The Cliffs Chiropractic 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 scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff had access to an e-learning training package that included mandatory modules such as health and safety, safeguarding, General Data Protection Regulations (GDPR), and radiation protection. During the inspection, it was confirmed that all employed radiographers were up to date with all required training.

Staff told us they understood how to recognise incidents and near misses and how they should be reported. Leaders understood how to investigate incidents and shared lessons learned with the team and wider service. Leaders told us learning was shared by the team during team meetings, as well as during informal catch-ups in lunch breaks or quiet periods when no patients were present. Staff knew what incidents required reporting and how to report them. Leaders told us incidents are recorded on paper forms and then stored securely.

Staff understood that when things went wrong, apologies should be given, along with honest information and suitable support. Leaders understood incidents should be investigated and when regulatory bodies should be notified of incidents.

Leaders stated that no incidents had required reporting, but examples were given of incidents that would be reported if they occurred, such as a patient fall or an excessive radiation dose. An injury log book was held by the service to record patient injury incidents. This was stored in a Health and Safety Executive (HSE) file, and no patient injuries had been reported in the last 12 months.

The service had no never events or serious incidents reported in the last 12 months. Never events are serious incidents that are completely preventable due to the availability of strong systemic protective barriers at national level.

Two staff members managed complaints: the service lead and a member of reception staff, ensuring independence if the complaint related to the clinic lead. Staff told us that complaints from non-registered parts of the service were discussed and shared for learning and improvement.

The service had a complaints policy; however, this was out of date.

Staff told us mandatory training was provided to all staff, and completion was monitored by the service. However, not all staff were up to date on mandatory training at the time of inspection.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service provided private services. Staff and leaders told us all patients self-refer for services and the clinic does not receive referrals from other care providers. The clinic scheduled the initial chiropractic appointment. If a diagnostic X‑ray was required, staff arranged this. The chiropractor shared information with the patients GP through secure email. We did not see evidence of this. It was not clear at the time of inspection if patients received a care summary or discharge summary after their chiropractor treatment.

Leaders shared information and imaging by email or by phone for acutely referred patients for ongoing care.

Leaders called 999 for patients needing immediate emergency care and treatment.

Staff adhered to The Society of Radiographers’ “Pause and Check” process. This initiative was applied to remind radiographers and operators to confirm they had the correct patient, the correct body part for imaging, and that all user settings were correct for the diagnostic examination.

Staff were trained in current Ionising Radiation Medical Exposure Regulations (IRMER) guidance, and recent training certificates for both staff members were seen after the inspection.

The service undertook Clinical Priority Assessment Criteria (CPAC) audits to review waiting times. Waiting times were observed to vary between 6 and 20 minutes and were not excessive.

The evidence showed some shortfalls. The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Staff identified the clinic lead as the safeguarding lead for the service. However, we were unable to see the appropriate training certificates on the day of the inspection. This was escalated to the clinic lead during the assessment period and copies of training certificates were sent to us, post assessment.

Patients under the age of 18 were seen by the service, although we were unable to see evidence of current child safeguarding training on the day of the inspection. A safeguarding adult's policy was in place and was in date. However, we did not see a safeguarding children’s policy on the day of the inspection, and we did not receive a copy after the inspection. We were not provided with suitable assurances that the clinic had an appropriate children’s safeguarding policy.

No safeguarding concerns had been raised with either the local authority or the Care Quality Commission during the 12-month period leading up to the inspection.

However, on the day of the inspection we saw adult safeguarding training certificates for 3 out of 10 members of staff and these were out of date. We were later sent updated adult safeguarding training certificates for all staff. On the day of the inspection, not all policies were up to date and did not cover children under 18.

Staff told us they understood how to protect patients from abuse and harm. Leaders provided training on how abuse could be recognised and reported. Staff completed training specific to their role in recognising and reporting abuse. Staff demonstrated confidence in recognising all types of abuse. Staff knew who to report safeguarding concerns to. The service had a designated trained safeguarding lead who had oversight of safeguarding concerns.

Staff had in date safeguarding adults and children level two training certificates. This was confirmed as being in line with the Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff Intercollegiate Document (January 2019), which sets out competency requirements for clinical staff in contact with children.

A description of how a safeguarding concern would be raised, and to whom it would be escalated, was provided by the lead radiographer.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service provided anti-bacterial soap and hand sanitiser in multiple areas of the clinic, and staff had access to handwashing facilities. However, hand hygiene audits were not conducted, so assurance was not obtained that handwashing was performed in a timely and safe manner.

Staff escalated concerns to the registered manager. Staff had confidence the registered manager would investigate concerns. Staff were aware of risks for patients with mobility issues and additional supports and aids were in place. Staff told us they supported patients with mobility issues. Leaders told us the building had been adapted to have wider corridors.

The service reported no cases of Healthcare-Associated Infections (HCAI) in the reporting period prior to the inspection. These infections are defined as those acquired in a healthcare setting that the patient did not have prior to attendance.

The service had systems in place to manage risks to pregnant women. Within the control booth, posters were displayed for staff reference.

Request forms were detailed and included the indication for the X-ray and the type of X-ray required for each patient.

Staff told us they documented exposure doses used for each patient, and backups of each image were made. X-ray images were saved to an electronic system and were saved on a central drive.

The clinic lead told us they completed risk assessments for each patient at each appointment, and these were updated when necessary. For example, female patients were risk assessed for pregnancy status. The referring clinicians interpreted the images taken by radiographers. Responsibility for interpreting X-rays was held by chiropractors, who had processes in place for escalating unexpected or significant findings.

The service had zero unplanned or urgent patient transfers. In the event of a medical emergency, the patient would be sent to hospital via the regional ambulance service.

Staff were aware of the risks of using x-rays, such as radiation exposure. The clinic lead had suitable measures to mitigate these risks. We observed lead aprons to protect against radiation. However, the clinic door did not have a sign to alert people when there x-rays being carried out.

Patients’ names, dates of birth and, where relevant, female X-ray questionnaire answers, were double checked by radiographers before x-ray procedures were conducted.

The evidence showed some shortfalls. The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Staff stored most records securely. Patient records were stored behind the reception desk in locked cabinets. However, we observed some patient records in one of the clinic rooms which was unlocked and easily accessible. We also observed a member of staff had not logged out of their computer and all records could be easily accessed, including emails.

The service did not have updated equipment risk assessments or audits. Required certificates for radiation use were not in date, and Ionising Radiation Medical Exposure Regulations (IRMER) had no review date.

Dated risk assessments were not observed on the day but these were sent electronically post assessment. Risk assessments and audits were dated from 2024 and we were unable to see current and up to date evidence to assure us that risks were being effectively monitored and managed.

The environment and facilities were well maintained and accessible to patients and relatives. Patients had access to toilets, changing rooms, and a waiting area. The waiting area and reception were arranged as an open plan space with magazines and children’s literature available. Grab rails were installed in toilets, and a ramped entry was available for patients with mobility needs and those using pushchairs. Fire exit signs were displayed, and two points of entry and exit to the building were provided.

The service had air conditioning, mood lighting and calming music which created a relaxing environment. There were separate male and female toilets.

The service had grab rails and stools to assist all patients to correctly position for x-rays. Equipment was available in the dual use x-ray room to steady patients who needed support moving into or out of required positions.

The service had an automated external defibrillator (AED) located in reception. The service had not trained radiology staff on how to use the AED; however, colleagues trained in its use were present to operate it if required. However, this training was out of date the care provider provided assurances this would be actioned.

All x-ray equipment was maintained, serviced and kept safe in line with national guidance.

The service had necessary radiation safety signage. However, this was kept in a folder.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Leaders told us staffing was planned in line with the number of patients booked to use the service. The service employed 2 part time radiographers; 1 was a senior radiographer responsible for leading audit work and the running of the diagnostic facility. No current vacancies were held by the service at the time of inspection.

The named Radiation Protection Advisor (RPA) needed to be updated in the control booth. We received evidence post assessment that the provider had a named RPA. IRMER documents had no review dates. A formal letter of appointment was required but the auditor had not found this. We were provided with evidence post assessment of a formal appointment letter which was present on site.

The service had a letter of appointment with a company providing a medical physics expert and a Radiation Protection Advisor. The technological components of radiology were managed by a medical physicist. The technological components of radiology were managed by medical physicists.

Radiation protection advice was provided by an RPA with the necessary experience and expertise for services using ionising radiation. Records of this were seen on the day of the inspection.

The service’s 2 radiographers had current training and knowledge of the Radiation Medical Exposure Regulations (IRMER). This meant that diagnostic referrals could be assessed by staff to confirm they were in accordance with IRMER.

The service had a designated Radiation Protection Supervisor (RPS) who was up to date with training competences. An RPS is appointed by an employer to ensure that work with ionising radiation complies with regulations.

Leaders told us that having 2 part-time radiographers allowed enough flexibility to cover illness and holidays. Senior staff reviewed clinic lists weekly. The service did not use a staffing tool, demand and clinic capacity was monitored to determine how many staff were required to safely run the service. There were no waiting times for patients and no clinics that had been cancelled due to lack of staff in the last 12 months.

The service reported 0 sickness recorded over 3 months prior to inspection. The service did not use bank, agency or locum staff at the time of inspection.

Radiographers were required to maintain registration with the Health and Care Professions Council (HCPC), and checks for both radiographers were reviewed and found to be in date.

Basic life support training was not required for the two radiographers. If a patient required basic life support, a chiropractor (who was up to date with cardiopulmonary resuscitation training) would assist. Chiropractic treatment rooms were located immediately adjacent to the x-ray room. This ensured that patients could be safely supported if basic life support was needed. All radiographers were trained in cardiopulmonary resuscitation (CPR) and refreshed their training every three years. Leaders told us chiropractors were always in at the same time as radiographers.

Leaders told us training needs were identified by managers, who gave staff opportunities to develop skills and knowledge with the clinic lead contributing 50% toward external course fees. Radiography staff were supported to complete role specific courses; for example, both radiographers had completed updated IRMER training. Staff maintained continuing professional development through reading journals, attending courses, and, for the lead radiographer, participating in external research.

Staff told us supervision meetings were held to provide support and development. However, staff had not received all up-to-date mandatory training. For example, training for the Mental Capacity Act 2005 was dated 2020.

We were not able to view all staff training certificates on the day and the training certificates available were expired. However, we received copies of current training documents after the inspection. Radiographers were not permitted to operate clinics without at least one chiropractor present.

The evidence showed some shortfalls. The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Staff cleaned the equipment after each patient contact. The service had an infection control guideline policy, although it had not been reviewed since 2011. This was escalated to the clinic lead, who stated that all clinic policies and guidelines would be reviewed and updated. We were not provided with evidence to assure us that this had been undertaken.

The service provided hand sanitiser in multiple areas of the clinic, and handwashing facilities were accessible to staff. However, staff did not complete hand hygiene audits. Therefore we could not be assured that handwashing was performed in a timely and safe manner. There were soap dispensers available. We were sent evidence of antibacterial hand soap post assessment.

Staff told us infection risks were controlled by the service to protect patients, staff, and others from infection. The service had an infection prevention control lead; the clinic lead was the Infection Prevention Control (IPC) lead for the service. However, during the inspection, we found dust on low lying areas of equipment.

The provider required radiographers to work bare below the elbows. However, compliance could not be verified at the time of the assessment as no patients were booked for imaging. There was also limited audit and assurance information available to demonstrate that adherence to this requirement was routinely monitored and embedded in practice.

The service employed an external cleaner, to clean the x-ray room. Leaders told us that audits were carried out by the service to assess clinic cleanliness. However, we were unable to see evidence of these audits during our assessment period.

Leaders provided personal protective equipment (PPE) in line with infection, prevention and control principles. We did not see staff working with patients on the day of the inspection because there were no scheduled diagnostic appointments.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.