We carried out this announced inspection on 6 March 2019 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 practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

We carried out an 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 services are provided to adults over the age of 18, privately and are not commissioned by the NHS.

The service is registered with the Care Quality Commission (CQC) under the Health and Social Care Act 2008 in respect of the services it provides. The Dove Clinic for Integrated Care is registered to provide the regulated activities of diagnostic and screening and treatment of disease, disorder or injury. The types of services provided are doctor’s consultation service and doctor’s treatment service.

At the time of the inspection a registered manager was in place. 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 and associated regulations about how the service is run.

We received 28 CQC comment cards filled in by patients who used the service. Feedback was very positive about the service delivered at the clinic.

Our key findings were:

• Care and treatment was planned and delivered in a way that was intended to ensure people’s safety.
• All treatment rooms were well organised and well equipped.
• Staff told us they only provided treatment to people over the age of 18.
• Staff were up to date with current guidance and were led by a proactive management team.
• Staff maintained the necessary skills and competence to support the needs of patients.
• There were effective systems in place to check all equipment had been service regularly.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• Systems and risk assessments were in place to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
• The premises provided a therapeutic environment for patients.
• The provider had infection control procedures which reflected published guidance.
• The practice had systems to help them manage risk to patients and staff.
• The provider had thorough staff recruitment procedures.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified an area of notable practice.

• The clinic was a forerunner for treatment innovation and investigating new treatment options to ensure patients received the most up to date care and treatment. Constant studies and clinical trials were carried out in conjunction with Oxford University and St Georges University in London to ensure the robustness of new innovation. Feedback from patients overwhelmingly reported positive change.

There were areas where the provider could make improvements. They should:

• Continue to monitor safeguarding training for all staff to be in line with national guidance.
• Continue to implement appropriate actions relating to newly introduced water testing processes to reduce the risk of Legionella.

We previously inspected The Dove Clinic on 14 March 2013 and found that people were not protected from unsafe or unsuitable equipment because the provider had not maintained all the equipment in the clinic. We told the provider that they must give urgent attention to ensure that all equipment was maintained. After the inspection the provider sent us an action plan telling us what they were going to to make the required improvements.

At this inspection we found that improvements had been made. We spoke with the registered manager, the assistant manager and two nurses. Records showed that appropriate arrangements were in place to check that equipment was correctly maintained and suitable for purpose. For example, we looked at the clinics register of equipment and found that equipment had been properly checked and that the servicing of equipment had been arranged.

We found that people attending the clinic were fully informed about the treatments on offer in the clinic. One person had commented in last year’s survey “first class service and unfailingly helpful”. Information packs and leaflets on treatments and fees were provided to all prospective clients. Our review of the written information and medical/nursing records assured us that people were fully aware that the treatments on offer should not be considered as a cure for cancer or other conditions.

The records we examined evidenced that people were given time to consider treatment options and they had consented to all the treatments they received.

We spoke with seven members of staff on duty during the inspection. We asked four people about appraisals and training. They all spoke positively about the training and support that they received from the management team. The personnel files of three members of staff we examined evidenced that they had all attended mandatory training sessions provided by the clinic.

We examined the equipment records held by the clinic. They did not provide assurance that all the equipment was adequately maintained. The manager told us that they would rectify this as a matter of urgency.

The clinic investigates and responds positively to complaints. Where the clinic’s investigation found evidence of shortfalls in the service they took steps to rectify this with the complainant and explore ways to prevent a recurrence.