Archived: Harley Street Nurses Limited

The report of this inspection was originally published on 26 May 2021. The service was rated as inadequate. Following the publication of the report, the provider requested a review of the ratings. The review of the ratings found that the CQC had made an error in following the process for receiving comments on the factual accuracy of the report from the provider. The Chief Inspector of Hospitals asked for a further review of the report and stated that this review should include additional evidence sent by the provider after the initial factual accuracy process had been completed.

The overall rating of this service remains inadequate.

Following the initial report, this service was placed in special measures. Following the review of the report, the overall rating remains inadequate. The service will, therefore, remain in special measures and will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action.

During the inspection we found:

• Governance arrangements for the monitoring and management of the service did not routinely include clinical oversight. None of the managers providing direction to, and control of, the nurses deployed by the provider were registered nurses and they did not have direct experience of providing community health services. Nor did they systematically involve clinicians with this experience to support them to oversee all aspects of clinical service delivery. The service did not use audits or data collection to monitor its performance.
• The service did not have sufficient systems for controlling infection risks. Although the service provided sufficient personal protective equipment, the service did not carry out checks to ensure that staff were using this equipment correctly.
• Staff received no supervision. Whilst staff could contact the nurse consultant, this was entirely at their own discretion. There were no systems for observing nurses’ practice.
• The service did not always manage medicines well. Systems for recording medicines administration were used at the discretion of each nurse. There were no systems for reviewing medicine records or checking for medicine errors.
• Staff were required to use their own equipment to take photographs that were required as part of the clinical care. This meant records were not stored securely, under the direction and control of the provider.

However,

• Following our inspection, the service introduced weekly checks of nursing records by the nurse consultant. These checks provided reasonable assurance that risks were being managed appropriately.
• Following our inspection, the service introduced a new form for recording nursing activities and hourly observations. These records were sufficient, accurate and complete.
• The service had enough staff to care for patients and keep them safe. Staff had completed training in key skills.
• Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care.