Our last inspection of 28 February 2013 found that, contrary to the practice's medical emergency policy, they did not have a child-sized dosage of adrenaline available in the practice. In addition, this had not been picked up during the regular checks on the emergency drugs undertaken by staff. The practice wrote to us and said that they had now included a child epipen for the emergency delivery of adrenaline in their emergency drugs kit and they had updated their emergency drugs checklist to reflect this.

We inspected the practice again on 1 May 2013 and saw that they now had a child epipen in place. We saw records of weekly checks on the emergency drugs and staff explained to us how this took place. However, the provider may wish to note that at the time of this inspection the new medical emergency drugs check sheet which included the child epipen was not in place.

On our last inspection we also found that appropriate infection control policies and procedures were not being followed, including procedures relating to the dating of sharps bins, availability of alcohol gel and the storage of sterilised instruments. On this inspection we found that these deficiencies had largely been corrected, though there were still some sharps bins that had not been dated.

People we spoke with said that "everything was explained very clearly", that the costs of treatments were made clear and that all their questions had been answered. All treatment took place in private consultation rooms. Written information about the practice was available in different languages and the practice had access to translators if necessary. The practice was accessible for people using wheelchairs.

In recent patient feedback 96% of respondents said they were "very satisfied" with their treatment. People using the service that we spoke with said the service was "wonderful" and that their medical history was checked at each visit. However, whilst the practice had a policy setting out what emergency drugs and equipment should be available, not all of the emergency drugs were available on the day of the inspection and recent checks on the drugs had not picked this up.

Whilst there were systems in place to reduce the risk and spread of infection, not all of these were being followed.

Staff received appropriate professional development. They were able, from time to time, to obtain further relevant qualifications.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.