We planned the inspection to check whether the registered provider was meeting the legal requirements within the Health and Social Care Act 2008 and associated regulations.

We carried out an announced focused follow-up inspection on 2 May 2018. CQC inspected the service on 6 December 2017 and asked the provider to make improvements regarding safe care and treatment; effective care and treatment and leadership. We checked these areas during this follow-up inspection and found improvements.

This was a joint dental and medical inspection of an independent healthcare service.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations. Systems had improved since the previous inspection, however further improvement was needed and these systems were not fully tested because medical patients had not been treated at the clinic since February 2018 following publication of the report.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations. Systems had improved since the previous inspection, however further improvement was needed and these systems were not fully tested because medical patients had not been treated at the clinic since February 2018 following publication of the report.

Are services well-led?

We found that this service was not providing a well-led service in accordance with the relevant regulations. Systems had improved since the previous inspection, however further improvement was needed and these systems were not fully tested because medical patients had not been treated at the clinic since February 2018 following publication of the report.

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 an announced focused inspection, carried out on 2 May 2018 to confirm that the practice had completed their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection on 6 December 2017. This report covers our findings in relation to those warning notices.

Polska Przychodnia is registered with the Care Quality Commission (CQC) as an independent provider of dental and medical services for children and adults and is located in Eccles, Greater Manchester. Patients are primarily Polish people with English as a second language who live in the United Kingdom and the service is accessed through pre-booked appointments.

The clinic is registered with the CQC to provide the following regulated activities:

• Diagnostic and screening procedures
• Surgical procedures
• Treatment of disease, disorder and injury
• Maternity and midwifery services
• Family Planning

The service mostly employs doctors, dentists and dental nurses on a sessional basis. However a physiotherapist also runs a clinic approximately once a month.

A full range of dental care including extractions is provided by the service.

The medical services includes:

• gynaecology;
• internal medicine defined as, dealing with the prevention, diagnosis, and treatment of adult diseases;
• treatment for ear, nose and throat conditions;
• orthopaedics;
• Psychiatry and
• Diagnostic tests.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner. At Polska Przychodnia the private physiotherapy sessions provided are exempt by law from CQC regulations.

The medical health care team consists of:

• Four doctors: an internal medical specialist, a gynaecologist, an ear, nose and throat (ENT) doctor and a psychiatrist.
• Five dentists, four dental nurses (one whom is a trainee and another is a locum).
• All the doctors and dentists are registered with either the General Medical Council (GMC) or the General Dental Council (GDC).
• The doctors and dentists are supported by the registered manager who was also trained as a phlebotomist, one full-time receptionist and one full time administrator.

The nominated individual for the service is also the registered manager. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Our key findings were:

Over all, we found improvements at the service during this follow-up inspection.

• Child protection systems and processes had improved and systems were in place to check whether paediatric services were provided in line with best practice guidance.

• Cleanliness and infection control audits were now in place and completed.
• Regular staff meetings lead by the registered manager had been established. A system was in place to ensure medical and dental staff working for the service attended. The agenda included reviewing the quality and development of the service.
• Processes were in place to ensure patient records were well written and contained sufficient detail about treatment and care provided.
• Processes for reporting incidents were in place and systems for dealing with and sharing safety alerts were reliable.
• Systems were in place to monitor antibiotic prescribing.
• Policies and procedures were readily available.
• The provider could demonstrate a clear understanding of their responsibilities under the Duty of Candour regulation and this was supported by a Duty of candour policy.
• Quality assurance was to be discussed at all team meetings and the provider had started an audit programme to review the outcome of changes that had been made.
• There was now clinical governance oversight of the dental services provided, although clinical oversight for the medical service was not yet established.

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

• Ensure that systems and processes are established and operated effectively to ensure good governance in accordance with the fundamental standards of care.
• Ensure staff have the correct support to demonstrate ongoing competency in their roles.

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 contents of the emergency medicines kit as this did not reflect current guidance.
• Review the emergency medicines risk assessment.
• Review the action taken in relation to making sure the x-ray machine was safe to use and used safely.

• Review the patient letters policy to ensure that letters are posted as required.
• Review the plan for organising a fixed wiring check so that a date is confirmed.
• Review whether a qualified engineer should also complete a legionella risk assessment for the building.
• Review a sample of care and treatment previously provided in order to set a baseline against which improvements can be measured.
• Review the accessibility of key policies and procedures in relation to the main language read and spoken by staff.
• Review the system for signposting patients to alternative services when the clinic is closed.

We carried out an announced comprehensive inspection on 06 December 2017 to ask the service the following key questions; are services safe, effective, caring, responsive and well-led? We planned the inspection to check whether the registered provider was meeting the legal requirements within the Health and Social Care Act 2008 and associated regulations.

This was a joint dental and medical inspection of an independent healthcare service.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the enforcement actions at the end of the report).

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the enforcement actions at the end of the report).

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. We have told the provider to take action (see full details of this action in the enforcement actions at the end of the report).

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.

Polska Przychodnia is registered with the Care Quality Commission (CQC) as an independent provider of dental and medical services for children and adults and is located in Eccles, Greater Manchester. Patients are primarily Polish people with English as a second language who live in the United Kingdom and the service is accessed through pre-booked appointments.

The clinic is registered with the CQC to provide the following regulated activities:

• Diagnostic and screening procedures
• Surgical procedures
• Treatment of disease, disorder and injury
• Maternity and midwifery services
• Family Planning

The service mostly employs doctors, dentists and dental nurses on a sessional basis. However a physiotherapist also runs a clinic approximately once a month.

A full range of dental care including extractions is provided by the service.

The medical services includes:

• gynaecology;
• internal medicine defined as, dealing with the prevention, diagnosis, and treatment of adult diseases
• treatment for ear, nose and throat conditions;
• orthopaedics;
• Psychiatry and
• Diagnostic tests.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of advice or treatment by, or under the supervision of, a medical practitioner. At Polska Przychodnia the private physiotherapy sessions provided are exempt by law from CQC regulations.

The medical health care team consists of:

• Four doctors: - an internal medical specialist, a gynaecologist, an ear, nose and throat (ENT) doctor and a psychiatrist.
• Five dentists.
• Four dental nurses (one is a trainee and another is a locum).
• All the doctors and dentists are registered with either the General Medical Council (GMC) or the General Dental Council (GDC).
• The doctors and dentists are supported by the registered manager who was also trained as a phlebotomist, a full-time receptionist and a full time administrator.

The Nominated Individual for the service is also the registered manager. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a 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 feedback about the service from six patients. All comments were positive and indicated the service was accessible; patients had confidence in the doctors and dentists and felt involved in planning their care and treatment. They told us the staff were caring and the clinic was always clean.

Our key findings were:

• Child protection and paediatric services were not provided in line with best practice guidance.

• There was no clinical governance oversight of the medical or dental services provided.
• The consulting rooms were clean and tidy. However cleanliness and infection control audits were not completed.
• Meetings to discuss patient outcomes did not take place and the doctors employed by the service did not meet with the registered manager to discuss the quality and development of the service.
• Patients’ records were poorly written and did not provide sufficient detail about treatment and care provided.
• Processes for reporting incidents were not in place and systems for dealing with safety alerts were not reliable.
• Medicines for dealing with medical emergencies were not in place and vaccines were not correctly stored.
• Antibiotic prescribing and monitoring was not based on national guidance.
• A whistleblowing policy was in place.
• The provider could not demonstrate a clear understanding of responsibilities under the Duty of Candour regulation.
• Information about the range of services and fees was available.
• Systems were in place to inform patients about blood and other test results.
• Quality assurance was not embedded within the culture of the service.

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

• Ensure systems and processes are in place to provide safe care and treatment.
• Ensure systems and processes are in place to safeguard service users from abuse and improper treatment.
• Ensure systems and processes are in place provide effective and good governance for the service.
• Ensure systems and processes are in place make sure suitably qualified, competent, skilled and experienced persons are continually employed by the service.

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 accessibility of key policies and procedures in relation to the main language read and spoken by staff.

Review the system for signposting patients to alternative services when the clinic is closed.