We carried out an announced comprehensive inspection on 2 July 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 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 Robens Centre for Occupational Health and Safety provides people with pre travel health assessment, travel medicine advice and vaccinations.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At The Robens Centre for Occupational Health and Safety services are provided to patients under arrangements made by their employer. These types of arrangements are exempt by law from CQC regulation. Therefore, at Robens Centre for Occupational Health and Safety, we were only able to inspect the services which are not arranged for patients by their employers.

The clinical director 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 reviewed feedback from clients through the completion of 37 Care Quality Commission comment cards and we spoke with three clients on the day of inspection. Feedback was consistently positive, with clients telling us that staff treated them with kindness, dignity and respect. Clients also told us they felt they were given the information they needed to make decisions in a way that they could understand.

Our key findings were:

• The service was offered on a private, fee paying basis only.
• The clinic had good facilities, and was well equipped, to treat clients and meet their needs.
• Assessments of a client’s treatment plan were thorough and followed national guidance.
• Clients received full and detailed explanations of any treatment options.
• The clinic had systems in place to identify, investigate and learn from incidents relating to the safety of clients and staff members.
• There were effective governance processes in place.
• There were processes in place to safeguard clients from abuse.
• Staff had not received training in infection control for four years. There were no cleaning schedules recorded and no infection control audit had been carried out. However, the premises were visibly clean and tidy.
• Risk assessments had been carried out and there were clear action plans to ensure that mitigating actions were completed. However, there was no risk assessment for the lack of defibrillator on the premises in case of a medical emergency at the time of our inspection. A risk assessment drafted following our inspection did not include an assessment of the time it would take to access a defibrillator stored in an adjacent premises.
• The clinic encouraged and valued feedback from clients and staff.
• Feedback from clients was positive.

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

• Ensure care and treatment is provided in a safe way to patients.

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 draft risk assessment relating to a lack of defibrillator on the premises, to include the timeliness of accessing devices on the university campus and the significance of this on patient care.

When we visited the travel health and vaccination clinic, a number of people were attending for consultations and vaccinations.

During our inspection we gathered evidence to help answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe and well looked after.

Measures had been put in place to minimise risks to people using the service and to deal with foreseeable emergencies.

Systems were in place to ensure that staff were qualified to carry out their roles.

Is the service effective?

The service operated efficiently. We saw that people were seen promptly, understood their vaccinations and the treatment options available to them. People told us that they felt well looked after while having their vaccinations.

One person told us “the nurse was very well informed and thorough”.

Is the service caring?

People were supported by attentive and professional staff. Staff explained vaccinations and gave reassurance.

A person using the service told us staff were “very professional” and “we are very happy”.

Is the service responsive?

People were asked to complete a questionnaire following their visit. Their views were taken into account by the management to improve their service. There was an effective complaints procedure in place.

One person said “from a customer point of view it is an excellent service”.

People and staff told us that they felt comfortable to speak out if they were unhappy.

Is the service well-led?

We found that staff employed by the provider had been recruited following appropriate vetting procedures to ensure that they were appropriately qualified and able to undertake their roles.

People told us the travel nurses and staffs were competent and knowledgeable about their travel health care needs, including health and safety when travelling abroad. People who used the service had their right to privacy maintained at all times and the advice and support they received from the staff were given in a way that maintained their dignity. They told us the service is responsive to their culture, religion, race and age.

We found people were involved in making decisions about their care, treatment and support. People were cared for in a suitably maintained environment. We found that the provider had not ensured that an effective selection process was in place to ensure suitable staffs were employed.

We spoke with four people who had used this service. They told us that staff were very helpful and professional, providing travel advice as well as vaccinations. People told us that they were involved in discussion about options for their care and were given sufficient information and time to make an informed choice. Four people who had received vaccinations at the service described the procedure as problem free. Records maintained by the service showed that in April 2012 a vaccination error occurred and as a result the service reviewed its practice. This notifiable incident was not referred to the Care Quality Commission (CQC) or Surrey County Council as required.The manager told us that she had attended a Surrey County Council training session on Safeguarding and had cascaded the learning to staff. However, staff interviews and training records indicated that no safeguarding adults training had occurred in the previous 12 months. No written safeguarding guidance was available to management or staff. People we spoke with described the facility as clean and said that the vaccination process was safe. We saw that hygiene and anti-infection procedures were effective though the provider was not benefitting from the advice contained within The Health and Social Care Act 2008 code of practice on the prevention and control of infections and related guidance.