The Clear Ear Clinic is operated by Clear Ear Clinic Limited. The service has no inpatient beds. Facilities include two clinic rooms, with operating microscopes and low-pressure suction systems to remove ear wax.

The service provides appointments on an outpatient basis to patients. We inspected the service using appropriate key lines of enquiry from our framework for outpatients and diagnostic imaging.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 13 July 2017.

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 do not rate

We regulate clinics that provide treatment on an outpatient basis but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The environment throughout the clinic was visibly clean and tidy.

• Equipment was readily available and tested regularly to ensure it was suitable for use on patients.

• Stock medicines and prescription pads were managed and stored appropriately. Nursing staff had been supported to become nurse prescribers.

• There were sufficient nursing and medical staff. We observed good working relationships between all grades of staff and professional disciplines, with communication with GPs initiated where necessary.

• Staff had awareness of what actions they would take in the event of a major incident, such as a fire.

• The clinic was open six days a week, with evening and weekend lists to suit patient need. Patients were able to access care and treatment in a timely way.

• All staff received appraisals and were happy with the quality of these and their clinical professional development opportunities.

• We observed systems in place to obtain consent from patients before carrying out a procedure or providing treatment. Patients were given sufficient information and time to give informed consent to the microsuction procedure.

• Interactions between staff and patients were observed to be positive across the clinic, with the patient at the centre of the care. All patients we spoke to and feedback we gathered was complimentary about the staff and the clinic as a whole.

• The needs of individuals with differing complex needs were well considered and largely met by the service. A telephone translation service was available. Clinicians were sensitive to the potential emotional needs of patients.

• There were a low number of complaints. When complaints were received they were used to identify learning and improve patient experience.

• The clinic had an overall vision and strategy and communicated this to staff, enabling them to feel involved in the development of the service.

• Nursing and medical staff thought that the registered manager was supportive and approachable. They felt able to raise concerns.

• Feedback was sought from staff and the public to develop and improve the service, as appropriate.

However, we also found the following issues that the service provider needs to improve:

• Not all staff were fully aware of their responsibilities under the duty of candour regulation.

• Hand hygiene practices were variable, with staff not always washing their hands between patients, as per policy.

• An expired vial of adrenalin was found in the resuscitation bag. This was immediately highlighted to the registered manager, who removed it. We were shown evidence that it was replaced following inspection.

• Clinical staff were not trained in the appropriate level of safeguarding, although they could describe how to recognise and escalate concerns. The provider had already started to action this by training all registered nurses post-inspection.

• Some staff had not familiarised themselves with some clinical policies, and some had not been updated since October 2015.

• There was no formalised risk register, with risk assessment forms being used instead. Some risks identified during inspection did not have a corresponding risk assessment. Risks were not graded according to severity or likelihood of event.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and 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 two requirement notices. Details are at the end of the report.

Professor Edward Baker

Chief Inspector of Hospitals