We carried out an announced comprehensive inspection on 5 September 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 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. The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low.

Our key findings were:

• There were systems in place to keep patients safe and safeguarded from abuse.
• Risks were generally well managed although, we identified a lack of oversight in relation to risks relating to the premises where responsibilities were shared and risks relating to the availability of emergency medicines had not been fully assessed.
• Incidents were acted on and used to support learning.
• The premises appeared well maintained. There were systems in place to support infection, prevention and control and for managing the safety of equipment.
• There were arrangements for the safe storage of medicines and recruitment of staff.
• The service hosted a range of specialist clinicians which they worked closely with to help ensure patients’ needs were met.
• Staff were supported with their learning and development needs and had access to training and regular appraisals. However, we identified some areas where specific training needs had not been fully considered for the service.
• There was evidence of audits undertaken to ensure the quality of service against policies and procedures.
• Patient information was shared as appropriate with relevant health and care professionals involved in the patients care and treatment and patients were informed.
• The provider had effective systems for obtaining consent to care and treatment.
• Feedback from people about the service they received was positive. People who had used the service felt involved in decisions and said that they were treated with dignity and respect.
• People who used the service received timely care.
• There was a complaints process in place and available on the provider website although this was not visible in the clinic.
• There were established governance arrangements and clear leadership to support the running of the service. Staff told us that they had staff meetings. However, meetings were generally not documented to demonstrate key information was being shared consistently and staff had formal opportunities to raise issues and concerns.

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 arrangements for staff meetings which provide a clear agenda, formal opportunities for key issues to be regularly discussed and for staff to raise issues. These should be documented for future reference.

During this inspection we conducted telephone interviews with three people who used the service, spoke with a commissioner, the manager and staff working at the service on the day.

Everyone that we spoke with said they were very happy with the care and treatment they received. One person said, “It’s an excellent service, everybody was kind and attentive.” We found that systems were in place to ensure that people received safe care and treatment.

People told us that they felt safe using the service. We found that systems were in place to ensure people were safeguarded from abuse.

People said that they received an excellent service. One person told us, “No complaints whatsoever. The place is clean and tidy, excellent service.” We saw that the provider had systems in place to monitor the quality of service people received.

During this inspection we conducted telephone interviews with two people who used the service, spoke with the manager and staff working at the service on the day.

People told us that their privacy and dignity was respected during their consultation and treatment. One person told us,” Yes my privacy and dignity was respected and the door was always closed during my consultation and treatment.”

People said they gave their consent to having care and treatment. We found that the provider had systems in place to obtain people’s consent to care and treatment.

Everyone we spoke with said they were very happy with the care and treatment they received. One person said, “They were excellent, I couldn’t rate them high enough.” We found that systems were in place to ensure that people received safe care and treatment.

People told us that they felt safe using the service. We found that improvement was needed to the guidance given to staff on how to keep people safe from abuse.

People said that the staff were polite and efficient. We found that people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

People said they received a good a good and efficient service. We saw that the provider had systems in place to monitor the quality of service people received.