We carried out an announced comprehensive inspection on 8 February 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 always 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.

Background

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.

This service was inspected in 2013 under our previous inspection regime and it was found at that time to be meeting all the essential standards of care.

The Women’s Wellness Centre is the clinical location of the provider Obsgyncare Ltd and located in Chelsea at 274 Fulham Road, London SW10 9EW. The service is a consultant-led private provider of integrated healthcare for women and children. The service also includes private GP services.

The day-to-day running of the service is provided by the centre manager with support of a business manager and finance manager. The provider employs two ultrasonographers, three healthcare assistants and three receptionists/administration staff. The service is overseen by the organisation’s three board members, of which the centre’s clinical director is the CEO. There are approximately 13 consultants who work under practising privileges (the granting of practising privileges is a well-established process within independent healthcare whereby a medical practitioner is granted permission to work in an independent hospital or clinic, in independent private practice, or within the provision of community services). All consultants hold NHS substantive positions in obstetrics and gynaecology, foetal medicine or paediatrics. The consultants source their own patients and also see patients who book directly with the service. They provide treatment and care with the support of the provider’s ultrasonography, midwife and healthcare assistant team. The service also has three GPs providing regular sessions.

Services provided include antenatal and postnatal care, gynaecology, including vaginal laser treatment, immunisations, sexual health and ultrasound scanning, including 3D and 4D baby ‘keepsake scans’ and GP services. The service also provide a range of complementary therapies, for example, physiotherapy and acupuncture. Complementary services are not regulated by CQC and were not inspected.

The service offers pre-bookable face-to-face appointments to both adults and children. Patients can access appointments Monday to Thursday from 8am to 8pm, Friday from 8am to 7pm and Saturday from 9am to 2pm. At the time of our inspection the service was seeing approximately ten thousand patients per annum.

The provider is registered with the Care Quality Commission (CQC) for the regulated activities of Treatment of Disease Disorder or Injury, Diagnostic & Screening Procedures, Maternity and Midwifery Services and Family Planning.

The centre manager 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.

As part of our inspection, we asked for CQC comments cards to be completed by patients prior to our inspection. Thirty-four comments cards were completed, all of which were positive about the service experienced. Patients commented that the centre offered an excellent service and staff were professional, caring and friendly. We also received five comments through the ‘share your experience’ portal on the CQC website, all of which were positive about the care received. We were unable to speak with any patients directly at the inspection.

Our key findings were:

• Although there were systems in place to assess, monitor and manage risks to patient safety, we found shortfalls in respect of medicine management and responding to a medical emergency, including access to emergency medicines.
• There were systems in place to safeguard children and vulnerable adults from abuse and staff we spoke with knew how to identify and report safeguarding concerns.
• The practice carried out staff checks on recruitment, including checks of professional registration where relevant.
• Staff we spoke with were aware of current evidence based guidance and they had the skills, knowledge and experience to carry out their roles. However, there were no systems in place to monitor that care and treatment was delivered in line with evidence based guidance.
• There was some quality improvement initiatives which included single cycle audits and reflection on formal patient feedback, but there was no on-going programme of continuous quality improvement.
• Consent procedures were in place and these were in line with legal requirements.
• Staff we spoke with were aware of their responsibility to respect people’s diversity and human rights. The service was caring, person centred and compassionate.
• Systems were in place to protect personal information about patients. The service was registered with the Information Commissioner’s Office (ICO).
• Patients were able to access care and treatment from the clinic within an appropriate timescale for their needs.
• Information about services and how to complain was available.
• The service had proactively gathered feedback from patients.
• Governance arrangements were in place. There were clear responsibilities, roles and systems of accountability to support good governance and management.

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

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

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

• Review the process for receiving, disseminating and acting on patient safety alerts.
• Review infection control processes including the potential need for a formal audit to include clinical waste segregation, staff training requirements and the recording of immunisation status in line with guidance.
• Review quality improvement initiatives which may include completed clinical audits.
• Consider arranging formal interpreter and translation services and review the information available for patients who do not speak English.
• Consider how to improve access to patients with hearing difficulties.

We spoke with three women who were very satisfied with their care and treatment at The Womens Wellness Centre. They reported that they were treated well, understood their care and found the service clean. They all said that care was very good from a staff team who were “knowledgeable, kind and helpful”. We saw examples of people’s feedback from 2012 and 2103 which was positive.

People told us that they could voice their opinions about the service as well as ask for more information. We saw that they were given enough information about the service and were involved in making decisions about what care and treatment they would receive.

There were suitable recruitment and employment processes and staff were supported by the provider's systems and policies. People were cared for in a safe environment by staff who had received the necessary training. There were procedures in place to deal with medical emergencies. The centre had systems to ensure that people were protected from the risk of infection. There was evidence that there was an effective process to review and monitor the quality and safety of the service provided.