Nurse Richard – The Wax Wizard

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

This means we looked for evidence that people were protected from abuse and avoidable harm.
This is the first assessment of this service. This key question has been rated as good. This meant people were safe and protected from avoidable harm.

The service provided safe care, and had enough staff to deliver care for patients. Staff assessed patients at the beginning of each session, and identified any potential risks. The environment was clean, well-maintained and fit for purpose.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

The provider had a process for managing and reviewing incidents.

There had been no incidents in the last 12 months.

There was evidence that changes had been made as a result of feedback, following an incident with an adult patient. The provider revised their policies, which included adding a further question to the consent form. The provider was a sole trader, and had an arrangement with an external practitioner to review incidents if necessary.

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. People referred themselves to the service. Most people booked online, but they could also call or send an email. The provider told us they had previously sent list of questions to people in advance, but this was often not completed fully so they now went through this with the person as part of their assessment. The provider had an online system for storing documents and information about patients.

The provider told us that most patients did not need any follow-up with the service. There may be occasions when this was necessary, such as if the wax was very hard. Some patients required repeat visits because of the natural build-up of wax over time. This may be every 3, 6, or 12 months depending on need.

Staff involved all the necessary healthcare services to ensure patients had continuity of safe care, both within the service and post-discharge. GPs were not able to refer patients directly, but the provider had contacted local GP practices to make them aware of the service.

The provider referred patients to their GP for further treatment when necessary, such as to treat an infection or for an ear, nose and throat (ENT) specialist referral. The provider sent information to the GP with the patient’s consent.

We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

The provider had a safeguarding policy, that identified potential safeguarding concerns and how these should be responded to. The policy included the contact details of statutory organisations, in the event that the provider needed to make a safeguarding referral or ask for advice if there were any safeguarding concerns. This included the local authority children’s safeguarding team and the local mental health urgent care team.

The provider was a sole trader. They had completed level 3 safeguarding training for adults and children, and had been a safeguarding lead in a previous role.

The provider had made no safeguarding referrals.

The provider followed safe procedures for children using the service. Children would always be accompanied by a parent or guardian.

We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

The provider completed an assessment, including of risk, at the beginning of each patient’s visit to the service. This included identifying any medical history, potential infections or other risks that may delay or prevent treatment from being carried out. The provider had detailed policies that identified common ear complaints, and the action that should be taken.

The provider was a qualified first aider, and had training in basic life support (BLS) at level 2 for adults and children. In the event of a medical emergency the service would call 999. The provider knew how to access nearby public defibrillators if necessary.

Staff knew about and dealt with any specific risk issues. The provider had policies on the action to take in the event of medical care being needed urgently. The provider gave us examples of occasions of when they had advised adult patients to attend the emergency department. Fortunately this was rare, but the provider was aware of concerning or ‘red flag’ signs and symptoms that required urgent assessment and treatment.

We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

The service had suitable facilities to meet the needs of patients. The service was on the ground floor of a shared building that provided a mix of independent health and beauty services. Each business had its own room and shared a waiting area and toilet. The landlord was responsible for maintenance and health and safety within the wider building and communal areas.

The provider was responsible for the maintenance and health and safety within their room/area. The service was clean and generally well maintained. The provider followed policies to ensure the safety of the service. This included fire, health and safety, maintenance and infection prevention and control. Staff did regular risk assessments of the care environment.

The service had enough suitable equipment to help them to safely care for patients. The provider had a plan for routine maintenance, which was carried out by an external company – this included portable appliance testing (PAT) of electrical items in the service.

Staff carried out daily safety checks of specialist equipment. The provider had an end-of-day to do list for cleaning and checks, which included the suction machine and equipment trolley. The manual for the machine that removes wax stated that it had no maintenance requirement, but that it should be checked before each use. Other equipment was replaced each year, so did not require routine servicing.

The provider had a computer monitor for patients to watch their treatment as it happened.

The provider had policies and equipment for use in the event of a medical emergency. The provider was a qualified first aider, as well as a registered nurse. The service had a first aid kit, glucometer, and body fluid spill kit. If a patient required urgent treatment, the provider would call 999, however, they knew how to access nearby public defibrillators if necessary.

Staff disposed of clinical waste safely. The provider had clear processes on the disposal of bodily, clinical and non-clinical waste. Bins for the disposal of clinical and non-clinical waste were accessible and appropriately stored.

We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

The provider was a sole trader, and the only person working in the service.

The provider had completed the necessary training to carry out ear wax removal. This included microsuction and ear care, ear irrigation and instrumentation, and endoscopic microsuction.

The provider was up to date with appropriate mandatory training, and ensured that this was repeated when necessary. This included fire safety, health and safety, resuscitation and basic life support level 2 for children, and moving and handling training.

We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

The service was clean and well maintained. The provider had clear policies on how to clean both equipment used for treatment, and for the general areas of the service such as patient chairs and flooring. Cleaning records were up-to-date and demonstrated that all areas were cleaned regularly. Staff cleaned equipment after patient contact.

Staff followed infection control principles including the use of personal protective equipment (PPE). PPE such as gloves and aprons were readily available. Policies were clear about when additional protection, such as face masks, may be required.

The provider stored cleaning materials appropriately. There was a COSHH (Control of Substances Hazardous to Health) policy and information about each of the chemicals used.

The provider carried out a daily check of water temperatures, as part of a routine Legionella risk assessment/prevention strategy.

We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

The provider was a sole trader, who was a registered nurse and non-medical prescriber. However, they did not prescribe medicines in the service.

Some patients were given complimentary sprays (olive oil or sodium bicarbonate) to soften ear wax, or a spray to treat inflammation of the ear canal. These were widely available over-the-counter sprays that did not require a prescription. Patients or their parents were given an information leaflet with the sprays, that clearly described when and how they should be used, how they should be stored, and when medical advice should be sort. The information described any limitations of their use with children, and under what age they should not be used unless directed by and in consultation with a doctor.

There was a policy describing the supply and use of the sprays. If the provider identified a medical problem that needed further attention, they advised the patient or their parents to go for medical treatment, such as from their GP or the emergency department. They wrote to the patient’s GP with their findings and recommended further testing, monitoring or potential treatment.