We carried out an announced comprehensive inspection on 21 June 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 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.

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 Practice is a private doctor consultation and treatment service. The clinic offers private consultations with a general physician with additional medical screening and vaccination services. There is one male GP supported by a medical secretary/practice manager. The service operates five days a week from 6B Sloane square, London, the building is shared with another private doctor. Services are provided on the second floor, there is one large doctor's consulting room and shared administration and reception areas.

The service is open from Monday to Friday 8.30am to 6pm.

Dr John Gayner 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.

We received feedback from 22 people about the service, including comment cards, all of which were very positive about the service and indicated that clients were treated with kindness and respect. Staff were described as helpful, caring, thorough and professional.

Our key findings were:

• Not all arrangements for dealing with medical emergencies were effective.

• There were no quality improvement activities in the service.

• The service lead was the lead member of staff for safeguarding and had undertaken adult and child safeguarding training.

• The provider was aware of current evidence based guidance and they had the skills, knowledge and experience to carry out his role.

• The provider was aware of their responsibility to respect people’s diversity and human rights.

• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

• There was a complaints procedure in place and information on how to complain was readily available.

• Governance arrangements were in place. There were clear responsibilities, roles and systems of accountability to support good governance and management.

• The service had systems and processes in place to ensure that patients were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

• There was a clear leadership structure and staff felt supported by management.

• The service had systems in place to collect and analyse feedback from patients.

There were areas where the provider must make improvements:

• 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 need for a formalised business continuity plan.

At our last inspection on 27 June 2014 we found some of the provider’s refrigerated medicine stock control records to be incorrect. We also found numerous medicines in unlocked accessible storage many of which had expired.

At our inspection on 18 September 2014 we found all medicine stock control records to be correct. We also found the expired medicines held in the two patient consultation rooms had been disposed of and all remaining medicines held were in date. The provider had introduced a stock control system which recorded and monitored medicine expiry dates and recorded when and to whom medicine was administered.

At our last inspection on 12 February 2014 we found the provider did not have appropriate stock taking and disposal arrangements in place for medicines held in the fridge.

At our inspection on 27 June 2014 we found the provider had introduced a stock control chart to record medicines held in the fridge. However we found some recording to be incorrect. We also found numerous medicines held in unlocked storage in the two patient consultation rooms. Many of these medicines had expired and there was no stock control record available for inspection.

We received confirmation from the provider on 01 July 2014 that all medicines found to have expired had been disposed of.

Consent was sought by doctors with sufficient knowledge of the person using the service. We saw that information was provided to allow people to make informed decisions. People we spoke with said ''they go through everything thoroughly so that you know what is happening.''

People who used the service had safe and appropriate care because their needs were established from when they began to use the service. One person said, ''If I need the doctor urgently I can get him on his mobile phone. The follow up is very good too, they check up on me to see that I am alright.''

Medicines were correctly obtained and stored securely but there were not appropriate arrangements in place to ensure medicines were fit for use. There were no arrangements in place for the safe disposal of unwanted or expired medicines.

The Practice ensured that people who used the service were safe and their welfare needs were being met by competent staff.

The provider had a complaints policy and procedure in place and information about this that was easily accessible to people using the service.

In the case of this location it was impractical to undertake a visit when patients were on site, so we did not speak to people who use services.