During our inspection we spoke with the parents of three children who used the service, one child who used the service, four members of staff and the provider. People told us they were happy with their care. One person told us, “It’s such a good idea to have a service like this. I’m really happy with it”. Another person told us, “We were told there is a bit of a delay today, but it’s not a problem as it’s been explained to us”.

We found that systems were in place to ensure that consent to procedures was gained in accordance with legal requirements. Consideration was given as appropriate, to include children in the decision making process.

People received compassionate care and treatment that ensured their safety and welfare. Appropriate checks were in place to make sure people were fit for surgery and systems were in place to reduce the risks of infection. People received care and treatment that was based upon best practice recommendations, but an accurate record of the care and treatment provided was not always maintained.

Staff told us they felt supported and had received the training required to enable them to work at the service.

The provider had systems in place to monitor the quality and effectiveness of the treatments they provided.

We found the following areas of good practice:

• We saw that when an incident was identified, the service conducted investigations to learn and improve. Outcomes from the investigation was discussed and shared at staff meetings.
• We saw that clinical risks to patients were assessed and that staff acted appropriately when risks were identified.
• The most recent results of an annual audit conducted showed that the centres rates of complications including infections were lower than other hospital providers it compared with.
• We saw that the service followed recommendations outlined in National Institute of Health and Care Excellence (NICE) guidelines for sedation.
• We spoke with parents who told us they had felt reassured by the information provided by staff, were all positive about their experience of the service and told us that there had been no concerns.
• Staff gave examples of improvements to the service as a result of patient feedback.
• There was a positive open working culture. We saw that there were staff meetings held every clinic day to debrief and discuss any concerns or good practice.

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

• We saw that there was no clear and effective governance framework to ensure that the service was running safely and delivering high quality care.
• We saw that there was no risk register in place to record and monitor potential or actual risks of the service.
• We found concerns over the supply, ordering, prescribing and disposal of controlled drugs.
• We saw that controlled drugs were stored and used at the centre but that staff were not documenting the use of them in accordance with up to date legislation.
• We saw that not all records of patient care was documented.
• We saw that staff mandatory training completion was unclear due to the lack of clear documentation and that the service policy was overdue for review.
• During the inspection we saw that some equipment was out of date and was stored with equipment that was fit for use.
• We had concerns over the security and suitability of the environment for treating young children.
• The service did not have standard operating procedures in place to ensure that the service was working to the most current and up to date recommendations.
• We saw that audits were conducted however these did not reflect concerns we had during the inspection and therefore did not provide assurance of the monitoring of quality and safety.