttention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and related conditions, such as specific learning difficulties, anxiety and depression. It was started in February 2016. Assessments are available to identify any diagnoses of these conditions and can lead to treatment and management plans including treatment with medicine if appropriate. There are trained clinicians who provided workshops for patients and their parents or guardians. Patients could request an assessment privately for a fee and the centre received referrals from NHS child and adolescent mental health services (CAMHs). NHS referrals were for assessment only, and a report of the assessment outcome was sent to patients, parents/guardians and to CAMHs, with proposed measures which could support those patients, including treatments.

The centre used sub-contracted staff including registered clinicians (for example, clinical psychologists and nurse prescribers) to undertake assessments and provide care. The services were provided from ground floor premises. The premises were easily accessible and could be accessed by wheelchair users and those with limited mobility.

There is a registered manager in post. 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.

We received 10 individual patient comments, sent directly to CQC prior to the inspection and three comment cards filled out by parents attending the service. All of the feedback we received from parents/carers or patients was positive regarding the services. Feedback was particularly positive regarding the caring and kind nature of staff, at a time of stress and difficulty for parents and patients.

Our key findings were:

• The provider had systems in place to identify and learn from risks in order to improve services where necessary.
• Most risks associated with the provision of services were well managed. However, there was not a full assessment of the potential risks posed by medical emergencies.
• Prescribing was undertaken safely, although the process for initialising patients on medicines was in the process of being reviewed.
• Assessments of patients’ potential conditions were thorough and followed national guidance.
• Patients received full and detailed explanations of any diagnoses and treatment options.
• Care was well planned and coordinated.
• The service was caring, person centred and compassionate.
• Services were delivered in an age appropriate way.
• The broader needs of patients were considered alongside any treatment or therapy needs.
• There were processes for receiving and acting on patient feedback.
• There were adequate governance arrangements in place in most aspects of the service.
• Clinicians demonstrated they had the skills and experience necessary to deliver care and treatment. However, there was no ongoing system in place to monitor staff training.

We identified regulations that were not being met and the provider must:

• Ensure care and treatment is provided in a safe way to patients.

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:

• Identify a system to monitor the ongoing training of staff who provide services to patients, in order to ensure they have the skills and knowledge required to provide care safely and effectively.