We carried out an announced comprehensive inspection on 2 August 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 care 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 medical service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The CQC previously inspected Victoria Dental & Healthcare Limited (known as Victoria Clinic) on 26 October 2017 and asked the provider to make improvements of the medical service. The registered provider had failed to ensure safe services were delivered, systems to monitor and support medical doctors were not established and effective systems of governance were not in place. We issued one warning notice in respect of Good governance; Regulation 17 HSCA (RA) Regulations 2014 and one requirement notice in respect of Safe care and treatment; Regulation 12 HSCA (RA) Regulations 2014.

The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Victoria Dental & Healthcare Limited on our website at www.cqc.org.uk

The inspection of the dental service, was undertaken at the same time on 26 October 2017, and we found it to be meeting the regulations.

We carried out this follow up comprehensive inspection to the medical service on 2 August 2018 to confirm that the registered provider had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection of 26 October 2017. This inspection visit identified improvements had been made in service delivery for key questions Safe, Effective and Well Led.

Our key findings were:

• Since the last inspection the registered manager had taken action and implemented governance systems to monitor and review clinical practice. This included clinical support and staff development.
• Action had been taken to improve the quality of handwritten patients’ medical records.
• Training certificates demonstrated doctors were trained to the appropriate children’s safeguarding level.
• The system for recording and sharing learning from significant events was established and this was supported by a significant event policy and procedure.
• The system for communicating and acting on patient safety alerts was established and action taken as required.
• Meeting minutes showed the doctors employed by the service had attended team meetings. The minutes showed these meeting to be a forum to share learning.
• The registered manager obtained advice and support from clinicians to improve clinical governance of the service.
• Information about services, fees and how to complain was available.
• Infection control arrangements were good. The premises were clean, tidy and fit for purpose.
• Medicines and equipment for dealing with medical emergencies were available and an effective system was in place to monitor their use and expiration dates.
• Systems to ensure appropriate follow up for abnormal blood and other test results were in place but these required strengthening.
• The registered manager had implemented systems to ensure doctors did not dispense medicines brought from outside the UK.

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

• Review and develop the procedure to provide a safe and consistent framework for doctors to respond to a patient’s refusal for further tests and investigations.
• Review the system of responding to abnormal test results by consistently recording the date feedback was provided to the patient.
• Review the policy for notifying the patient’s GP of treatment, changing the options to an automatic opt in agreement unless specifically requested to the contrary by the patient.
• Review and develop further, a programme of continuous quality improvement activity.
• Review, formalise and record systems of patient identification including parental responsibility.

We carried out an announced inspection on 26 October 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check on concerns we had received and whether the registered provider was meeting the legal requirements within the Health and Social Care Act 2008 and associated regulations.

This was a joint dental and medical inspection of an independent healthcare service. This report relates to the medical service only. A separate report has been written for the dental service provided by the clinic. You can read the dental report by selecting the ’all reports’ link for Victoria Dental & Healthcare on our website at www.cqc.org.uk.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).

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 have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).

Background

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 on concerns we had received and whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Victoria Dental & Healthcare (which operates as Victoria Clinic) is registered with the Care Quality Commission (CQC) as an independent provider of dental and medical services and treats both adults and children at one location in Manchester. The clinic is registered with the CQC to provide the following regulated activities:

• Diagnostic and screening procedures
• Surgical procedures
• Treatment of disease, disorder and injury
• Maternity and midwifery services.

Services are provided primarily to Polish people who live in the United Kingdom with English as a second language and are available on a pre-bookable appointment basis.

This is not a GP service. The clinic employs doctors on a sessional basis who are working within their specialised field of either gynaecology, internal medicine, dermatology, orthopaedics or psychiatry. Medical consultations and diagnostic tests are provided by the clinic. No surgical procedures are carried out.

The nominated individual of the service is also the registered manager. A nominated individual has responsibility for supervising the way in which regulated activities are managed. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The healthcare team consists of:

• Five dentists (including the registered manager)
• One dental hygienist
• Three dental nurses (two of whom are trainees)
• One head nurse (also a trainee dental nurse)
• Seven doctors (including an internal medical specialist, gynaecologists, dermatologist, orthopaedist, psychiatrist and aesthetics specialist)
• A psychotherapist
• An orthopaedic technician
• Four non-clinical members of staff including a practice manager and receptionists

All of the doctors and dentists are appropriately registered with either the General Medical Council (GMC) or the General Dental Council (GDC).

Victoria Clinic is open from 11am until 6pm on a Monday and Tuesday; 11am to 10pm on a Wednesday, Friday and Sunday; 11am to 9pm on a Thursday and 9am to 10pm on a Saturday. The provider is not required to offer an out of hour’s service or emergency care. Patients who require emergency medical assistance or out of hours services are requested to contact the NHS 111 service or attend the local accident and emergency department.

Our key findings were:

• The registered manager had not considered what oversight or governance of clinical practice was required when expanding the service despite being responsible and accountable for quality and safety.
• Patients’ medical records that we viewed were handwritten and did not always contain sufficient detail. For example some of the records we viewed did not include a diagnosis or record the batch number of injections.
• Not all doctors had completed safeguarding training to the appropriate level.
• The system for recording and sharing learning from significant events was not effective. The provider did not have a significant event policy or procedure.
• The system for communicating and acting on patient safety alerts was not effective.
• The doctors employed by the service did not attend any team meetings and there was no formal route for sharing relevant information with them. The doctors were not involved in the clinical governance of the practice.
• Staff were not supported by the provider in their clinical professional development.
• We did not see any evidence of clinical supervision.
• Information about services, fees and how to complain was available.
• Infection control arrangements were good. The premises were clean, tidy and fit for purpose.
• Medicines and equipment for dealing with medical emergencies were available and an effective system was in place to monitor their use and expiration dates.
• There was no system in place to ensure that there was appropriate follow up for abnormal blood and other test results.
• There were limited formal governance arrangements in respect of the medical service offered by the provider.
• There was a broad range of policies and procedures, but individual documents were not always signed nor dated by the reviewer.
• The practice was dispensing medicines brought to the UK from Poland which were not licenced for use in the UK. These medicines were not always appropriately labelled when dispensed.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

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

There were areas where the provider should make improvements:

• Replace the self-inflating oxygen mask and purchase a paediatric oxygen mask.
• Update the clinic complaints policy to reflect appropriate route of escalation for health care related complaints
• Review staff awareness of Gillick competency and ensure they are aware of their responsibilities in relation to this.

We spoke to five patients who used the service. All of the people we spoke with were happy with the service they had received. Comments included: "I'm petrified of dentists but [the dentist] is great". “The dentist has done a fabulous job. No complaints”. “I needed emergency treatment on a Sunday. I’m so glad I found them”. "I work some distance away but will travel back to use them”. And: [The dentist] does some special treatment which means I don't get any pain from injections, it's great".

The practice team consisted of two dentists, a dental technician, dental nurses and reception staff.

We found that patients who used the service were given sufficient information which enabled them to make informed choices about their treatment and costs.

Patient records were clear, personalised and regularly updated with people’s health needs. We saw that records were kept secure and patient confidentiality was maintained.

The practice had policies and procedures in place to protect vulnerable people. We saw that staff had been suitably trained and knew who to contact if they suspected abuse.

We found the premises were clean and the practice followed all recommended guidelines from the department of health.

The practice had robust procedures in place for the recruitment of staff and we saw that systems were in place for the practice to deal with and learn from any complaints received.