We visited the St. Albans Medical centre on 18 June 2013, On the day we visited the centre we found that there were no people due to be seen at the centre. This was due to the consultant taking routine annual leave. We were told that if there were any emergency cases that needed immediate attention then the practice had a list of on-call consultants available to deal with people while the practice consult was unavailable. Due to this reduced functionality on the day of our inspection we will return to the practice at a future date to carry out a full inspection.

We spoke with staff at the service and were told that the practice was 'doing well' but 'could improve in areas' such as employing more consultants as currently there was only one consultant available. We were told that patients spoke 'highly' of the consultant and that he had a 'following' of patients.

We carried out an announced comprehensive inspection on 16 October 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.

St Albans Medical Centre is a privately run medical centre which specialises in the diagnosis of visual impairments such as Cataracts and Glaucoma. The centre carries out some treatments such as the insertion of punctal plugs. (A punctal plug is a small medical device that is inserted into the tear duct of an eye to block the duct. This prevents the drainage of liquid from the eye. They are used to treat dry eyes). The centre does not carry out any other treatment on site and will refer people to hospitals in London for treatment, which is carried out by the centre’s Consultant Ophthalmic Surgeon. St Albans Medical Centre is primarily used to carry out the diagnosis, pre-operative consultation and after care for people.

The Consultant Ophthalmologist Surgeon 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.

We received 26 completed CQC comment cards. All the completed cards indicated that patients were treated with kindness and respect. Staff were described as caring and professional. In addition, comment cards described the environment as clean and tidy.

Our key findings were:

• The service did not have adequate systems to manage risk so that safety incidents were less likely to happen. The service was unable to demonstrate how they learned from incidents and complaints and improve their processes.
• The service did not have comprehensive systems in place to keep people safe and safeguarded from abuse.
• The service reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• Structures, processes and systems to support good governance and management were not clearly set out, understood and effective.

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

• 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.
• Ensure specified information is available regarding each person employed.

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 medicines stock control procedures to ensure medical consumables are available and within the expiry date recommended by the manufacturers.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice