We carried out an announced comprehensive inspection on 27 February 2018 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

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 not providing well-led care in accordance with the relevant regulations

Background

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.

Health Hub is an independent provider of medical services. The service provides Ear, Nose and Throat (ENT) consultations, travel vaccinations, management of minor injuries and a number of other services that are not regulated by the CQC. Services are provided at 282 Milkwood Road, Herne Hill, London, SE2 0EZ in the London borough of Lambeth. All of the services provided are private and are therefore fee paying, no NHS services are provided at Health Hub.

The service is open Monday to Friday from 8am to 8pm and Saturday 9am to 1pm. The service does not offer elective care outside of these hours.

The premise is located on the ground floor and is therefore accessible to all. The property is leased by the provider and the premises consist of a patient reception area, and five consulting rooms.

The service is operated by two partners, one of whom is the manager of the service and the other the lead clinician who is an ENT specialist. The service also employs a nurse, a service manager and four receptionists. Other staff are employed by the service but they are involved in the provision of services that are not regulated by CQC.

The lead clinician 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. The service is registered with the Care Quality Commission (CQC) to provide the regulated activity of treatment of disease, disorder or injury.

Our key findings were:

• The service had systems in place to manage significant events.
• Medicines were in place to manage some emergencies, but some medicines for use in emergencies were not in place at the time of the inspection.
• Policies and procedures were in place to govern all relevant areas, but the service did not have patient group directives in place for the practice nurse.
• The service had an infection control policy but had carried out an audit. The rooms and all equipment were clean, but there were no spills kits in place and sharps bins were not dated.
• Clinicians assessed patients’ needs and delivered care in line with current evidence based guidance.
• The service had limited systems in place for monitoring and auditing the care that had been provided.
• Staff had not been trained in areas relevant to their role.
• Patients were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand. The complaints system was clear but was not clearly advertised.
• Patients were provided with information relating to their condition and where relevant how to manage their condition at home.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• The clinic sought feedback from patients, which showed that a large majority of patients were satisfied with the service they had received.
• The clinic was aware of and complied with the requirements of the Duty of Candour.

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

• Ensure that systems and processes are in place to ensure safe care and treatment. This should include systems for delegated actions to nurses, medicines and equipment to manage emergencies and full infection control processes.
• Ensure that systems and processes are in place to ensure good governance. This should include ensuring staff are trained in relevant areas, supervision of the nurse working at the service, advertising the complaints process and monitoring and auditing care.

You can see full details of the regulations not being met at the end of this report.

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

• Review how MHRA alerts are processed and records maintained.
• Review how available the Needlestick policy is for staff who might require it in an emergency.
• Ensure that identification is verified for patients, parents and carers attending the service.