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9 Harley Street Limited Good

Inspection Summary


Overall summary & rating

Good

Updated 17 January 2019

9 Harley Street is operated by 9 Harley Street Limited. The service provides a range of diagnostic imaging services including computerised tomography (CT), magnetic resonance imaging (MR) and ultrasound scanning (USS) to adults and to a very small proportion of children.

The service provides outpatients and diagnostic imaging services only. Our inspection focussed on the regulated activity diagnostic and screening procedures.

We inspected this service using our comprehensive inspection methodology. This inspection was unannounced which meant the provider did not know the date of the inspection in advance.

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 rated it as Good overall.

  • There were systems to keep people safe. Mandatory training and safeguarding training for both children and adults had been completed by all staff.

  • Equipment was maintained and serviced appropriately and there were safeguards to protect people from the risks from radiation.

  • We saw that staff had received training to operate scanning equipment safely and there were opportunities for further staff development.

  • Staff worked to appropriate guidance. Consent processes were appropriate and staff had received training in the Mental Capacity Act and associated legislation.

  • Staff were caring and patients’ privacy and dignity was respected. Feedback from patients was consistently positive.

  • Services were planned and delivered in order they met the needs of patients. Adaptations to the environment had been considered and implemented to ensure the clinical setting was appropriate for patients.

  • The service managed staffing effectively. Staff with the right skills and experience were deployed appropriately ensuring patients were safe and that their care needs were met.

  • When things went wrong, lessons were learnt and changes were implemented to reduce the risk of similar incidents occurring again in the future.

  • Risks associated with the delivery of services had been considered with appropriate mitigations in place.

  • Staff described a culture of openness and transparency. The leadership team were visible, approachable and responsive.

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

  • There were examples when non-registered healthcare professionals were involved in the administration of medicines without the appropriate processes being in place. The provider took immediate action to stop this activity at the time of the inspection.

  • The provider was working with consultants to ensure contemporaneous health care records were readily accessible at all times. Improvements were required to ensure all consultants complied with the providers health records policy.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)

Inspection areas

Safe

Good

Updated 17 January 2019

We rated safe as Good because:

  • Infection control was managed with a regular audit programme to ensure the service continued to meet regulatory requirements. The service was visibly clean and tidy and cleaning schedules had been completed.

  • Equipment was appropriately maintained and there were records to show that servicing and quality assurance had taken place.

  • Local rules were displayed and had been signed by the radiographers.

  • Risk to patients were minimised by policies and procedures.

  • The service had appropriate warning signs and access to imaging areas was restricted.

  • There was a procedure to report incidents and feedback to staff when incidents had taken place.

  • Staff levels were planned in relation to the level of activity at the service. The provider adopted a zero tolerance policy to lone working.

  • Medicines were stored safely and securely.

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

  • We found that non-registered health care professionals were, on occasion, involved in the administration of medicines which had been prepared by named health care professionals. This was addressed at the time of the inspection.

  • Radiography health care support workers had not signed the local radiation rules.

  • Health care records were not consistently being made readily accessible and available at all times by consultants.

Effective

Insufficient evidence to rate

Updated 17 January 2019

We do not currently collect sufficient evidence to enable us to rate this key question.

  • The service used appropriate guidelines from the National Institute of Health and Care Excellence.

  • Diagnostic reference levels were used so that patients received the minimum amount of radiation.

  • The service had a comprehensive audit plan to support patient safety, quality improvement and patient satisfaction. Audits were supported by action plans.

  • Staff training was in place and there were opportunities for staff to develop.

  • Appraisal rates were at 100% and there was a training needs analysis as part of the appraisal process.

  • There were processes for consent and staff had received training in the Mental Capacity Act and associated legislation.

Caring

Good

Updated 17 January 2019

We rated caring as Good because:

  • Patient feedback was consistently good with high numbers of compliments received as part of the patient experience questionnaire programme.

  • Staff were supportive, caring and ensured patient’s privacy and dignity was maintained.

  • Staff had sufficient time to support patients. This was especially true for claustrophobic patients who required MR imaging.

Responsive

Outstanding

Updated 17 January 2019

We rated responsive as Outstanding because:

  • Services were sufficiently flexible to meet the needs of patients. Clinic opening times could be extended in the event a patient required an urgent scan for example.

  • The provider was supporting charity fundraising campaigns, as well as establishing care pathways for vulnerable women, in conjunction with a local church.

  • The environment had been designed so it was suitably appropriate for all ages and for those with restricted mobility or other needs.

  • Consideration was given to those individuals whose first language was not English.

  • The service had a complaints policy and had received five formal complaints in the reporting period. Four of the five complaints were upheld. There was evidence of learning from each complaint with good escalation of patient feedback to the management committee.

Well-led

Good

Updated 17 January 2019

We rated well-led as Good because:

  • Staff described a culture of openness and transparency.

  • The leadership team were visible, approachable and responsive.

  • There was a clear vision for the service which was directed towards the development of a clinically led centre of excellence.

  • Risk, governance and operational performance was well managed.

  • There was a cohesive and visible leadership team who were committed to developing clinically-led, highly responsive services.

  • There was a culture of improvement and safety was a priority for this service.

Checks on specific services

Diagnostic imaging

Good

Updated 17 January 2019

The service provided radiological, magnetic resonance and ultrasound scanning services which were safe.

There were systems to monitor safety, patient outcomes and patient experience.

Appropriate, nationally referenced guidelines were used in the delivery of services including those for the control of radiation.

Staff were caring and privacy and dignity was consistently respected.

The service was sufficiently responsive to make reasonable adjustments for patients with disabilities or other needs

Risk, governance and operational performance was well managed.

There was a cohesive and visible leadership team who were committed to developing clinically-led, highly responsive services.

There was a culture of improvement and safety was a priority for this service.