We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 23rd March 2017. The service is an NHS funded community ears, nose, and throat (ENT) outpatients clinic and is operated by Sellindge Practice Limited. The service opened in 2011 and sees and treats patients aged two years and over with an ear, nose or throat problem that are registered with a GP practice within Ashford, Canterbury, South Kent Coast, Thanet or West Kent CCGs. Only NHS patients were seen and treated at this service.

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.

We found the following issues that the service provider needs to improve

• We saw the medical practitioner was not bare below the elbow and did not demonstrate an appropriate hand washing technique in line with ‘five moments for hand hygiene’ from the World Health Organisation (WHO) guidelines on hand hygiene in health care.

• We found safety tests on a nasendoscope (a flexible telescope is used to look into the back of the nose) were not carried out in line with national recommendations.

• We saw consulting rooms where clinical procedures were carried out were carpeted. This meant the service was non-compliant with the Department of Health (DH) Health Building Note (HBN 00-09) Design for flooring, walls, ceilings, sanitary ware and windows which states carpets should be avoided in clinical areas to avoid contamination.

• We saw posters on hand washing were out of date and not in line with World Health Organisation (WHO) guidelines on hand hygiene in health care.

We found the following areas of good practice:

• The service had direct access to ear, nose and throat (ENT) waiting lists and ENT operating lists. This meant that patients did not have to attend the hospital for a consultation prior to a procedure and were placed on the operating list in a more effective manner.

• The service received positive feedback from patients saying they were treated with a caring attitude and were informed about their treatment.

• The service managed staffing effectively and services always had enough staff with the appropriate skills, experience, and training to keep patients safe and to meet their care needs.

• The service had a small and dedicated team, there was clear leadership and staff felt supported by their managers.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected Sellindge Surgery. Details are at the end of the report.

We spoke with three patients who told us they were satisfied with the service provided. Comments we heard included: “I am more than happy with what they’ve been doing for me here”, “Very good” and “I am pleased with the service”.

We saw that treatment options and medications prescribed were discussed and sufficient time given for patients to talk about their health issues with their practitioner.

Patients were protected from the risk of abuse as staff had received training in the safeguarding of vulnerable adults. There were written instructions for staff to follow in order to report suspected abuse.

We saw that patients were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

There was an effective complaints system available.