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Archived: David Fraser Badenoch - Diagnostics Good

Inspection Summary


Overall summary & rating

Good

Updated 27 March 2019

David Fraser Badenoch - Diagnostics is operated by David Fraser Badenoch and is a single, inepdent service. The service has one consultation room, one diagnostics room, one minor procedures room and one recovery room. The service discontinued the x-ray provision before our inspection took place and was in the process of deregistration. This did not affect any other aspect of the service. The x-ray equipment was marked as out of use and was due to be removed.

The service provides urologist consultations, eight types of ultrasound examination, intravenous urography, flexible cystoscopy, bladder installation, vasectomy, excision of minor skin lesions, minor orthopaedic procedures and phlebotomy on an outpatient basis. At the time of our inspection the service was registered to provide plain x-ray examination but had recently ceased this service. Several other providers use the service’s facilities. Each service has its own registration and we did not inspect these. We inspected all aspects of the diagnostics service; surgical services will be inspected separately.

The service provides care and treatment to patients who self-pay or whose insurance company pays for their care. The team also provided care for patients referred from clinical staff based in embassies.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 18 December 2018 followed by a telephone interview with the head of clinical service on 19 December 2018.

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.

Services we rate

We have not previously rated this service. We rated it as Good overall.

We found good practice:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • The service team acted on audits and quality evaluations to continually identify opportunities for benchmarking and improvement.
  • Safety and risk management processes were clearly embedded in practice and a strict referral system meant staff saw patients only when they had enough information to provide a safe level of care.
  • Staff managed all areas relating to health and safety, such as medicines management and staffing, in line with established processes and protocols. The registered manager and the lead nurse ensured protocols were reviewed and updated in a timely fashion to reflect the latest national standards.
  • Staff worked in a no-blame culture that encouraged open discussion of mistakes and reporting of incidents. This included use of the duty of candour, which staff used to ensure patients were kept informed when things went wrong. This approach included the incident, complaint and governance processes.
  • The service did not have a waiting list and had no delayed or cancelled appointments for non-clinical reasons in the previous 12 months.
  • Governance processes included all staff and helped the team to assess the quality of the service and to drive development and improvement.
  • The registered manager had implemented an improvement plan for appraisals amongst non-clinical staff. In December 2018, 50% of this staff group had completed an appraisal, which was an improvement from 33% in October 2018. The manager planned to have completed all appraisals by February 2019.

We found areas of outstanding practice:

  • The team maintained a proactive awareness of new and emerging treatments nationally and internationally. This resulted in the development of new and innovative procedures for patients.
  • Administration staff had undertaken detailed analysis of the feedback behaviour of patients to understand what prevented more consistent completion of feedback. They had tested and introduced new feedback designs that had resulted in a significantly higher response rate, which staff used to improve the service.

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

  • The management of sharps was not in line with Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 and presented a safety risk. The service addressed this at the time of our inspection and should ensure the new standard is maintained.
  • There was limited privacy and confidentiality in the recovery area. The service planned to address this by utilising more space following the discontinuation of the x-ray service.
  • An established medical advisory board (MAB) was in place although attendance was sporadic, at only 59% of the expected attendances in the previous three meetings.
  • The service did not have facilities for independent language interpretation for patients, which presented a risk when staff needed to discuss clinical issues or break bad news.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.

Inspection areas

Safe

Good

Updated 27 March 2019

We rated safe as Good because:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service controlled infection risk well.
  • The service had suitable premises and equipment and looked after them well.
  • Staff completed and updated risk assessments for each patient.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment.
  • The service followed best practice when prescribing, giving, recording and storing medicines.
  • The service managed patient safety incidents well.
  • The service used safety monitoring results well.

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

  • The management of sharps was not in line with Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 and presented a safety risk.

Effective

Updated 27 March 2019

We do not currently rate effective and found the following areas of good practice:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff assessed and monitored patients regularly to see if they were in pain.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them.
  • The service made sure staff were competent for their roles.
  • Staff of different kinds worked together as a team to benefit patients.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

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

Only 50% of administrative staff had an up-to-date appraisal although a schedule was in place to address this. 

Caring

Good

Updated 27 March 2019

We rated caring as

Good

because:

  • Staff cared for patients with compassion.
  • Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.

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

  • There was limited privacy and confidentiality in the recovery area although the service had an immediate plan in place to address this.

Responsive

Good

Updated 27 March 2019

We rated responsive as Good because:

  • The service planned and provided services in a way that met the needs of local people.
  • The service took account of patients’ individual needs.
  • People could access the service when they needed it.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

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

  • The service did not have routine access to language interpreters. Although processes were in place for patients referred from embassies, there was a lack of assurance around consent and safeguarding for patients who received language support from relatives.

Well-led

Good

Updated 27 March 2019

We rated well-led as Good because:

  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action, which it developed with staff, patients, and local community groups.
  • Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.
  • The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation.

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

  • Attendance of members at medical advisory board (MAB) meetings was sporadic, which meant there was limited assurance of the effectiveness of the group.
Checks on specific services

Diagnostic imaging

Good

Updated 27 March 2019

We rated this service as good because it was safe, effective, caring,

responsive and well-led. Some areas of infection control and privacy required

improvement and were addressed after our inspection.