• Hospital
  • Independent hospital

The Kings Oak Hospital

Overall: Good read more about inspection ratings

Chase Farm (North Side), Chase Farm (North Side) Enfield, London, EN2 8SD (020) 8370 9500

Provided and run by:
Circle Health Group Limited

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about The Kings Oak Hospital on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about The Kings Oak Hospital, you can give feedback on this service.

14 June 2022

During a routine inspection

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

25 September 2019

During an inspection looking at part of the service

BMI The Kings Oak is operated by BMI Healthcare Limited. The hospital has 47 beds. Facilities include two operating theatres, one medical and surgical ward, one ward for services for children and young people, phlebotomy and minor operations room, outpatients and diagnostic imaging department.

The hospital provides surgery, medical care, services for children and young people, and outpatients and diagnostic imaging. We inspected surgical services only during this inspection.

We previously inspected surgical services in April 2019 where we rated safe as ‘inadequate’ and well led as ‘requires improvement’. During the April 2019 inspection, we also identified a breach in regulation 12 (safe care and treatment) and 17 (good governance) of the Health and Social Care Act (HSCA) 2008. We inspected this service using our focused inspection methodology to reinspect the Safe and Well Led domains and determine if improvements had been made. We looked at processes around safer surgery, infection control, safety culture and leadership within theatres. We carried out the announced focused inspection on 25 September 2019.

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

Our rating of this hospital improved. We rated it as Good overall.

We found areas of good practice in surgery:

  • Leaders understood and managed the priorities and issues the service faced. Following the CQC inspection in April 2019, leaders worked with staff to improve practices in the theatres and build a culture to support patient safety. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

  • Leaders in the service worked to promote an open culture where patients, their families and staff could raise concerns without fear. Improvements were made in the service so that staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development.

  • Staff completed and updated risk assessments for each patient and minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

We found areas of practice that require improvement in surgery:

  • Although the service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment, they did not always staff theatres in accordance with best practice. The service continued to have a high-dependency on agency staff in theatres, however most agency staff were familiar to the service and worked there regularly.

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.

Dr Nigel Acheson

Deputy chief Inspector of Hospitals

8 to 9 April 2019

During a routine inspection

BMI The Kings Oak Hospital is operated by BMI Healthcare Limited. The hospital provided inpatient and day care services and had a total of 47 beds, including four children and young people beds. The hospital has two theatres, endoscopy, phlebotomy and minor operations room, outpatients and diagnostic imaging department.

The hospital provides surgery, medical care, services for children and young people, outpatients and diagnostic imaging. We inspected surgery, medical care, services for children and young people and outpatients.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 8 to 9 April 2019.

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.

The main service provided by this hospital was surgery. Where our findings on surgery – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the surgery service level.

Services we rate

Our rating of this hospital stayed the same. We rated it as requires improvement overall.

Although we found good practice in all of the four services we inspected with marked improvement in medical care and key physical refurbishments in the medical care and surgical ward, we found areas of improvement in surgery and services for children and young people.

We found areas of practice that require improvement:

Medical care

  • Mandatory training was below the hospital target for the inpatient ward staff (79%) and lowest among the medical service.

  • Not all staff had received an annual appraisal. Current appraisal rates for nursing staff were 75% which was below the hospital standard of 90%.


  • Although staff completed and updated risk assessments for patients on the ward, not all staff were fully engaged with best practice processes for safer surgeries. Some staff did not always follow procedures for safer surgery in theatres and other staff did not challenge poor behaviours.

  • The service did not always control infection risk well. Although staff mostly kept equipment and the premises clean, they did not always maintain best practice in infection prevention control. We observed that staff were not always bare below the elbow in clinical areas and that clinical waste was not always disposed of properly.

  • Although the service had recently refurbished some areas, other areas of the environment continued to require improvement. There continued to be challenges around space in the theatre environment.

  • Although the service followed best practice when prescribing, giving and recording medicines they did not always follow best practice when storing medicines. There was no clear accountability for responsibility of fluids being in date and at the right temperatures in the fluid warming cabinet.

  • While we found the service provided enough nursing staff, with the right mix of qualification and skills, to keep patients safe and provide the right care and treatment, there was a high-dependency on bank and agency staff use.

  • Although most managers across the service promoted a positive culture that supported and valued staff, we found there were areas requiring improvement in theatres for creating a culture of safety and supporting staff to challenge poor practice.

  • Although the service had systems to identify risks, plans to eliminate or reduce them, and cope with both the expected and unexpected, we found in theatres these were not always put into practice, especially in attentiveness of staff with the WHO checklist.

  • Although the service had systems in place to improve service quality, in practice we found that these systems were not always effective.

Services for children and young people

  • Mandatory training compliance was low for paediatric basic life support (PBLS) and paediatric intermediate life support (PILS) hospital wide. However, children’s nurses within the CYP service were trained in PILS and were available when children and young people accessed the hospital..

  • Equipment storage in the paediatric resuscitation trolleys was not in standard order. Information folders held on the trolleys was disorganised and contained varying contents in different areas of the hospital.

  • Where paediatric warning scores were escalated, there was no evidence of actions taken documented within patient records.

  • The hospital wide audit schedule included documentation and pain management audits, however these were not specific to the children and young people’s department.

  • There was a lack of health promotion material specific to children and young people on Acorn ward and within other areas within the hospital where children and young people were seen.

  • There was no designated waiting area for children in the outpatient’s department. Children, young people and their parents and carers were seated within the main area along with other adults.

  • Areas within the hospital where children and young people were seen lacked a child friendly environment and atmosphere.

  • The en-suite bathrooms were not accessible for patients who used a wheelchair as there was no specialist equipment available to use the bath or toilet.

  • There was a lack of child friendly or easy read information available within the hospital.

  • There was no formal monitoring of the objectives and priorities set out in the five-year plan for the children and young people’s service by the senior management team.

  • Staff spoke about making improvements within the children and young people’s service, however there were no action plans in place to demonstrate how these would be achieved.

  • There was no medical representative on the corporate children and young people’s committee or the resuscitation committee held within the hospital.

  • Departmental risks were recorded on the risk register including those identified for children and young people (CYP). At the time of our inspection we did not find any risks recorded on the register relating to CYP despite staff identifying risks at that time.

  • Patient satisfactory forms were available for children and young people, their parents and carers to provide feedback about their care and treatment. However, there was no audit of the feedback provided for children and young people up to the age of 16 years.


  • Some aspects of equipment and premises did not meet hygiene standards. This included the resuscitation trolley, the treatment room, the clean utility room fridge, the phlebotomy room, the minor operations treatment room and the urology waiting area.

  • Although the service had suitable premises and equipment there were maintenance issues on wall fixings, treatment room trolleys and some PAT testing. There were no aprons available in the phlebotomy room.

  • Although the service followed best practice most of the time, we found some issues with the storage of medicines. Resuscitation trolleys were not in a temperature controlled area as advised by the pharmacist due to the storage of medicines on them. Both were kept in the corridor beside a radiator.

  • The store cupboard contained a small amount of stock that required temperature monitoring at below 25 degrees. The room was warm and no temperature checking was taking place.

  • Waiting beyond appointment times continued to be a problem and was common, often for long periods of up to an hour. Patients felt they received a good service from the doctors and did not mind if the doctor was delayed or overrunning but just wanted to be informed of this. Waiting times for clinics were not displayed in waiting areas. There was a notice on display at the reception desk that advised patients to report to reception if they had been waiting more than 20 minutes. This was an action taken from a complaint regarding waiting times.

  • There was an access policy that required six weeks’ notice of any clinic cancellation. We were told this was difficult to implement, as clinics were cancelled at late notice.

  • All referrals were triaged before being accepted for a first appointment which was described as a time consuming undertaking for the senior nurses involved that meant working weekends when not on duty in order to clear backlogs.

  • At the last inspection we found that staff felt the changes in leadership of the hospital were unclear. At this inspection the clinical director and associate clinical director posts had both been vacant for three months. There were new starters for both on the first day of our unannounced inspection.

  • Recent staff survey results showed that bullying and harassment continued to be an issue. The results were not broken down by staff site or speciality, so they were unable to identify where the issue was located. The leadership team said they planned to work with staff to address the issue, and that it had improved slightly since the last survey.

  • Reception staff were not aware of General Data Protection Regulation 2016 (GDPR).

However we also found the following areas of good practice across all services:

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

  • The service used safety monitoring results well. The service collected safety information and shared it with staff. Managers used this to improve the service.

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

  • 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.

  • The service assessed nutritional states and provided food and drink to meet patient need.

  • Staff assessed and monitored patients to see if they were in pain. Patients were asked to complete patient questionnaires upon discharge and through this pain relief was monitored post discharge.

  • Staff followed policy and procedures on consent and on when a patient could not give consent.

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

  • The services took account of patients’ individual needs.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

Nigel Acheson

Deputy Chief Inspector of Hospitals

11-13 October 2016

During a routine inspection

BMI The Kings Oak Hospital is an acute independent hospital in Enfield that provides outpatient, day care and inpatient services. It has 52 registered beds. The hospital is owned and managed by BMI Healthcare Limited.

The hospital provides a range of services including surgical procedures, outpatient consultations and diagnostic imaging services. Services are provided to both insured and self-pay private patients and to NHS patients.

We inspected the hospital on 11-13 October 2016 as part of our independent hospital inspection programme. The inspection was conducted using the CQC’s comprehensive inspection methodology. It was a routine planned inspection. We inspected the following three core services at the hospital: medicine, surgery and outpatients and diagnostic imaging.

Prior to the inspection, the hospital's senior management team took the decision to restrict the treatment of children to outpatients only, with the exception of over 16s who were on an adult care pathway.

Facts and Data

The hospital had 42 beds (registered to have a maximum of 52), split across three wards; Hadley ward with 18 beds, Ridgeway ward with 16 beds and six beds on the short stay ward which were not in use. All rooms had ensuite facilities.

There were 5,304 inpatient and day case episodes of care recorded at the hospital from July 2015 to June 2016; of these 44% were NHS funded and 56% were private or self-funded. There were 42,476 outpatient total attendances in the same reporting period; of these 37% were NHS funded and 63% were private or self-funded.

BMI The Kings Oak provided an outpatient service for various specialties. This included, but was not limited to, gynaecology, cardiology, dermatology, oncology, ophthalmology and orthopaedics. Outpatient services were provided from 12 consulting rooms, in addition to a minor procedures room, minor treatment room and phlebotomy room.

There were two operating theatres (one with laminar airflow) and an intervention radiology suite adjacent to the recovery area. There were 4,968 visits to the theatre between July 2015 and June 2016. The five most common surgical procedures performed were:

Image-guided injection(s) into joint(s) (985)

Dorsal root ganglion block (407)

Facet joint injection (263)

Hysterescopy (170)

Multiple arthroscopic op on knee (inc meniscectomy) (166)

Inpatient and day patient endoscopies were undertaken in the theatre department and beds on the wards were used pre and post procedure for recovery. Procedures undertaken included oesophago-gastro duodenoscopy (OGD), colonoscopy, and flexible sigmoidoscopy. There were 379 endoscopy procedures carried out in the twelve months before our inspection.

There were 259 doctors with practising privileges at the hospital and 104.6 whole time equivalent employed staff.

Patients were admitted and treated under the direct care of a consultant and medical care was supported 24 hours a day by an onsite resident medical officer (RMO) Patients were cared by registered nurses, health care assistants and allied health professionals such as physiotherapists and pharmacists who were employed by the hospital.

The hospital Accountable Officer for Controlled Drugs is the Executive Director.

BMI The Kings Oak was last inspected by the CQC in October 2013.

We inspected and reported on the following three core services:

• Medical care

• Surgery

• Outpatients and diagnostic imaging

We rated the hospital as requires improvement overall.

Our key findings were as follows:

Are services safe at this hospital?

We rated safe as requires improvement overall because:

  • The environment did not always meet the requirements of Health Building Notice (HBN) 00-09: Infection control in the built environment. For example, patient rooms and some ward corridors had carpeted floors.
  • In the pharmacy, there were no dispensing benches or work surfaces provided for counting or checking items.
  • The hospital's target for staff having completed their mandatory training was 90%. Across the hospital 74% of all staff had completed their mandatory training. This was below the hospital's target.
  • We identified risks relating to infection prevention and control. There were no signs to encourage hand washing and hand gel dispensers were not clearly marked. In patient rooms some of the carpets had dirty marks and there were marks on the walls, in corners and on skirting boards.
  • Suction equipment which required to be stored in sterile packaging was left open in all patient rooms.
  • Records were not always completed fully. We saw operation notes that were not dated and did not contain the name of the surgeons or anaesthetist. There were inconsistencies in recording National Early Warning Scores (NEWS) on the observation charts.
  • Cleaning products were not stored in locked cupboards as required by the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
  • There was no established system for monitoring cleaning within the department including the cleaning of trolleys.


  • There was a good incident reporting culture. We saw that incidents were investigated and learning was shared with staff.
  • Staff had a good understanding of processes for safeguarding adults and children.
  • The RMO provided medical cover 24 hours a day, seven days a week. This meant concerns regarding a patient could be escalated at any time of the day.
  • Staffing levels and skills mix were planned using an acuity tool and there were enough staff on duty on every shift to ensure patient received safe care.
  • There had been no hospital acquired infection in the reporting period and we saw evidence surgical site infection was closely monitored.
  • The diagnostic imaging department complied with policies and procedures based on the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R).
  • There was evidence of the WHO checklist being completed and audited in interventional radiography. Patient protocols were in place in radiology.

Are services effective at this hospital?

We rated effective as requires improvement overall because:

  • Although the hospital completed consent form audits, no action had been taken to rectify the findings from previous audits that patients were not receiving written information about their procedure.
  • There was no audit of national early warning score (NEWS) systems to identify deteriorating patients which meant the hospital was unable to identify if improvements in practice and outcomes were required.
  • It was not clear who was responsible for providing the resident medical officers (RMOs) with clinical supervision.
  • The nurses working in the endoscopy room had not been endoscopy trained.
  • There was no formal audit programme reviewing the use of guidelines in practice.


  • The hospital used a combination of professional guidance produced by the National Institute for Health and Care Excellence (NICE) and the Royal Colleges
  • Patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice.
  • Pain scores were recorded and patients told us their pain was well managed.
  • The hospital measured patient outcomes via a range of measures which included mortality, transfers out, infection rates, readmission rates, referral to treatment times, patient satisfaction scores, incidents, complaints, staff questionnaires, audits, Friends and Family Tests, and mandatory training rates.
  • Patient surgery outcomes were within the expected range, although the small number of patients meant it was difficult to compare against national data for specific procedures such as joint replacements.
  • Staff were suitably qualified and skilled to carry out their roles effectively and in line with best practice (except for endoscopy, see below).
  • Staff obtained written and verbal consent to care and treatment which was in line with legislation and guidance.

Are services caring at this hospital?

We rated caring as good overall because:

  • We observed that patients and their families were treated with kindness, dignity and respect
  • Friends and Family Test (FFT) scores were consistently high with good response rates.
  • Patients we spoke with were consistently positive about the care they received.
  • The privacy and dignity of patients was maintained with the use of closed doors and windows and signs on doors to indicate personal care taking place within.
  • Patients and their relatives felt involved in their care and were clear on how to contact the hospital if they had any concerns following their discharge.
  • Staff offered emotional support to patients and provided encouragement and reassurance to help patients achieve their recovery goals.


  • Patients did not have access to information on how to access further emotional support if needed.

Are services responsive at this hospital?

We rated responsive as good overall because:

  • Services were planned to meet the needs of patients and to ensure contractual requirements were met. Patients could book a convenient date and time for their appointment.
  • Weekend and evening outpatient clinics were regularly being provided to offer flexibility in the service.
  • For patients undergoing surgery, the hospital consistently met the referral to treatment target (RTT) of 90% for NHS admitted patients waiting less than 18 weeks from the time of referral to treatment.
  • The hospital was meeting national waiting times for diagnostic imaging within six weeks and outpatient appointments within 18 weeks for incomplete pathways for their NHS patients.
  • Complaints were investigated in line with the BMI policy and we saw patient mostly received acknowledgment and response within agreed timescales. Learning from complaints was shared with staff.
  • Staff had attended training on dementia and had access to resources to assist them in caring for patients living with dementia.
  • Patients had single rooms that provided privacy and comfort with en suite facilities and there was no restricted visiting times for patients.


  • The ward environment was not suitable for the care of patients living with dementia.
  • We did not see evidence of any actions taken to ensure all patients underwent a pre-operative assessment, despite operations being cancelled due to the lack of pre-assessment.

Are services well led at this hospital?

We rated well led as requires improvement overall because:

  • Senior managers were not aware that regular endoscopy procedures were being carried out at the hospital and also showed limited knowledge of how many or what types of medical patients were admitted to the hospital.
  • There was a lack of stability in the management team as the physiotherapy manager post was vacant and several members of senior management were quite new in post.
  • Some staff felt the recent changes in leadership of the hospital were unclear.
  • Not all staff were positive about their local leadership.
  • Staff told us of some instances of bullying behaviour by senior staff towards more junior staff.


  • There was a clear management and operational structure within the hospital that worked across the two hospital sites.
  • Most staff were aware of BMI’s corporate strategy aiming to deliver best quality care, best practice, and best outcomes for patients.
  • There was a clinical governance structure in place and we saw the senior management team understood the key risks and kept an up to date risk register. The hospital risk register included corporate and clinical risks.
  • Staff said they felt supported by their colleagues and there was evidence of good team-working.
  • Most staff we spoke with told us they received good support from the senior team, who were very visible and approachable
  • Patient satisfaction was monitored and reported on monthly through the patient satisfaction dashboard.
  • We saw evidence of actions taken to improve findings from the Patient-led Assessment of the Care Environment (PLACE) audit.
  • The senior management team and departmental leads were aware of the risks of the hospital and had plans in place to mitigate and eliminate these risks.
  • Monthly meetings were in place for all levels of staff. 

There were areas of poor practice where the provider needs to make improvements.

The provider should:


Ensure all clinical areas comply with the requirements of Health Building Notice HBN) 00-09: Infection control in the built environment.

Ensure all cleaning products are stored in locked cupboards as required by the Control of Substances Hazardous to Health Regulations 2002 (COSHH).

Ensure all staff are clear and consistent on the scoring of NEWS to avoid delays in escalating deteriorating patients.

Medical care

Ensure a system for monitoring the cleaning of the endoscopy department is in place including the cleaning of trolleys.

Ensure the endoscopy room is no longer used for storage.

Ensure that signage is place to encourage hand washing and identify hand gel dispensers.

Ensure controlled drugs are disposed of in a timely way.

Should provide dispensing benches or work surfaces provided for counting or checking items.

Improve the environment in patient’s rooms and bathrooms.

Ensure staff completed their mandatory training.

Undertake audits of national early warning score (NEWS) systems to identify deteriorating patients.

Ensure that the resident medical officer RMO’s has regular clinical supervision.

Outpatients and diagnostic imaging

Ensure the hospital's target for mandatory training is met.

Improve staffing in radiology for sonographers.

Professor Sir Mike Richards

Chief Inspector of Hospitals

15 October 2013

During a routine inspection

We spoke with several patients who were in-patients in the hospital on the day of our visit. Everyone told us they were happy with the care and treatment provided. For example, one patient said, “staff are in and out of my room all of the time, they are amazing.” All patients we spoke with said their pain had been well controlled and said they would definitely recommend the hospital to others. Patients had received clear information and explanations of care and confirmed that the risks and benefits of surgical procedures had been explained to them and they had been asked to give their written consent.

Patients told us they considered the service was clean and hygienic. For example, one patient said, “the hospital is spotlessly clean.” There were effective systems in place to reduce the risk of infection.

Records kept by the service were accurate and fit for purpose. There was an effective system in place for assessing and monitoring the quality of the service and the premises were maintained in a way that made them safe for patients, staff and visitors.

14 September 2012

During a routine inspection

We spoke with four patients on the in-patient ward. They were happy with the care and treatment they had received. Patients told us that staff were friendly and approachable and responded quickly to their needs. One patient described the standard of care and treatment as 'phenomenal'. Staff were described as 'brilliant' and 'really lovely'. Patients knew what medicines had been prescribed for them and what they were for. They were satisfied with the meals provided.

Staff underwent the necessary checks before starting work or being granted practising privileges (admitting rights). Staff were supported to deliver care and treatment safely and to an appropriate standard.

15 November 2011

During a routine inspection

The patients we spoke to during our visit to the hospital were very positive about the care and treatment they received. Nurses were described as 'excellent' and 'fantastic. Another patient said of staff, 'I couldn't fault them in any way'. Patients were provided with the information they needed and told us that care and treatment was fully explained to them. Patients had a choice of meals on the menu and could request drinks and snacks when they wanted them.