Vision of Hope

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment of this service since CQC introduced ratings.This key question has been rated as requires improvement. The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive and positive culture of safety based on openness. They did not always investigate and report safety events and risks.

The service was unable to demonstrate they could identify and respond to incidents as they occurred. There had been no recorded incidents over the previous 12 months although we learned a safety incident had occurred when a chair had broken. This had not been identified or reviewed as a safety incident. The broken chair remained in the treatment room and presented an ongoing hazard to people using the service. We did not find evidence to show that learning from incidents resulted in changes that improved care.

The service worked with people to establish and maintain safe systems of care, in which safety was managed or monitored.

The service liaised with people’s NHS GPs and other health professionals (for example, NHS oncology teams) when appropriate and with the consent of people using the service. We were told that people often preferred not to share this information with their other health professionals and their decision was respected. The doctor operating the service told us that the complementary treatments offered by the service would not interact with conventional therapies. However, if they considered clinical information sharing to be important and a person declined to have it shared, the service would not proceed with the treatment. Test results were reviewed and acted on promptly. The service signposted people to an independent dietitian and for counselling if they might benefit from this more specialised advice and support.

The service worked with people and healthcare partners to understand what being safe meant to them and how to achieve that but there were gaps in systems and processes to protect people from abuse.

The service’s safeguarding policy and process to report any safeguarding concerns in relation to vulnerable adults, however the policy had not been reviewed since January 2019. The policy included detailed information about local authority contacts in the local area but did not outline how to proceed if a person requiring safeguarding protection was resident elsewhere. (The service was used by people living across England.) We could not locate a policy or documented process on safeguarding children during our assessment, but this was found and supplied after our site visit. The provider (who is medical doctor) had received training on safeguarding, but this was out of date at the time of our assessment.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe and supportive.

People were provided with information about relevant treatments and dietary supplements before and after their consultations. People were advised on risks related to their condition and any treatments and actions to take if they experienced side effects or other issues.

The service did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

The provider was unable to provide assurance that equipment had been properly maintained. No evidence was provided to demonstrate that blood pressure monitors were within their warranty date. No calibration checks had been carried out.This increased the risk that equipment might give inaccurate and unreliable readings.

The service had not commissioned a fire safety risk assessment in recent years in relation to the premises in line with legal requirements. There was no Legionella risk assessment or other health and safety risk assessments or monitoring checklists.

One of the chairs in the treatment room was broken but had not been removed. We observed that the provider issued a verbal warningto people not to sit in the chair when they arrived but there was no other indication to deter people from sitting on the chairand the provider did not stay in the room with people continuously. This presented an ongoing hazard to people using the service.

The service had an automated external defibrillator for use in the event of a medical emergency. However, while we were told this was regularly checked, the checks were not documented.

The service made sure there were enough qualified, skilled and experienced staff with access to effective support, supervision and professional development.

The service was operated by an individual provider who was a medical doctor. No other staff were employed by the service. The provider was appropriately qualified, and their professional registration was in date. The provider was clear with people using the service about their professional qualifications and that they were not a specialist oncologist.

The service had not recruited staff members since our previous inspection but there was a recruitment policy should this position change. The policy included appropriate checks in line with legislation; however, this had not been reviewed since 2019.

The service used a specific ‘protocol’ created in the US as the framework for developing complementary treatment plans for people. The provider kept up to date with any developments relating to the protocol through reading relevant papers or other related materials. They did not have routine contact with other clinicians using the protocol, but they told us they could reach out if necessary. They completed an appraisal every year with an external appraiser which covered training and professional development.

However, the provider was not up to date with their safeguarding training in line with recommendations for clinicians in the UK. They told us they would arrange and complete this training after the assessment. They had completed training on the Mental Capacity Act (2005) but over 3 years ago. They were up to date with Basic Life Support training. They were unable to describe other training they considered required and which needed regular updating for the role.

The service did not assess or manage the risk of infection. They did not detect and control the risk of it spreading.

The provider had not conducted an audit of infection prevention and control of the clinical environment. They had not considered the susceptibility of service users and any risks that the environment and other users may pose to them. (Some types of cancer, such as certain blood cancers, can weaken people’s immune systems).

An impermeable flooring had been installed but this was not compliant with required standards as there was nofloor to wallsealing. The designated area for handwashing, including the sink and taps, were not compliant with current infection-control guidelines for clinical areas The service had not conducted a risk assessment to show how these risks were being satisfactorily mitigated.

The service was unable to evidence the frequency of cleaning activities as these had not been recorded. We were told that the provider cleaned the room daily and deep cleaned periodically, however there was no record of this, and there was no cleaning checklist to evidence what was cleaned daily or periodically. The treatment room and equipment showed signs of wear and tear which made it difficult to assess cleanliness in this environment.

The organisation of the treatment room and equipment were not always appropriate for a clinical setting. For example, while receiving high-dose intravenous vitamin C infusion, patients were seated in low, leather-type fabric-covered, domestic chairs with buttoned upholstery. The coverings around the buttons were pleated. There were fabric cushions and blankets on the chairs. While this provided a homely atmosphere, we found the environment was inappropriate for the treatment provided. We were told that the chairs were wiped down with clinical wipes before and after each patient. This was insufficient to ensure that this style of chair was clean and safe to use for this purpose. The treatment room furnishings included draped curtains that were inappropriate for a clinical setting due to the difficulty in keeping them clean and dust-free. The service could not provide a documented risk assessment to show how infection prevention and control risks were being satisfactorily mitigated.

However, following our site visit, the service supplied a documented aseptic protocol including the steps taken (for example, non-touch technique) to prevent the spread of infection in carrying out high-dose intravenous vitamin C infusion.

The service did not ensure that medicines and treatments were prescribed and stored safely. However, the service involved people in planning their medicines.

We reviewed a sample of clinical records and found prescriptions did not always contain necessary information. The prescriptions we saw were handwritten. One prescription was for a medicine in liquid form, but the prescriber had not stated the concentration of this liquid preparation on the prescription. This increased the risk of a dispensing error. However, we observed the service had included other required details such as the person’s details, the prescriber’s details and the prescriber’s signature.

The service was prescribing a range of ‘repurposed’ medicines (also known as prescribing off label). The service could not provide us with a policy about their use of repurposed medicines with explicit documentation of the information shared with each patient. While all people we spoke with told us this was explained clearly, but this had not documented. (An off-label or repurposed prescription is when a doctor prescribes a medicine in a way that is not specified in its official product license, such as, for a different condition, a different dose, or for a different age group.)

Medicines requiring refrigeration were not stored appropriately. The service kept a stock of medicines on the premises including some for use in an emergency. A small quantity of a medicine (used to treat very low blood sugar in a medical emergency), was stored in a small fridge in the treatment room. We observed the internal compartment of the fridge to have a heavy build-up of ice (to the extent it was difficult to fully close the door). This build-up was sufficient to reduce the airflow around the medicines and potentially compromise the internal temperature control. The service was not keeping a daily record of internal temperatures of the fridge (including the daily maximum and minimum) and could not assure us that cool temperatures had been consistently maintained to protect the integrity of this medicine.

However, the service automatically received national patient safety alerts which were reviewed for relevance. There was a formal policy governing this process, but this had not been reviewed since 2019.

People using the service told us they had been advised on what to do and who to contact if they experienced any unexpected symptoms after starting a treatment, medicine or a dietary supplement.