Archived: The Oving Clinic

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 assessed a total of 5 quality statements from this key question. We found a breach of the legal regulations in relation to safe care and treatment. We found formal systems were not in place for reporting and learning from incidents, risks were not formally assessed when they were identified, and medicine systems were not always safe. Medicine systems were not consistently safe, and equipment used to provide care and treatment to patients were not consistently maintained within guidance. For example, medicines had passed their date of expiry or maintained according to the manufacturer’s guidelines. Staff were not fully trained in the roles they were to perform. For example the Health Care staff were not competently trained in the roles of auditing, ordering and storage of medicines. Staff were not receiving appropriate support by supervision, team meetings and appraisal. The provider responded to our immediate concerns once escalated and they told us they had made improvements with medicine systems, staff support, and policies were reviewed.

This service scored 22 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The 5 patients we spoke with praised the staff at the clinic. They felt safe when they were receiving treatment and although a member of staff was always present, they felt able to request to be accompanied by a relative or to have a chaperone.

There were no recorded accidents documented in the Accident Book for over 2 years. There was no formal system for learning from events although staff were able to give examples on how to prevent reoccurrence of accidents. While the staff told us how reoccurrences of incidents was prevented, their feedback was variable on how learning was shared.

Staff said they felt confident to report areas of concern to the provider.

The service had a risk assessment policy in place, however this was not consistently followed by staff. Some staff gave examples of individual risk and how they were mitigated. For example, some prescribed medicines such as anticoagulants were to be paused before any procedures. Other areas of risk included anaphylactic reaction, fear from needles and minor bleeding. The Complaints procedure displayed lacked detail on how to raise concerns. Missing from the procedure were the agencies to contact where there were unresolved complaints. Administrative staff had attended basic life support training, moving and transferring and infection control in April 2023.

Patients were consulted about their treatment goals. They knew care records were kept about their appointments and their GP's were kept informed of their treatment. There were follow up appointments with the consulting doctors.

Information leaflets about the services provided were on display in the reception area

Patients felt able to approach the provider with complaints

Referrals for treatment at the clinic were by patient to patient recommendations or by their GP. Initial consultations prior to treatment were at the clinic and by the appropriate consulting doctor.

The consulting doctors discussed with the health care assistant potential risks before appointments. For example, oxygen was always made available for some patients that had disclosed a fear of syringe needles and prone to fainting and gasses for pain relief was also available.

The post procedure routine was for patients to wait in the reception area for half to an hour before leaving the clinic

There was an accessible toilet although there were parts of the clinic that were not level. Patients had to use stairs to access the physiotherapy

Patients’ records were electronic and held securely with appropriate passwords. Care records included detailed appointment notes along with copies of any correspondence to GP with outcomes of treatment provided the clinic.

There was an out of hours procedure and leaflets which gave patient advice on who to contact for after procedure emergencies. For example, patients were to contact the clinic during opening hours and GP out of clinic hours.

There were follow up appointments with the consulting doctors. The discharge policy was not linked to the emergency procedures and post treatment arrangements

We did not look at Safeguarding during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

We did not look at Involving people to manage risks during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

Patients said the staff were always available for support and they were able to have family members join the appointments. Patients felt confident that staff would support them with their access to consulting rooms.

The provider responded to our formal requests to improve systems and process for the maintenance of equipment. We were reassured in writing that auditing systems were introduced to ensure equipment was kept well maintained and within manufacturer’s guidance.

The clinic was arranged into 2 consulting and 2 treatments rooms for fluoroscopy (diagnostic equipment) and a physiotherapy. There was an area for administration staff that was adjacent to the reception space.

The reception area was spacious with access to a well maintained garden. There was a notice board and information leaflets about the practice and various musculoskeletal conditions.

The provider did not always ensure patients treatment was safe by maintaining equipment and facilities within good practice guidance or within manufactures recommendations. The provider did not always ensure patients treatment was safe by maintaining equipment and facilities within good practice guidance or within manufactures recommendations. The physiotherapy and diagnostic ultrasound equipment had not been serviced in the last 12 months which might affect patient safety. Following the onsite visit the provider submitted evidence that diagnostic equipment was maintained according to the manufacturer’s recommendations. There was no formal system for checking that equipment had not passed their expiry dates such as spinal needles, cannulas and diagnostic equipment had not been replaced in line with manufacturers warranty. The arrangements for monitoring the safety and upkeep of the premises were not fully effective. Fire risk assessment was not developed although the fire alarm systems were checked annually by an external contractor. Formal assessments of people mobility needs were not in place. The staff had insight into supporting people with mobility needs when using the clinic. For example, people unable to climb stairs to the physiotherapy room on the first floor were offered the consulting room on the ground level.

Patients were positive about the staff including the administrative staff. They said the staff were always on duty and were friendly and helpful.

Staff were not receiving all the training appropriate and relevant to their role. The health care assistant had not received training to cover all areas of responsibilities for auditing and ordering medicines. There were medicines and equipment that had passed their expiry dates placing patients’ risk from medicine systems that were not well managed. Staff were not having regular supervision, appraisal and support to develop and improve services. Since the onsite inspection, the provider reported that they have reinstated six monthly line management appraisals. Administrative staff had attended statutory training in Basic First Aid, Fire Safety and Manual Handling.

There were no formal systems that ensured staff were supported through supervision and team meetings. Training records were available for administrative staff but not for the health care assistant. The provider was also unable to demonstrate whether the training requirements, as well as the roles and responsibilities, set for staff were role appropriate.

We did not look at Infection prevention and control during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

Patients said their consent was gained before treatment was delivered. Patients said their treatment had helped them.

The provider had not ensured the competencies of the health care assistant covering the role for auditing safe handling of medicines.

We identified concerns about safe management of medicines, they were out of date items, medicines, fluids, dressings etc in the clinic were discarded or disposed.

- Every item of the emergency grab bag that was out of date has either been replaced or awaiting delivery.

- The ultrasound equipment was to be serviced.

These were formally escalated to the provider, and we were reassured safe system of medicines were to be introduced

Some stocks of medicines had passed their date of expiry including local anaesthetics and benzodiazepines. There were stocks of medicines labelled with patient’s names that had passed their date of expiry. For example, Hyaluronidase. Medicines storage processes were open to confusion where medicines stocks for personal use was kept in the same medicine cabinet, were not clearly labelled as well as patient stock medicines which had also passed their expiry date.

The approach to medicines did not fully reflect current best practice or professional guidance. Systems were not in place to ensure medicines and equipment in use had not passed their date of expiry.

Patients were placed at potential risk in the event of an emergency. Emergency equipment to use in the event of an emergency or for minor injuries were not regularly checked and some items were missing as well as other pieces of equipment being past their expiry date. The checklist for the defibrillator was missing, mask and gloves and benzodiazepine had passed their expiry date.

Subsequent to the inspection and upon our request the provider told us that medicine auditing systems were introduced and all out of date medicines were removed.