We carried out an announced comprehensive inspection at La Maison Médicale on 25 April 2018. At the February 2018 inspection, we issued the practice with a warning notice for breach of Regulation 12 of the Health and Social Care Act (HCSA) 2014. We found that the provider did not have sufficient systems and processes in place to keep people safe. The report on the April 2018 focused follow-up inspection can be found by selecting the ‘all reports’ link for La Maison Médicale on our website at www.cqc.org.uk.

This inspection was a focused follow-up inspection carried out on 12 September 2018 to confirm that the practice had addressed the issues in the warning notice and now met the legal requirements. This report covers our findings in relation to those requirements and is a supplementary report to accompany the current full comprehensive inspection report on the service.

At this inspection we found that the requirements of the warning notice had been met.

Our key findings were:-

• Emergency medicines kept on site were suitable for patients.
• Infection prevention control audits had commenced at the service.

In addition we noted:

• The service had commenced reviewing and updating their standard operating procedures.
• A Legionella assessment had taken place at the service in July 2018.
• The service had been in contact with the landlord of the building in which the service is situated to arrange for a fire drill to be undertaken. Three members of staff are scheduled to undertake fire warden training in October 2018.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice ​

We carried out an announced comprehensive inspection on 25 April 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 not 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.

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.

Background

La Maison Médical is private doctors’ clinic based in South Kensington, in the south-west part of central London. The service provides services to the whole community. A large number of patients registered with the service have French as either their primary or second language. The service provides patients with access to a number of clinical specialists, a number of which are located primarily in France, but are registered to practice medicine in the UK. These specialists have experience in a number of areas including general medicine, dermatology, gynaecology, urology, as well as providing physiological and lifestyle assessments. These clinical specialists are contracted to work at the service when their services are required by a registered patient.

The services offered by La Maison Médicale are provided to adults and children as private patients.

The service is situated in a rented basement floor of a terraced converted building, which has consultation/treatment rooms, a patient waiting area, patient toilets and rooms for administrative staff.

The nominated individual (the point of contact between the Commission and the service) 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.

La Maison Médicale is registered to conduct the following regulated activities under the Health and Social Care Act 2008:-

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

Prior to our visit, the service was provided with feedback cards for their patients to complete with their views about the service by completing comments cards. Seventeen feedback cards were completed prior or during our inspection of the service.

Our key findings were:

• Staff had been trained with the skills and knowledge to deliver care and treatment.
• There was no evidence of clinical staff meetings and/or opportunities to share clinical learning/knowledge.
• The service had systems to keep people safe and safeguarded from abuse, however these were not clearly defined.
• The service did not have adequate medicines in place in the event of a medical emergency at the service.
• Information about services and how to complain was available. Information about the range of services and fees were available.
• The service had not conducted a recent review of service policies and procedures.
• The service had good facilities and was (with the exception of emergency medicines) equipped to treat patients.
• There was no oversight or quality assurance of the work of clinical work conducted at the service.
• The service kept patient information secure.
• The service did not conduct fire drills and did not have a trained fire warden on site

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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

The areas where the provider could make improvements and should:-

• Review arrangements for the provision of training, specifically in relation to infection control, information governance and Mental Capacity Act 2005 training.
• Review arrangements regarding written guidance relating to the continuation of business in the event that the service could not operate from it registered address.
• Review arrangements to obtain up-to-date an Legionella testing certificate.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice ​

We did not speak to any patients during our visit.

We looked at the personnel files for six newly recruited staff and found sufficient information to demonstrate that they had been recruited safely.

The provider assured us that they were working towards obtaining all relevant information for all staff recruited prior to our last inspection on 17 September 2014.

We found suitable arrangements in place for obtaining the consent of people who used services, in relation to the care and treatments provided for them.

We spoke to two people who were using the service during our visit. They said they were asked for their opinions when care and treatment was being offered. One person said that the relationship between staff and patients at the clinic was personal and caring. Another person said they had been looking for one of the consultants who had moved from another clinic and were happy to have found them. We found staff were concerned with ensuring the best experience for people they provided treatment to.

The clinic had arrangements in place to ensure the premises were kept in a clean manner. Staff showed an awareness of the importance of maintaining high standards of hygiene in the clinic. We found evidence that the clinic was cleaned regularly and clinical waste was disposed of appropriately. The clinic was clean and tidy when we visited.

We found the provider did not have effective recruitment procedures in place. Some of the required checks were not made on staff before they commenced their employment

One person told us if they had a complaint they would speak to the consultant or reception. The clinic had a complaints policy in place. We saw evidence that questionnaires were completed requesting feedback on each consultant at the clinic.

No people who use the service were present when we visited. They had made positive comments about the service in the quality questionnaires they had completed. We did not speak directly to them.

They told us they felt respected, treated with dignity, safe using the service and staff were competent. They were informed of how screening and diagnosis would take place and involved in the decision-making about the alternative choices of treatment available. This included any risks attached. They were also aware of how to make a complaint and who to.