We carried out an announced comprehensive inspection on 26 September 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 providing safe services 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 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.

Tollgate Clinic Limited is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of surgery for carpel tunnel syndrome, and non-scalpel vasectomy services.

A senior manager 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.

Nine people provided feedback about the service provided at the clinic. Feedback was very positive regarding the treatment and care provided.

Our key findings were:

• We found an open and transparent approach to safety at the service.
• There was an effective system to record and report significant events.
• Risks to patients were assessed and well managed.
• Information relating to patients was accurate and enabled staff to make appropriate treatment choices.
• Patients’ care needs were assessed and delivered according to their need.
• Treatment and care was delivered in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The service maintained appropriate standards of cleanliness and hygiene.
• Information about how to complain was available and easy to understand.
• The clinic worked proactively with those services that referred patients into the service, to improve their experience.
• The service was well equipped to treat patients and the facilities met their needs. However emergency items of equipment and medicines were in separate rooms and not signposted to ensure easy access when an emergency occurred.
• Patient feedback was consistently positive.
• Patients said they were treated with compassion, dignity and respect and were fully involved in the decisions about their care and treatment.
• There was a clear leadership structure and staff felt supported by management.
• The service proactively sought feedback from staff and patients, which it acted on.
• The service was aware and complied with the requirements of the duty of candour.

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

• Review where emergency equipment and medicine is stored, and the signposting to ensure easy access should a medical emergency occur.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

We did not speak with people who use the service because on the day of our visit there were no surgical procedures being undertaken and therefore no people we could speak with. The general manager informed us that people using the service were routinely surveyed following their visit to determine their views on the quality of the service provided. We looked at the records of six people who used the service and found that the person was always contacted following their procedure. The records viewed showed that people provided positive feedback about the service. One person was quoted as saying, ‘Very happy with the results.’ Another person was quoted as saying, ‘Excellent I could not be happier.’

We found that detailed medical assessments were undertaken to ensure people’s welfare before the procedure. People were also provided with plentiful information about post surgical care. The service had effective procedures in place to monitor infection prevention systems at the service. We found that on the day of our inspection the service was clean and well maintained.

We found that staff were supported through training, professional development, accreditation and appraisals. This ensured that people were suitably skilled to provide an effective service to people. We found that the records were accurate and fit for purpose.

We did not speak with people who use the service because on the day of our visit the people who were at the clinic were undergoing surgical procedures. The general manager informed us that people using the service were routinely surveyed following their visit to determine their views on the quality of the service provided. We looked at the results for the surveys for August/September 2012 and these showed overall a very high rate of satisfaction with regard to receiving information, convenience of appointment, service received and staff. We saw compliment cards with positive comments such as "Thank you for making it such a positive experience."