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Inspection carried out on 19 October 2019

During a routine inspection

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 carried out on 27 September and 8 October 2013

During a routine inspection

People who used the service told us they had experienced appropriate treatment and care. One person said, �I�m more than happy with the care and couldn�t be happier with the result.� Another person said, �It was a good experience and they put the patient first. They did the right things at the right time.�

People told us they had opportunities to ask questions and these had always been answered. One person said they had requested some additional information and were provided with this promptly. Two people said although they were satisfied with their care and treatment they would have liked to have received more information about their recovery.

The provider had taken steps to provide care and treatment in an environment that was suitably designed and adequately maintained. People we spoke with said they had been comfortable when they received care and treatment. Consultations were always held in private so their confidentiality was maintained.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to monitor the quality of the service people received. One member of staff said, "We always make sure we follow procedure and I have every confidence we are doing everything properly." Another member of staff said, "Patients get good continuity. We have a specialist team who are longstanding.� Staff confirmed regular discussions took place where they talked about care and safety.

Inspection carried out on 8, 14 January 2013

During a routine inspection

We were not able to speak with patients who used the service because there was not a clinic for podiatry on the days of our inspection. We reviewed three care records and found that in each file a detailed consent form was in place which included the potential risks and complications and how their personal information may be used. We reviewed the feedback which patients provided and found patients' experiences to be positive.

We also saw that each patient had been asked to consent to their GP being contacted with regards to the treatment they were undergoing. Patients were protected from unsafe or unsuitable equipment because the provider ensured maintenance and regular checks were undertaken. Staff spoken with and records seen confirmed that staff were appropriately trained and supported to undertake their roles.

Our observations of the treatment room demonstrated to us that it was clean, free from any unpleasant odours and that infection control practices were in place. Hand gels were readily available and cleaning equipment and wipes were in place. This ensured that cleaning in between people having treatments was carried out.

We also found that staff received appropriate training and support and that the service had various methods in place to monitor the quality of service it provided. An appropriate complaints system was in place.

Inspection carried out on 1 December 2011

During a routine inspection

On the day of our visit there were no patients attending the clinic. We spoke with three people who had used the service on the telephone and we looked at survey questionnaires that had been completed by people.

People told us they were happy with the service and the treatment they had received. Comments included:

�Very happy, very impressed.�

�Follow up care was exceptional, very good advice and responses to queries.�

�The surgeon was very careful and I was monitored well throughout.�

�Clear instructions were given and an information sheet to take away.�

�The clinic was very clean.�

People said they had been given all the information they needed prior to having their surgery and their consent had been taken properly. They said:

�The surgeon went through everything well, risks, what to expect, what to do after.�

�Explained everything well, very thorough.�

People also spoke highly of the staff. They said:

�Felt comfortable and at ease with all the staff and would have expressed concerns if I hadn�t.�

�Had every confidence in them, great surgeon, felt in good hands.�

The surveys we looked at showed that people felt their expectations were met and the aims of treatment were fulfilled. For example, one person said their aim was to be �pain free� after their surgery and they stated that they were.

Reports under our old system of regulation (including those from before CQC was created)