Archived: The Oving Clinic

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• 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

The service had made improvements since the last inspection. The service now processes in place to ensure that staff working under practicing privileges. Staff recorded incidents well and shared learning from these at team meetings. The service had the facilities and equipment to meet the needs of the patients and their families using the service. Emergency equipment was now in place and checked regularly.

However, the service was in breach of regulation for safe and effective staffing in relation to training. The service did not ensure that staff received training appropriate to their role, such as infection prevention and control training.

This service scored 31 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Managers made sure staff attended team meetings or had access to full minutes when they could not attend. Staff had access to the information they needed to fulfil their roles.

Staff raised concerns and reported incidents and near misses in line with service policy. Staff and leaders were able to describe how incidents and accidents were now reported. Incident reports were detailed and identified actions to improve practice. The service had three incidents since the last inspection. None of these were required to be reported to the Care Quality Commission.

The service now had processes in place to share learning from events with all staff. Staff shared learning from incidents in team meetings and minutes from these meetings were available to staff who could not attend. Managers discussed improvements in practice with staff.

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.

Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff now checked regularly.

The service had suitable facilities to meet the needs of patients and their families. The service had a ramp and wheelchair for those with mobility issues which made the ground floor accessible to all. The service had enough rooms to accommodate those with accessibility needs.

Whilst staff received the training that was deemed mandatory by the provider, they had not received the appropriate training to support them in their role, such as Learning disability and autism training and infection prevention and control. Since the inspection, the service has shown that all staff have received learning disability and autism training. Infection prevention and control training remains missing from the mandatory training and had expired in June 2024 for the health care assistant. This has now also been included in their mandatory training. The service provided e-learning to staff via an external provider. Staff who were not employed directly by the service and/or had practicing privileges were required to demonstrate training had been completed by their main employer, typically this was the NHS. The service now monitored mandatory training and alerted staff when they needed to update their training. All staff had now completed safeguarding training appropriate for their role, including child safeguarding, and basic life support training.

Staff received a twice-yearly appraisal from their manager. Staff felt they could get support from the service owner and practice manager when they needed it.

The service conducted yearly appraisals for all employed staff. There was limited documentation for this due to new starters at the service and staff having been on long term leave. The nominated individual had an appraisal conducted yearly by Faculty of Sport and Exercise Medicine UK Appraisal and Revalidation Panel. This is in line with the General Medical Council (GMC) guidelines.

The service was unable to demonstrate how they decided what needed to be mandatory training for staff. The mandatory training provided did not reflect the responsibilities of all staff. Infection prevention and control training was not included in the required training for the healthcare assistant in the “practice nurse” role, whose role it was to stock check medicines and assist with procedures. The healthcare assistant did not administer medication or carry out procedures on their own. Staff had not completed learning disability and autism training which is a statutory requirement for all healthcare workers. We fed this back to the service. Since the assessment, all staff have completed learning disability and autism training.

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.

The provider had made improvements following the last inspection. There were the foundations of a governance structure in place, underpinned by policies and procedures. However, these required further enhancement to provide assurance that there was robust oversight for the safe use of medicines.

There was evidence that staff had undertaken medicines related training, but not for the use of medical gases.

There was no robust process in place for assuring all current medicines were reconciled, before the provider began treatment. The provider relied on patients to notify them about medications they were taking. The service owner told us that they had regular contact with general practitioners regarding patient care and would escalate any concerns regarding the patient's presentation to the GP. The service did not have access to a summary of care records.

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Medicines were stored securely, yet we were not assured that they were stored at the manufacturer's recommended temperature. Some medicines were being stored in the fridge when they were not required to be. The medicines cupboard was not temperature checked.

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Medicines incidents were clearly recorded and discussed at staff meetings, to share learning from events.

Audits were in place for medicines stock. However, this was a basic overview of prescribing and did not include an audit of medicines storage, ordering, controlled drugs, disposal or administration of 'formulary' items. There was a lack of oversight for the prescribing of medicines. After the inspection, the service implemented a process for monitoring prescribing. However, it would take time to assess the effectiveness of this as the process will need time to embed into practice.

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The provider had a medicines management policy in place. However, this lacked detail. It did not include training, audit, supervision, oxygen storage management and usage, prescribing, emergency medicines bag or private prescription security.

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