You are here

Inspection Summary


Overall summary & rating

Good

Updated 24 April 2020

The Lawrence Clinic is operated by TLC Medical Centre limited liability partnership (LLP). It is a multidisciplinary clinic, offering musculoskeletal, complementary and front foot surgery. The clinic was established in October 2003 bringing together specialists in medicine, surgery and complementary medicine under one roof. The clinic was owned and managed by four directors, one of whom was the registered manager. The directors did not undertake any clinical functions.

The Lawrence Clinic provided front foot surgery for adults aged 18 and over. We inspected this service using our comprehensive inspection methodology. We carried out the short notice announced part of the inspection on 19 October 2019. It was necessary to conduct a short notice announced inspection because the service was only open one or two Saturdays per month and only if demand from users of the service required it.

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.

The main service provided by this clinic was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery service level.

Services we rate

We rated this service as Good overall.

We found good practice:

  • The service had enough staff to care for patients and keep them safe. Medical staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

  • Leaders ran services using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and staff were committed to improving services.

  • Mandatory training completion was high and all staff had received an appraisal within the last year.

  • The provider had robust arrangements in place for obtaining consent for patients having surgery or other procedures at the service.

However, we found the following areas of concern:

  • There were tears on the couch in the theatre, which posed an infection risk. The clinic was in the process of replacing this item.

  • At the time of the inspection, the provider did not have a process in place to protect the public from the risk of Legionnaires disease. This was evidenced in the bathroom where the shower hose had been removed, leaving an outlet which was not tested regularly. We raised this as a concern with the registered manager at the time of the inspection. Since the inspection, the provider had contracted with an external company to have the water tested regularly.

  • The service did not take minutes of all meetings. It is good practice to minute discussions of meetings so there is an accurate record of what was discussed.

  • The service did not have a written strategy in place, however the small team’s vision and ethos and shared values were evident.

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. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North)

Inspection areas

Safe

Good

Updated 24 April 2020

We rated it as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff completed topics such as fire training and sepsis training. As the clinical staff were employed by the NHS, they completed mandatory training with their employer and provided evidence of completion to The Lawrence Clinic.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

  • All policies were stored on a computer in the reception area. Hard copies were also available in the reception area and pre-operation consulting room.

However;

  • At the time of the inspection, the provider did not have a process in place to protect the public from the risk of Legionnaires disease. This was evidenced in the bathroom where the shower hose had been removed and thus left an outlet which was not tested regularly. We raised this with the registered manager at the time of the inspection. Since the inspection, the provider had made arrangements with an external company to have the water tested regularly.

  • During the inspection, we saw tears on the couch in the theatre which meant there was the potential for an increased risk of cross infection. After the inspection, the registered manager told us that the couch was scheduled to be replaced at the beginning of 2020. The provider noted the concerns we shared onsite and began the procurement process for a new couch immediately.

Effective

Good

Updated 24 April 2020

We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.

  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

  • We observed good multi-disciplinary working and communication between the team in the clinic on the day of our inspection.

Caring

Good

Updated 24 April 2020

We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Good

Updated 24 April 2020

We rated it as Good because:

  • The service planned and provided care in a way that met the needs of local people and the communities served.

  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services.

  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

However;

  • The director told us that they never had a patient attend requiring an interpreter, but if they did require an interpreter they could attend with a family member to interpret. This is not best practice. The service had on file details of two interpretation and sign language companies whose services could be accessed should the need arise.

  • The clinic’s complaints process directed complainants to CQC, however it is not within the remit of CQC to assist with individual complaints.

Well-led

Requires improvement

Updated 24 April 2020

We rated it as Requires improvement because:

  • The service did not have a written strategy in place, thus it was difficult to see how staff and leaders could objectively assess the performance and quality of the service.

  • The service did not take minutes of all the meetings they held. It is good practice to minute all meetings so that there is a clear record of the discussions.

  • There was no central risk register. Some of the issues the service was aware of, such as a torn couch, were not listed as risks by the provider.

  • Some of the overarching systems required to keep people safe had not been implemented by the provider. For example, legionella testing was not being carried out, although this was remedied after our inspection after we brought this to senior leaders’ attention.

However;

  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

  • Leaders and staff actively and openly engaged with patients and staff to plan and manage services.

  • The staff we spoke with felt told us they supported by the provider. Staff told us they enjoyed working at the clinic and that they received support and mentoring from their line manager.

Checks on specific services

Outpatients

Good

Updated 24 April 2020

Outpatient services were a very small proportion of the service’s activity. Where arrangements were the same, we have reported findings in the surgery section. We rated this service as good. The safe, caring and responsive domains were rated as good, and the well led domain as requires improvement. We do not rate the effective domain.

Surgery

Good

Updated 24 April 2020

Surgery was the main activity of the hospital. We rated this service as good. The safe, effective, caring and responsive domains were rated as good, and the well led domain as requires improvement.