We carried out an announced comprehensive inspection at St. Laurence’s Medical Centre (SK Health (Knowsley) Ltd) on 31 October 2017. We found that the service was not providing safe care and treatment and asked the provider to make improvements. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for St. Laurence’s Medical Centre on our website at www.cqc.org.uk.

This desk-based review was carried out on 5 June 2018 to confirm that the practice 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 31 October 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our findings were:

We found that this service had improved the systems in place to support safe care in accordance with the relevant regulations.

Background

St. Laurence’s Medical Centre (SKHealth (Knowsley) Ltd) provides minor surgery and Ear, Nose and Throat (ENT) consultations and procedures. They offer diagnosis, treatment and support for people aged 16 years old and over within the Knowsley area of Liverpool.

The hours of operation are: Monday, Wednesday and Thursdays 1pm – 3.30pm. The service is run by three doctors and a business manager, and is supported by two nurses, one healthcare assistant and administrative staff.

One of the doctors 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.

St. Laurence’s Medical Centre is registered with the Care Quality Commission (CQC) as an independent doctor’s consultation and treatment service.

The provider is registered with the CQC to provide the following regulated activity:

• Surgical procedures

Our key findings were:

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

• Revised recruitment procedures were in place.
• Infection prevention and control practices were in place to keep people safe and minimise the risk of infections.
• Staff had received training in safeguarding appropriate to their role.
• Information and advice was available to give to patients following their procedures.
• Patient satisfaction surveys were carried out and results collated and reported upon annually.
• Staff meetings were documented. Service review meetings were also held regularly and documented.
• A training and development policy and plan had been implemented.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 31 October 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 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.

CQC have not previously inspected this service.

St. Laurence’s Medical Centre (SKHealth Knowsley Ltd) provides minor surgery and Ear, Nose and Throat (ENT) consultations and procedures. They offer diagnosis, treatment and support for people aged 16 years old and over within the Knowsley area of Liverpool.

The hours of operation are: Monday, Wednesday and Thursdays 1pm – 3.30pm. The service is run by three doctors and a business manager, and is supported by two nurses, one healthcare assistant and administrative staff.

One of the doctors 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.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection. We received 36 comment cards which were overall very positive about the standard of care received. Comments included; staff treated them with compassion, dignity and respect, staff provided them with good information on treatments, staff allayed anxieties and were professional.

Our key findings were:

• There were systems in place to report, analyse and learn from significant events, incidents and near misses.
• Recruitment procedures required improvement in order to ensure staff were employed appropriately.
• Systems and practices for the prevention and control of infection required improvement to ensure risks of infection were minimised.
• There were policies and procedures in place for safeguarding patients from the risk of abuse. Most staff had received training in safeguarding, however not all had at an appropriate level to their role.
• Patients’ needs were assessed and treatment was planned and delivered following best practice guidance.

• Staff felt supported. They had access to training and development opportunities.

• Patients commented that they were treated with compassion, dignity and respect. Patients were given good verbal information regarding their treatment; however written information was not available.

• Access to the service was monitored to ensure it met the needs of patients. Contract monitoring meetings with the Clinical Commissioning Group (CCG) were evident.

• There was a system in place to manage complaints.
• There were systems in place to monitor and improve quality and identify risk.
• Patient satisfaction views were obtained at the time of treatment. However no further satisfaction surveys or follow up feedback was obtained.

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

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure care and treatment is provided in a safe way to patients. For example, infection risks to patients, public and staff are minimised by assessment and implementation of appropriate prevention and control measures.

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 staff training and development and implement a plan to include identification and monitoring of staff training needs. Include safeguarding training for all staff employed and at an appropriate level for their role.
• Review the availability of written information regarding treatments given and post-operative care.
• Review systems to proactively gain patient feedback at intervals following treatment.
• Review governance/staff meetings to include documenting agendas and discussions.