Warwick Nuffield MRI is operated by Alliance Medical Limited. The service provides diagnostic imaging through magnetic resonance imaging (MRI) scanning only.

Warwick Nuffield MRI registered with the CQC in 2010. It was last inspected in October 2012 under the previous CQC methodology, and at the time, the service met the standards it was measured against.

We inspected this service under our independent single speciality diagnostic framework and using our comprehensive inspection methodology. We carried out an unannounced inspection on 2 April 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

We have not previously rated this service. At this inspection, we rated the service as good overall.

We found the following areas of good practice:

• Most staff understood how to protect patients from abuse. They had received training on how to recognise and report abuse, and generally knew how to apply it.

• The service controlled infection risk well. We observed well-presented staff who kept the equipment and premises clean. They used control measures to prevent the spread of infection.

• The service had appropriate arrangements in place to manage risks to patients and visitors.

• While there had been recent challenges with staff sickness, the service had sufficient staff of an appropriate skill mix, to enable the effective delivery of safe care and treatment.

• The service provided care and treatment based on national guidance and evidence of its effectiveness.

• All staff were aware of the importance for gaining consent from patients before conducting any procedures. They understood how and when to assess whether a patient had capacity to make decisions about their care.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• The service planned and provided services in a way that met the needs of local people.

• People could access the service when they needed it. While waiting times from referral to scanning did not meet the service’s contractual requirements, they were still in line with good practice.

• The service engaged well with patients to plan and manage appropriate services.

However, we found areas of practice that the service needed to improve:

• The service did not have an effective process to monitor the quality of their scan images, which was representative of the service they provided.

• The local governance framework was limited, and staff were not always informed about performance, complaints, incidents, patient feedback and audit results in a timely manner.

• The service did not have full oversight of the competencies, skills, and capabilities of staff. There were no processes in place to enable staff to undergo clinical supervision, and there were no opportunities for staff to complete continued professional development.

• There were not effective arrangements in place for managing risks, and there was limited evidence that risks, and their mitigating actions were discussed with the local team.

• Staff engagement was limited, and staff felt disconnected from the organisation. Staff meetings did not take place regularly. Corporate senior managers also did not always provide adequate support or oversight to the unit.

• There were limited provisions made for children and young people in the service’s waiting area.

• Staff did not receive training on how to communicate and care for patients living with dementia, learning difficulties and mental ill health.

• There was a variable understanding of the duty of candour regulation.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)

During the visit we reviewed five outcomes which we have found to be compliant. We found that people's needs and risks had been assessed and treatment planned and delivered in line with their needs. We found this was reflected in the healthcare records we reviewed during the visit. We saw systems in place to protect people from abuse and discussions with the registered manager confirmed she knew who to approach and what to do should there be any concerns in this area.

Although we found this provider to be compliant against the outcomes we have inspected we have asked them to take note of some findings which relate to the availability of specific policies and guidance.

There were two people using the service on the day of the inspection. We made ourselves available to speak with these people but just one person chose to speak with us. As we have not been able to speak with more people using the service we gathered evidence of people's experiences by reviewing completed satisfaction surveys.

We spoke with three people who use the service who told us that they were happy with the care they had received. They told us that staff were friendly and helpful. They all confirmed that they were given all the information they needed about their scan. People knew what would happen after their scan and that they would get their results from their consultant.

One person said, "The staff put me at ease and explained everything beforehand, and as we went along."

Another person told us, "I wasn’t nervous. They were all very professional."

During our visit we spoke with the senior radiographer. The radiographer competently described and showed us documentary evidence of safe and personalised care given to people through co ordinated assessment, planning and delivery of care.

We observed care being delivered in a way that supported people's care needs, welfare and safety. The people we saw appeared to be relaxed during their scans.