We previously carried out an announced comprehensive inspection of The Baltic Medical Centre on 22 March 2018 and found that it was not providing safe, effective, caring or well-led services and was in breach of Regulation 10: ‘Dignity and respect’, Regulation 12: ‘Safe care and treatment’ and Regulation 17: ‘Good governance’ of the Health and Social Care Act 2008.

In line with the Care Quality Commission’s (CQC) enforcement processes we issued two warning notices in relation to the breaches of safe, effective, and well-led services which required The Baltic Medical Centre to comply with Regulation 12 and Regulation 17 by 29 June 2018. We also issued a requirement notice in relation to Regulation 10 and the provision of caring services. The full comprehensive report of the 22 March 2018 inspection can be found by selecting the ‘all reports’ link for The Baltic Medical Centre on our website at www.cqc.org.uk.

We carried out this focused 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 now meeting the requirements of the Health and Social Care Act 2008.

The previous inspection on 22 March 2018 identified areas where the provider had not complied with Regulation 10: ‘Dignity and respect’. We found:

• There was a privacy screen in one of the treatment rooms, but there were no curtains or screens available in any of the other rooms for patients to maintain their dignity. The treatment rooms had slatted blinds in external windows which we saw had gaps in between, which did not ensure patients’ privacy.

The inspection on 22 March 2018 identified areas where the provider had not complied with Regulation 12: ‘Safe care and treatment’. We found:

• The service was not receiving medicines safety alert and there was no system to ensure alerts were acted upon.
• Medicines were found which were not licenced for use in the UK, some medicines were used for multiple patients with no opening date recorded, some medicines were for patient use but had been obtained through prescriptions for staff members.
• Blank prescriptions were not secure.
• There was no evidence of regular checks of the emergency medicines.
• Clinical specimens were kept in domestic refrigerator with no evidence of regular monitoring of the refrigerator temperature.
• There were no sterile non-latex gloves available.
• There were carpets in treatment rooms and the floor in the surgical room was not a single impervious surface.
• Some sinks in treatment rooms had plugs and overflows.
• Sharps bins were unlabelled and one large sharps bin was placed on the floor.
• There were no signs or posters regarding sharps injuries and the ‘safe use and disposal of sharps’ policy did not state that, in the event of sharps injury, the wound should be bled.
• There was no evidence that the ear irrigator was cleaned.
• Not all staff had completed child safeguarding training to the appropriate level.
• Some staff members’ disclosure and barring service (DBS) checks did not have any details of the outcome.
• There were no regular fire alarm tests or fire drills and no trained fire marshalls.

The inspection on 22 March 2018 also identified areas where the provider had not complied with Regulation 17: ‘Good governance’. We found:

• The service did not have any clinical oversight of the treatment and care being provided by individual clinicians.
• Clinicians had not completed an appraisal by the service since 2016.
• The service did not carry out any quality improvement activity, such as clinical audits.
• Individual clinicians completed their own clinical audits, but there was no evidence of outcomes or learning being shared amongst staff.
• There was no evidence of analysis of significant events or complaints and no evidence that lessons learned were shared with all staff.
• The service’s policies did not always include all relevant and necessary information.
• The service did not have an adequate system to verify patients’ identities, including checking that adults attending with children had parental responsibility.
• Staff told us that regular staff meetings took place, however these were not minuted.

At this inspection on 5 July 2018 we found that the provider had taken action in relation to the provision of safe, effective, caring and well-led services and was now compliant with the Regulations.

Our key findings were:

• There was an effective system to record, share and act upon safety alerts.
• There were no unlicensed or open medicines in the cupboard.
• Blank prescriptions were kept securely.
• The service had medicines and equipment for use in an emergency and we saw evidence that these were checked regularly.
• Clinical specimens were stored appropriately.
• The service had appropriate flooring and sinks in treatment rooms.
• Sharps bins were labelled.
• There was evidence that the ear irrigator was regularly cleaned.
• All staff who worked at the service and interacted with patients had completed child safeguarding training to the appropriate level.
• Staff DBS checks had been completed and the documentation was stored in staff files.
• Fire safety arrangements kept patients safe.
• The service had completed clinical audits and the findings and recommendations were shared with staff.
• There were curtains or privacy screens available in all treatment rooms.
• The service had appointed the general practitioner as the clinical lead for the service and they had oversight of the clinicians.
• We saw completed appraisals for all clinicians.
• Significant events and complaints were analysed, appropriate actions were taken, and learning was communicated to staff.
• The service had updated their policies to include all relevant and necessary information.
• The service had updated the patient identification process around adults attending with a child under 16 years for appointments. However, the service did not ask for any other identification to verify the name, date of birth and contact details given by patients.
• Regular staff meetings took place and discussions were minuted.

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

• Review the process for checking and recording patient identification.

We carried out an announced comprehensive inspection on 22 March 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that, in one area, this service was not 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.

The Baltic Medical Centre is an independent health service based in Canary Wharf, London, providing consultations, treatment and referrals for patients who primarily come from Eastern Europe.

Our key findings were:

• Patient feedback was positive about the service and staff told us that they felt supported and able to raise concerns.

• There was no clinical oversight of the treatment and care being provided by individual clinicians. The service was not signed up to receive any medicines safety alerts and did not carry out clinical audits for clinicians.
• Not all staff had completed child safeguarding training to the appropriate level.
• There was a system for recording significant events and complaints. However, there was no evidence of analysis of events or complaints and no evidence that lessons learned were shared with all staff.
• Staff told us that regular staff meetings took place, however these were not minuted.
• Disclosure and Barring Service (DBS) checks in two staff members’ files did not have any details of the outcome of the check.
• There were no curtains or screens available in most of the treatment rooms for patients to maintain their dignity.
• On the day of inspection, the service did not have all appropriate emergency medicines. There was also no evidence that regular checks of the emergency medicines were being completed.
• We found risks relating to infection prevention and control on the day of inspection, including in relation to clinical specimens, sharps bins, cleaning of equipment, and the flooring and sinks.
• We found three boxes of medicines that were not licenced for use in the UK, medicines being used for patients which had been obtained through individual prescriptions in staff members’ names, open tubes of cream which we were told were being used for multiple patients which had no opening date recorded, and we saw that blank prescriptions were not kept securely.
• The service had policies in place which were available to all staff. However, the policies did not always include all relevant and necessary information.
• The service did not have an adequate system to verify patients’ identities, including checking that adults attending with children had parental responsibility.
• The service did not carry out any regular fire alarm tests or fire drills, and there were no trained fire marshalls.

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

• Ensure that all patients are treated with dignity and respect.
• Ensure care and treatment is provided in a safe way to patients.
• 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 arrangements for ensuring the competency and professional development of staff in relation to training.