We carried out this inspection to check whether the provider had made improvements to the service since we last inspected on the 9 December 2013. At this inspection we found the provider was not ensuring that patients who used the service were protected against the risk of inappropriate care and treatment by ensuring theatre records were completed fully.

We saw that the provider had made significant changes to the way theatre records were stored, recorded and audited. They had ensured patient’s personal records including medical records were accurate and fit for purpose. The registered manager had reviewed patient’s pathways. We saw the provider now used an electronic system (meditech) for all pre assessment and post assessment checks. Staff meetings minutes we reviewed showed that records and documentation was a regular agenda item. This enabled staff to fully understood the importance effective record keeping.

We saw that a patient signed a consent form along with the doctor. The consent was rechecked again before the procedure by staff. One person said, “everything was explained to me, in a way I could understand.”

Staff we spoke with were able to explain how they would treat patients as individuals. They fully understood the cultural needs of the patients they cared for and were able to give examples. Patients we spoke with agreed, one person said, “they always ask what I’d like to be called and then they call me that.”

The centre was cleaned daily and looked well maintained. One patient said, “it looks clean and tidy, but it could be a little warmer.” Another said, “It’s a nice place.” The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained.

Staffing levels had been risk assessed and were constantly being reviewed to ensure patients were safe. We spoke with five people; they said there were enough nursing staff to meet their needs. One person said, “you are seen quickly, by the nursing staff.”

We reviewed the 2013 survey of patient’s who use the service. We saw 182 people responded who rated the quality of the care as "excellent."

We saw that staff were not fully completing either of the check list of the 10 care records five had not fully completed the pre-procedure check list and none of the 10 notes had a fully completed WHO checklists. We talked with theatre staff and nursing staff who confirmed these check lists should be fully completed.

Patients indicated that they were well treated and staff were respectful towards them. They informed us that staff explained procedures to them and they had consented to procedures carried out. Their views can be summarised by the following comment, “I find the staff are friendly and helpful. I have received a good service.”

Patients expressed confidence in the staff who attended to them. Essential training had been provided for staff. Staff informed us that they had been provided with support and they worked well together.

There were arrangements for infection control checks and tasks. Staff were knowledgeable regarding infection control and training had been provided The premises were clean and well maintained. There was documented evidence that equipment used had been maintained and inspected by specialist contractors. Risks assessments of the premises and regular safety checks had also been carried out by staff.

Arrangements for clinical governance and quality assurance were in place. Audits of services provided and waiting times had been carried out. The views of patients had been sought and an action plan was in place for improving the service.

HCA Healthcare UK Outpatients & Diagnostics Centre at Golders Green is operated by Wellington Diagnostic Services LLP. The centre was opened in 2007; it offers private outpatients consultations, diagnostic tests and treatment for people of all ages including children. The centre was established to serve the local community with diagnostic and screening facilities.

Patients are offered fast and convenient access to a wide range of services ensuring timely diagnosis and management. The centre uses the latest diagnostic imaging technology, including Computerised Tomography (CT), Magnetic Resonance Imaging (MRI), a Bone Densitometry (DEXA) scanner, X-ray, ultrasound and specialist cardiac screening, pathology, minor procedures and most of these procedures are accommodated on the same day.

We inspected this service using our comprehensive inspection methodology. We inspected the diagnostic and outpatient department. We carried out the unannounced part of the inspection on the 23 and 29 October 2018.

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 rated it as good overall.

• The service had a strong, visible patient centred culture. Staff were highly motivated and aspired to offer care that was kind and promoted people’s dignity.
• Patient’s individual needs and preferences were central to the planning and delivery of the service. The services were flexible and provided choice.
• The centre offered a wide range of outpatient clinics and diagnostic imaging services to meet the needs of patients, this gave choice and continuity of care to patients.
• The service had systems to monitor the quality and safety of the service. The use of audits, risk assessments and recording of information relating to the service performance was to a high standard.
• The managers were clear about the vision and strategy of the organisation to make sure it provided high quality care.
• The centre was clean and tidy with infection control processes in place.
• There were no reported infections in the last 12 months.
• Staff were positive about their working experience and felt supported to be part of a team.
• Patients we spoke to and feedback we received about the service was positive. There was a minimum of 24-hour turnaround for patients from their initial contact to having their scan done at the centre.
• The service exceeded its key performance indicator for reporting on diagnostic images with 98% of reports being completed within 24 hours.
• Staff demonstrated kindness and understanding of how to meet patients’ needs to ensure that their experience was positive.

We found areas of practice that require improvement:

• The local rules for radiation protection were generic and were not specifically adapted to the service.
• The staff sign off sheet for the patient group directions did not include the details of each patient group direction.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and the South East)