We carried out an announced comprehensive inspection in February 2018 to ask the service the following key questions; are services safe, effective, caring, responsive and well-led. We found the service was not providing effective or well-led care in accordance with the relevant regulations. We also noted there were areas where improvement was required to ensure the service was providing safe care. As a result, we issued two requirement notices as legal requirements were not being met and asked the provider to send us a report of what actions they were going to take to meet legal requirements. The full comprehensive report can be found by selecting the ‘reports’ link for 999 Medical & Diagnostic Centre on our website at https://www.cqc.org.uk/location/1-167818627.

This inspection was an announced comprehensive follow up inspection carried out on 7 February 2019 to check whether the provider had taken action to meet the legal requirements’ as set out in the requirement notices. This report covers our findings in relation to all five key questions.

Our findings were:

Are services safe?

We found that this service was 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.

999 Medical & Diagnostic Centre is an independent health service based in North London. The provider supplies private general practitioner services. Dr Eric Ansell 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.

Our key findings were:

• Systems were in place to keep people who used the service safeguarded from abuse.
• There was a protocol in place to ensure identity checks were undertaken when a patient presented at the service for the first time.
• Doctors made use of NICE guidelines and shared learning from complex patient cases.
• The service had systems to update external bodies such as GPs and consultants of care being provided to patients.
• All staff members were up-to-date with training relevant to their role.
• Systems were in place to protect personal information about people who used the service.
• Prescription pads were used and stored in a safe way.
• The service carried out assessments to identify and mitigate risks including those associated with fire and infection.
• The service used a range of visual and written materials to help people understand and make decisions about their care and treatment.
• Completed CQC comment cards showed people who used the service were able to access care and treatment from the service within an appropriate timescale for their needs

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Patients we spoke with told us that they received appropriate information and support regarding their care and treatment.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We spoke with the resident GP. They told us about the initial patient consultation and steps taken to help ensure that care delivered was patient centred.

Staff members we spoke with were able to explain possible types of abuse. They were also able to explain how they would report a safeguarding concern.

None of the patients we spoke with expressed any concerns regarding staff training. One patient referred to the staff as, “amazing - from reception staff through to the manager, the doctor and the consultants.”

When we inspected on 20 March 2013, we saw that the provider did not have a system of ensuring they were continuously updated with continuing professional development (CPD) and mandatory or refresher training completed. We asked the provider to take action. When we inspected on 10 October 2013, we saw that consultant records included up to date mandatory training and supervision notes.

When we inspected on 20 March, we did not see evidence of a system that identified adverse events and near misses. We asked the provider to take action. When we inspected on 10 October 2013, we saw that the provider had a system for reporting incidents and was recording key information, so as to learn from incidents.

We were not able to speak to people using the service because they were not present during the inspection. We gathered evidence of people’s experiences of the service by reviewing their feedback and talking with staff. A survey that was undertaken in 2012 showed 35 out of 38 respondents thought staff were excellent at respecting their privacy and dignity. The manager and staff understood the importance of respecting patients’ privacy and dignity and explained to us how they ensured this was the case; pointing to the arrangements in place and the manner in which staff spoke and interacted with patients.

In cases where we were able to get information, we saw patients’ needs and risks were assessed, which meant interventions were planned and delivered in a way that ensured patients’ safety. The familiarity of staff with safeguarding policy and relevant procedures along with appropriate management support structures, meant patients were protected from abuse.

We observed that the provider ensured that the administrative staff were trained and appraised. However, the absence of a similar system to monitor the performance of practitioners who were registered to practice on the premises meant their work was not subjected to a robust quality assurance programme.

We carried out an announced comprehensive inspection on22 February 2018to 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 there were areas for improvement required to ensure that this service was providing safe care in accordance with the relevant regulations. The service provided evidence following the inspection to show that action was taken to make immediate improvements as a result of the inspection.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations. Specifically, there was no evidence of staff appraisal within the last 12 months and limited evidence of staff training.

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 not providing well-led care in accordance with the relevant regulation. Specifically, we found that there were systematic weaknesses in governance systems.

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 provider supplies private general practitioner services. Dr Eric Ansell 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 reviewed17 CQC patient comment cards and spoke with two patients about the service, all the feedback we received was positive about the staff, access to the service and standard of care received.

Our key findings were:

• There were systems in place to manage risks to the premises and patient safety; however these were not always effective.

• There was no evidence of clinical audit or quality improvement.

• Not all staff had received essential training and regular appraisal and there was no system in place to monitor this prior to the service receiving the notice of inspection.

• There were systems in place for acting on significant events and complaints.

• There were arrangements in place to protect children and vulnerable adults from abuse.

• Adequate recruitment and monitoring information was held for all staff.

• Care and treatment was provided in accordance with current guidelines.

• Patient feedback indicated that staff were caring and appointments were easily accessible.

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

• Systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

• The provider must ensure that persons employed in the provision of a regulated activity receive appropriate training and appraisal to enable them to carry out the duties they were employed to perform

There wereareas of practice where the providershould make an improvement. The provider should:

• Consider the provision of a hearing loop.