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Worcestershire Imaging Centre Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 28 February 2019

Worcestershire Imaging Centre is operated by The Worcestershire Imaging Centre Limited. The service is commissioned by a local NHS trust and provides MRI (Magnetic Resonance Imaging) diagnostic facilities for adults and children. We inspected diagnostic imaging services at this location.

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.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice announced inspection on 15 January 2019. This was the second inspection since registration. 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 service provided diagnostic and screening procedures.

Services we rate

We previously did not have the authority to rate this service as legislation had not previously applied to all types of independent services, which meant that some providers had been inspected, but not rated. The department of Health had amended the performance assessment regulations to enable CQC rate almost all independent healthcare providers. We rated this service as requires improvement overall.

We found areas of practice that the service needed to improve:

  • The service had no lead for safeguarding who was trained to level three and had no access to a named professional who was trained to level four. This did not meet national guidance.

  • Radiographers did not have up-to-date competencies to enable them effectively to carry out their role.

  • Staff told us bank staff had local induction. However, we saw no evidence that local induction had been completed as no induction checklists had been completed.

  • There was lack of robust governance process in place to provide oversight around staff competencies and overall management of risks.

  • Hand hygiene audits were not undertaken to measure staff compliance with the World Health Organisation’s (WHO) ‘Five Moments for Hand Hygiene.’

However, we also found the following areas of good practice:

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

  • Staff were caring, kind and engaged well with patients.

  • Services were planned in a way that met the needs of patients and the local community. Patients were offered a choice of appointments.

  • Incidents were reported, investigated and learning was implemented.

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. We also issued the provider with four requirement notices that affected diagnostic and screening procedures. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (Central)

Inspection areas

Safe

Requires improvement

Updated 28 February 2019

We rated safe as Requires improvement because:

  • There were not always effective systems in place regarding the storage and handling of medicines.

  • The service did not have a safeguarding level three trained lead. This was not in line with national guidance.

  • Infection prevention and control audits were not carried out. We were not assured the service monitored their systems and used results to improve patient safety.

  • The service did not have a robust process in place to ensure the consultant radiologists were fit for practise and competent for their role.

However, we also found the following areas of good practice:

  • Patients’ individual care records were generally written and managed in a way that kept people safe. Records seen were accurate, complete, legible, and up-to-date.

  • Patients personal data and information were kept secure and only staff had access to that information.

Effective

Updated 28 February 2019

We currently do not rate effective, we found:

  • On inspection, we saw no evidence of up-to-date competencies required to enable radiographers effectively to carry out their role. These were provided at a later date.

  • The service used bank staff who had local induction. We saw no evidence that local induction had been completed as no induction checklists had been completed.

  • There was limited evidence on image quality reviews.

    We could not be assured that learning was always shared.

There was

a lack of evidence of practical competencies for staff at the time of the inspection. These were not stored in staff files. The service provided these at a later date following the inspection.

However;

  • Staff we spoke with demonstrated a good understanding of the national legislation that affected their practice.

  • Staff of different kinds worked together as a team to benefit patients.

Caring

Good

Updated 28 February 2019

We rated caring as Good because:

  • Patients received information in a way which they understood and felt involved in their care. Patients were always given the opportunity to ask staff questions, and patients felt comfortable doing so.

  • There were systems in place for the service to receive feedback from patients. Feedback received from patients was positive.

  • Staff provided patients and those close to them with emotional support; all staff were sympathetic to anxious or distressed patients.

  • Patients received information in a way which they understood and felt involved in their care.

Responsive

Good

Updated 28 February 2019

We rated responsive as Good because:

  • The service ensured there were appointments available to meet the needs of the patients.

  • Patients had timely access to all scans.

  • Interpretation services were available for patients whose first language was not English.

  • Information on how to raise a concern or a complaint was available. Complaints and concerns were responded to in line with the service’s complaints policy.

  • There was a system in place for supporting patients living with dementia or learning disability.

Well-led

Requires improvement

Updated 28 February 2019

We rated well-led as Requires improvement because:

  • There was not an effective governance framework in place. The governance system did not ensure that systems were in place to mitigate risks identified during our inspection.

  • There was a lack of effective governance framework to support the delivery of quality patient care. There was no clear oversight of the day to day working of the service.

  • The service did not have a registered manager in post, and had not had one since March 2017.

However;

  • Staff we spoke with found the managing director to be approachable and supportive.

  • All staff we spoke with told us they felt respected and valued.

  • Staff we spoke with told us they felt proud to work for the service and they enjoyed the work they did within the clinic.

Checks on specific services

Diagnostic imaging

Requires improvement

Updated 28 February 2019

The provision of magnetic resonance imaging scans which is classified under the diagnostic imaging core service, was the core service provided at this service. We rated this service as requires improvement overall because staff did not have sufficient competencies to enable them carry out their role. Out of date medicines were found on site. The service did not have a safeguarding lead and no member of staff had been trained to safeguarding children level three. There was no robust governance system in place to ensure risks identified during our inspection had been recognised by the service. However, feedback from patients was positive. Appointments were scheduled to meet the needs and demands of the patients who required their services.