We undertook a comprehensive inspection of Cumberland House Clinic on the 6 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found that the service was providing effective, caring, responsive, well led care however, they were not providing safe care in accordance with the relevant regulations.

The full comprehensive report following the inspection on 6 November 2017 can be found by selecting the ‘all reports’ link for Cumberland House Clinic on our website at www.cqc.org.uk.

We undertook an announced focused inspection of Cumberland House Clinic out on the 12 December 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 6 November 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection. At the inspection we found that:

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 care 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.

Our key findings were as follows:

• Safeguarding policies and procedures were up to date to ensure patients were protected from abuse and improper treatment.

• Maintenance arrangements had been reviewed. In areas where work was identified at our last inspection as requiring improvement, this had been completed.

• The provider had a completed health and safety risk assessment supporting their decision not to have an emergency defibrillator (used to attempt to restart a person’s heart in an emergency) on site. Emergency medicines were now in place. However, the service did not have oxygen available on site and there was no risk assessment in place to support this decision.

• Information available to support patients to complain was in place.

• New arrangements were in place to ensure the safe storage of past medical records for patients.

• Improvements were made to the standards of record keeping, for example, the records made for the administration of medicines. However, it was recommended that this should improve further to meet professional standards.

In addition, the provider should:

• Take action to ensure that records made about patient treatments are clear, accurate and contemporaneous.

• Review the service quality improvement activities to ensure care and services are measured against evidence base standards. Ideally, a clinical audit is a continuous cycle should be put into place that is continuously measured with improvements made after each cycle.

• The provider should carry out a risk assessment of what is required to keep patients safe and ensure effective care is provided. In particular, this should include the availability of oxygen for use in an emergency.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 6 November 2017 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 providing safe care in accordance with the relevant regulations.

The impact of our concerns is minor for patients using the service, in terms of the quality and safety of clinical care. The likelihood of this occurring in the future is low once it has been put right. We have told the provider to take action (see full details of this action in the Requirement Notices at the end of this report).

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 care 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 a comprehensive inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Cumberland House Clinic provides Consultant assessment for medically insured and self-paying patients. Children under 18 were not seen at the clinic. The service provides clinical diagnosis and opinion, X ray examination and the undertaking of joint injections by the registered provider Dr Mc Loughlin. The clinic ground floor has a reception area, WC facilities, and a consulting /treatment room. The X ray equipment is located on the first floor and is not accessible to people with a physical disability. Alternative arrangements were made by the provider for these patients. The clinic is registered with CQC to provide the following regulated activities:

• Diagnostic and screening procedures
• Treatment of disease, disorder or injury

The provider 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 comment cards to be completed by patients prior to our inspection. We received nine comment cards which were all positive about the standard of care received. Patients said the clinic was always clean, they found it easy to get an appointment and they felt staff were respectful and treated them with dignity. We spoke with one patient during the inspection whose comments aligned with these views.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The clinic had systems to minimise risks to patient safety but improvments were required relating to records management and responding to medical emergencies.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Patients said they were treated with care, compassion, dignity and respect and were involved in their care and decisions about their treatment.

• The provider offered consultations to anyone who requested and paid the appropriate fee, and did not discriminate against any client group. During our inspection we observed that members of staff were courteous and very helpful to patients and treated them with dignity and respect.

• Systems were in place to monitor complaints but information to support patients was not available.

• The service had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback via patient surveys from patients, which it acted on.
• Staff worked well together as a team.

• The provider was aware of the requirements of the duty of candour.

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

• The registered person had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment.

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

• Review the plans in place for business continuity in the case of emergencies.

During the inspection we looked at the arrangements the service had in place for assessing people’s needs, service delivery and recruitment procedures. Care records were maintained using both paper records and a secure electronic system. We found appropriate storage for paper records was in place. This meant the information was safe and remained confidential to those with authorised access.

We looked at the records of two people. We noted they had been involved in their assessment and had consented to the treatment being provided. The care records had documented evidence that the service had discussed the treatment choices available to them. Both people had been involved in a face to face consultation as part of the decision making process

During this inspection we were unable to seek the views of people being supported by the service. This was because on the day we inspected there were no appointments for people to attend the clinic. However, the provider was consulting people about their service through their quality monitoring procedures. We saw completed surveys with people providing feedback about their experience of the service. These included: “I was very satisfied with the professionalism of the service I received. The standard of information provided to me was very good”. All of the surveys we saw confirmed the Consultant had explained the treatment required. We saw consent for any procedures to be undertaken had been requested and recorded.