We found the following areas of good practice:

• Systems were in place for reporting, monitoring and managing incidents.
• Medicines were stored securely and issued in line with good practice.
• Patient details were managed correctly.
• Staff understood the principles of safeguarding.
• Staff were appropriately trained and qualified to provide care, following national and local guidelines.
• Audits allowed staff to monitor performance and compare this with other organisations nationally.
• Multi-disciplinary and team working was evident with links to external community groups and services.
• Consent processes were thorough and reflected guidance.
• Staff providing care focussed on the individual needs of patients, providing care that was respectful, supportive and encouraging, giving privacy and confidence to patients.
• Clinics were run in a timely way. Results of an internal survey of waiting times at Brook Blackburn between April and December 2016 showed 62% of patients were seen within ten minutes and 98% of patients were seen within 60 minutes of their arrival time.
• Some individual needs were met. For example, sign posting to counselling services was in place.

However, we also found the following issues that the service provider needs to improve:

• Incident reports did not include information about the level of harm sustained, incident type or whether Duty of Candour had been considered or implemented. This made it more difficult to identify trends or implement and record that Duty of Candour had been implemented following incidents.
• Managers had not received training about Duty of Candour legislation. This posed a risk that managers may be less aware of the principles of this legislation and when to apply it in practice.
• Although safeguarding training was in place, we were not assured that all staff were trained to the levels described in either the corporate policy or national guidance. Additionally, forms to record safeguarding issues did not include information about Female Genital Mutilation (FGM) and the general process for reporting safeguarding concerns was not streamlined. Having a more complicated process could increase the risk of errors.
• One of the treatment rooms was situated immediately adjacent to the street outside. We were concerned that the needs of patients in relation to privacy and dignity may not be adequately met, especially if services expand in future.
• Cleaning records were not always completed. This meant staff were less able to confirm that cleaning had been completed.
• The risk register did not include details of actions to manage the risk over time or who was responsible for the risk.
• Staff ethnicity was not representative of the local ethnic population. Only white female staff were in employment at the time of our inspection.
• Professional registration was not included in staff files. Instead this information was stored on a separate electronic system which meant managers had to check more than one place to obtain important information about individual staff. Having a less streamlined process could lead to more errors when checking staff details.

Following this inspection, we told the provider that it must make one improvement because a regulation was being breached, and should make other improvements, despite regulations not being breached in these areas, to help the service improve. Details are at the end of the report.